Brooks W B, Orgren R, Wallace A G
New Hampshire Area Health Education Center, Dartmouth Medical School, Hanover, New Hampshire 03755, USA.
Acad Med. 1999 Jan;74(1 Suppl):S3-8. doi: 10.1097/00001888-199901001-00024.
Dartmouth Medical School was one of 16 U.S. medical schools that received a Generalist Physician Initiative (GPI) grant from The Robert Wood Johnson Foundation in 1994. This article describes institutional change at the school, noting that while the context in which the GPI was launched was receptive, the grant enabled Dartmouth to accelerate institutional changes already under way. Perhaps even more important is that Dartmouth used an approach to change that worked, and although the specific actions may not generalize to other schools, the authors hope the principles will. Key among these principles were capitalizing on a sense of urgency for change, creating and empowering a guiding coalition, developing and communicating the vision, generating short-term wins, consolidating gains, and anchoring new approaches to the existing institutional culture. Changes at Dartmouth are described in the areas of admission and recruitment, undergraduate and graduate medical education, and supporting community practice. The authors also describe shortcomings in developing the program, such as maintaining the guiding coalition in the face of the changing health care system and clinical pressures, developing a vision and strategy in areas managed by the state, and engagement of a broad-based group.
达特茅斯医学院是1994年从罗伯特·伍德·约翰逊基金会获得通科医师倡议（GPI）资助的16所美国医学院校之一。本文描述了该校的制度变革，指出虽然启动GPI时的背景是有利的，但这笔资助使达特茅斯能够加速已经在进行的制度变革。或许更重要的是，达特茅斯采用了一种有效的变革方法，虽然具体行动可能无法推广到其他学校，但作者希望这些原则能够推广。这些原则的关键在于利用变革的紧迫感、创建并授权一个指导联盟、制定并传达愿景、取得短期成效、巩固成果以及将新方法融入现有的制度文化。文中描述了达特茅斯在招生与招聘、本科和研究生医学教育以及支持社区实践等方面的变革。作者还描述了该项目发展过程中的不足之处，比如在不断变化的医疗保健系统和临床压力面前维持指导联盟、在由州管理的领域制定愿景和战略以及让广泛群体参与进来。
