Devries J M, Berkelhamer J E, Molteni R A, Edwards K S, Kachur E K
Department of Pediatrics, Oakwood Healthcare System, Dearborn, Michigan 48123-2500, USA.
Pediatrics. 1998 Apr;101(4 Pt 2):753-9; discussion 760-1.
The preparation of pediatric residents to function optimally in managed care environments challenges educators to create a new set of educational objectives and competencies and to incorporate these into curricula that are already full. Many of the skills needed to practice managed care are those that have been required for the practice of pediatrics in any setting. Nevertheless, the emergence of managed care requires the identification of new knowledge to be acquired and new skills and attitudes to be incorporated into daily practice. These competencies can be identified most thoroughly through collaboration among physicians, educators, and leaders of managed care organizations. This joint effort should also serve to establish a foundation on which collaborative, mutually beneficial learning environments can be created. The development of curricula that provide the opportunities needed to attain managed care proficiencies requires an individualized approach for each program that takes into account the degree of managed care penetration in each training environment. Programs in which a managed care approach to patient care predominates will be able to promote most easily their trainees' incorporation of these principles into routine practice. Those with less regular exposure will be forced either to promote managed care principles in an environment in which they may not be accepted or practiced, or to join in partnership with managed care organizations (MCOs) to train residents. Regardless of the setting, evaluation methodologies must be developed to ensure that each of the core competencies has been learned, can be applied to clinical situations, and is retained throughout the training period. These efforts require the development of faculty who understand and can model a managed care approach to patient management. The ongoing evolution of managed care systems encourages the development of new, creative strategies to train faculty, who may find themselves learning about this emerging environment at the same time as are their trainees.
培养儿科住院医师在管理式医疗环境中实现最佳职能，这对教育工作者提出了挑战，他们需要制定一套新的教育目标和能力要求，并将其纳入本已安排得满满当当的课程中。开展管理式医疗所需的许多技能，是在任何环境下从事儿科工作都必需的。然而，管理式医疗的出现要求确定需要获取的新知识，以及要融入日常实践的新技能和态度。通过医生、教育工作者和管理式医疗组织的领导者之间的合作，可以最全面地确定这些能力。这种共同努力还应有助于奠定基础，在此基础上创建协作性的、互利的学习环境。开发提供获得管理式医疗专业技能所需机会的课程，需要针对每个项目采取个性化方法，要考虑到每个培训环境中管理式医疗的渗透程度。以管理式医疗方法为主导提供患者护理的项目，将能够最轻松地促使其学员将这些原则融入日常实践。那些接触管理式医疗较少的项目，要么不得不在一个可能不被接受或践行这些原则的环境中推广管理式医疗原则，要么与管理式医疗组织（MCO）合作培训住院医师。无论在何种环境下，都必须制定评估方法，以确保每项核心能力都已被掌握、能够应用于临床情况并在整个培训期间得以保持。这些努力需要培养一批理解并能示范以管理式医疗方法进行患者管理的教员。管理式医疗系统的不断演变鼓励开发新的、有创意的策略来培训教员，而这些教员可能会发现自己与学员同时在了解这个新出现的环境。
