Lane D S, Ross V
Department of Preventive Medicine, School of Medicine, State University of New York at Stony Brook, 11794-8036, USA.
Am J Prev Med. 1998 Apr;14(3):229-36. doi: 10.1016/s0749-3797(97)00068-8.
The recent and profound changes in the American health care delivery system have created a need for physicians who are trained and willing to assume a high level of responsibility for managing evolving health care organizations. Yet most physicians receive no formal training in medical administration and management because changes in medical school and residency education have lagged behind changes in clinical practice and reimbursement. To avoid haphazard approaches and unnecessary duplication of resources, it is important for physicians involved in managerial medicine to collectively identify competencies in this area needed in the marketplace. The American College of Preventive Medicine (ACPM), with funding from the Health Resources and Services Administration (HRSA), undertook an effort to identify competencies essential for physicians who will fill leadership roles in medical management. Like ACPM's earlier effort to develop core competencies in preventive medicine, this project drew upon the theoretical model of competency-based education. This article describes the strategy we followed in reaching consensus among a diverse group of physician executives and preventive medicine residency program directors, and includes the list of medical management competencies and performance indicators developed. Recurrent issues that can sidetrack competency development projects are also presented as well as suggestions for overcoming them. The competencies can serve as a framework for expanding current core preventive medicine training in management and administration and for developing new training programs to equip physicians with the special expertise they will need to provide management leadership within the changing landscape of health care delivery.
美国医疗保健服务体系最近发生的深刻变化，使得对经过培训且愿意为管理不断发展的医疗保健机构承担高度责任的医生产生了需求。然而，大多数医生没有接受过医疗管理方面的正规培训，因为医学院和住院医师培训教育的变革落后于临床实践和报销方式的变化。为避免采取随意的方法和不必要的资源重复，参与管理医学的医生共同确定市场所需的该领域能力非常重要。美国预防医学学院（ACPM）在卫生资源与服务管理局（HRSA）的资助下，努力确定对在医疗管理中担任领导角色的医生至关重要的能力。与ACPM早期制定预防医学核心能力的努力一样，该项目借鉴了基于能力的教育理论模型。本文描述了我们在不同的医生管理人员和预防医学住院医师项目主任群体中达成共识所遵循的策略，包括制定的医疗管理能力和绩效指标清单。还介绍了可能使能力发展项目偏离正轨的反复出现的问题以及克服这些问题的建议。这些能力可作为一个框架，用于扩展当前预防医学在管理和行政方面的核心培训，并开发新的培训项目，以使医生具备在不断变化的医疗保健服务格局中提供管理领导所需的特殊专业知识。
