Thompson R, Haber D, Chambers C, Fanuiel L, Krohn K, Smith A J
Department of Family Medicine, University of Texas Medical Branch, Galveston, USA.
Fam Med. 1998 Jan;30(1):24-8.
Family practice residencies are expected to include opportunities for trainees to learn about population-based approaches to health care delivery.
To prepare them for community projects later in training, first-year residents were introduced to a community-oriented primary care (COPC) curriculum by an interdisciplinary team with representatives from public health and academic family medicine. During their mid-year orientation month, the residents spent three afternoons in community settings, each year focusing on a different public health issue. The residents spent the first afternoon discussing principles of community medicine, the COPC model, and planning community interviews. The second afternoon, they interviewed in the community. The residents reported and evaluated on the third afternoon.
During the 3 years described, most residents participated with enthusiasm, later reporting increased awareness and use of community resources. However, months after the third experience, a comparison of clinic records before and after the orientation showed no difference in the residents' inclusion of the health issue studied in managing their patients, although social workers and other non-physician faculty team members reported that residents consulted them more frequently following the community orientation.
It is important to provide residents with an efficiently designed and attractive community orientation early in training. An interdisciplinary team should plan and coordinate their experiences, but all faculty should role model good community behavior. Although the 1996 residents described behavioral changes following this brief orientation, this was not documented by a chart review.
家庭医学住院医师培训预计要为学员提供学习基于人群的医疗服务方法的机会。
为使他们在培训后期能参与社区项目做准备，一年级住院医师由来自公共卫生和学术性家庭医学领域的代表组成的跨学科团队引入了以社区为导向的初级保健（COPC）课程。在年中定向月期间，住院医师在社区环境中度过三个下午，每年聚焦一个不同的公共卫生问题。住院医师在第一个下午讨论社区医学原则、COPC模式并规划社区访谈。第二个下午，他们在社区进行访谈。住院医师在第三个下午进行汇报和评估。
在所述的3年期间，大多数住院医师积极参与，后来报告称对社区资源的认识和利用有所增加。然而，在第三次经历数月后，对定向前后的诊所记录进行比较发现，住院医师在管理患者时对所研究的健康问题的纳入情况没有差异，尽管社会工作者和其他非医师教员团队成员报告称，住院医师在社区定向后更频繁地向他们咨询。
在培训早期为住院医师提供设计高效且有吸引力的社区定向很重要。跨学科团队应规划和协调他们的经历，但所有教员都应树立良好的社区行为榜样。尽管1996年的住院医师在这次简短的定向后描述了行为变化，但图表审查并未记录这一点。
