Rodney W M, Crown L A, Hahn R, Martin J
Department of Family Medicine, University of Tennessee, Memphis, USA.
Fam Med. 1998 Nov-Dec;30(10):712-9.
The urban family practice residencies of Memphis were not providing sufficient training or encouragement to young physicians for practice in rural communities.
In 1990, the Department of Family Medicine, in partnership with the State of Tennessee Health Access Act and the Baptist Health Care System, developed a teaching practice in a rural county of western Tennessee. The family practice curriculum included special skills in advanced women's health care and emergency medicine so that uniformly trained physicians could provide around-the-clock coverage in the hospital, including the delivery of babies and first-hour emergency care.
After 7 years, the group now includes six full-time board-certified, OB-capable family physicians. In addition, faculty members from the department's urban program in Memphis are required to contribute a "mini locum tenens" of 2-3 days of rural coverage per month. Since 1992, the practice has provided care for more than 54,000 continuity office visits, 81,000 emergency department visits, more than 3,500 hospital admissions, and 621 obstetrical deliveries. Since 1994, residents have been assigned to the site full time, with growth to 12 (4-4-4) residents assigned to this location as of 1997. Several graduates from the initial group of residents have remained in the community after graduation, and three others have established practices in rural areas. Most recently, control of the practice is being transferred from the family medicine department to the university's corporate group practice. This may result in fundamental changes in the practice's operation.
The approach described in this report may be useful for the expansion of urban departments of family medicine into rural and underserved communities.
孟菲斯的城市家庭医学住院医师培训项目没有为年轻医生提供足够的培训和鼓励，使他们在农村社区开展医疗实践。
1990年，家庭医学系与田纳西州医疗准入法案以及浸信会医疗保健系统合作，在田纳西州西部的一个农村县开展了一项教学实践。家庭医学课程包括高级妇女保健和急诊医学方面的特殊技能，以便经过统一培训的医生能够在医院提供全天候服务，包括接生和首小时急诊护理。
7年后，该团队现在有六名全职的获得委员会认证、具备产科服务能力的家庭医生。此外，孟菲斯该系城市项目的教员每月需要提供2至3天的农村服务“短期替班”。自1992年以来，该诊所已提供了超过54000次连续性门诊、81000次急诊科就诊、超过3500次住院治疗以及621例产科分娩护理。自1994年以来，住院医师被全职分配到该地点，截至1997年，分配到该地点的住院医师增加到12名（4 - 4 - 4模式）。最初一批住院医师中的几名毕业生毕业后留在了该社区，另外三名在农村地区开业行医。最近，该诊所的控制权正从家庭医学系转移到大学的企业集团诊所。这可能会导致诊所运营发生根本性变化。
本报告中描述的方法可能有助于城市家庭医学系向农村和医疗服务不足的社区扩展。
