Continuing medical education: Changes in health care and continuing medical education for the 21st century
Continuing medical education: Changes in health care and continuing medical education for the 21st century
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继续医学教育：21世纪医疗保健和继续医学教育的变化
DOI：
10.1136/bmj.316.7127.301
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发表时间：
1998
影响因子：
--
通讯作者：
A. Towle
中科院分区：
文献类型：
--
作者：
A. Towle
由于医疗实践和社会的变化，正在发生一场保健革命。这些包括不断变化的人口统计和疾病模式;新技术;医疗保健服务的变化;消费主义的增加;患者赋权和自主权;对有效性和效率的重视;以及不断变化的专业角色。这些都是医学专业在21世纪世纪所面临的挑战，而继续医学教育必须对此作出回应。
#人口统计数据和疾病模式
20年后，大多数富裕国家65岁及以上人口的比例将翻一番，达到20- 25%左右。今天，老年人消费了保健总开支的大约三分之一;如果目前的趋势继续下去，到2000年，他们将消费一半。[1]其结果将是，预防和治疗保健的需要将转向老年人的慢性健康问题，对照顾非常虚弱或生病的老年病人的需求将大量增加。将有更大的压力来限制螺旋上升的医疗费用。
#总结要点
教育系统必须能够更好地对外部世界的迅速变化作出反应，并使保健服务的雇主和用户参与进来
教育制度的文化，现在主要是由考试成绩和强调实际内容所塑造的，必须改变为一种重视自我指导的学习者和解决问题的人
有需要改善持续医学教育的成效，例如发展更佳的医患沟通及跨专业持续教育计划
预计发病率的总体模式不会有重大变化，但一些健康问题会增加。健康损失的领域将包括社会阶层差距的扩大，酒精消费和药物成瘾的增加，以及老年痴呆症病例的增加。
A revolution in health care is occurring as a result of changes in the practice of medicine and in society. These include changing demographics and the pattern of disease; new technologies; changes in health care delivery; increasing consumerism; patient empowerment and autonomy; an emphasis on effectiveness and efficiency; and changing professional roles. These are the challenges which will face the medical profession in the 21st century and to which continuing medical education must respond.
### Demographics and the pattern of disease
In 20 years' time the proportion of most rich countries' populations aged 65 and over will have doubled to around 20-25%. Old people today consume about a third of total health care spending; if present trends continue, by the year 2000 they will be consuming half.1 The consequences will be a shift in the need for preventive and curative health care in the direction of the chronic health problems of older people and a large increase in demand for care of very frail or ill dependent elderly patients. There will be even greater pressures to cap spiralling healthcare costs.
#### Summary points
The education system must be better able to respond to rapid changes in the outside world and involve employers and users of health services
The culture of the education system, now largely shaped by performance in examinations and emphasis on factual content, must be changed to one which values self directed learners and problem solvers
There is a need to improve the effectiveness of continuing medical education, such as developing better programmes on doctor-patient communication and interprofessional continuing education
No major changes in overall patterns of morbidity are expected, but some health problems will increase. Health loss areas will include the widening of social class disparities, increasing alcohol consumption and drug addiction, and increasing numbers of cases of senile …