Bowen J L
Center for Medical Education Research, University of Washington School of Medicine, Seattle, USA.
West J Med. 1998 May;168(5):371-7.
Graduate medical education has been criticized for failing to adequately prepare young physicians to enter the workforce upon completion of their training. In addressing this criticism, the author makes arguments both for and against this assertion. Broad qualitative changes (graduate medical education training position allocation, subspecialists' role in health care delivery, educational quality, faculty development, and faculty promotion) that graduate medical education has undergone and is undergoing are discussed. Population health management, clinical resource management, teamwork, continuous quality improvement, ethics, and evidence-based medicine are addressed as important curricular elements for residency training. Innovations in graduate medical education that are being introduced as well as those that should be tried are discussed. Finally, the author asserts that although residency education should not be vocationally driven by the needs of managed care organizations, a powerful opportunity exists for collaborative educational research between academic medicine and managed care organizations. In a health care environment undergoing rapid changes, the primary goals of graduate medical education have not significantly changed: to produce compassionate physicians with a passion for lifelong learning who have leadership skills, are critical thinkers, skilled at self-assessment, and able to adapt to the needs of the health care marketplace.
毕业后医学教育因未能让年轻医生在培训结束后充分做好进入职场的准备而受到批评。在回应这一批评时，作者对这一断言提出了支持和反对的观点。文中讨论了毕业后医学教育已经历和正在经历的广泛质性变化（毕业后医学教育培训岗位分配、亚专科医生在医疗服务提供中的作用、教育质量、师资发展和师资晋升）。人口健康管理、临床资源管理、团队合作、持续质量改进、伦理学和循证医学被视为住院医师培训的重要课程内容。文中讨论了正在引入的以及应该尝试的毕业后医学教育创新。最后，作者断言，虽然住院医师教育不应由管理式医疗组织的需求驱动，但学术医学与管理式医疗组织之间开展合作教育研究存在巨大机遇。在一个快速变化的医疗环境中，毕业后医学教育的主要目标并未发生显著变化：培养富有同情心、热爱终身学习、具备领导能力、善于批判性思考、擅长自我评估且能够适应医疗市场需求的医生。
