Defining the generalist physician's training.
Defining the generalist physician's training.
复制标题
定义全科医生的培训。
DOI：
10.1001/jama.1994.03510430053034
复制
发表时间：
1994
期刊：
影响因子：
--
通讯作者：
Thomas G. DeWitt
中科院分区：
文献类型：
--
作者：
Marc L. Rivo;John Saultz;Steven A. Wartman;Thomas G. DeWitt
目标
确定各专科在多大程度上培养住院医生初级保健实践所需的广泛能力，并提出改善全科医师培训的指导方针。
数据来源
发病率和死亡率的主要原因、1991年全国流动医疗调查数据、专家报告以及住院医师培训的特殊要求。
设计
从数据源中，我们确定了受过广泛培训的全科医师在初级保健实践中可以处理的常见症状和诊断。然后，我们根据全科医师的七项执业标准编制了一份 60 个必要的住院医师培训内容的清单。根据家庭执业、内科、儿科、妇产科和急诊医学住院医师培训的特殊要求，我们确定了这些要求涉及 60 个组成部分和连续性护理培训的程度。
结果
与急诊医学（42%）和妇产科（47%）相比，几乎所有 60 个全科培训内容都是家庭医学（95%）、内科（91%）和儿科（91%）所需要的。家庭医学、内科和儿科住院医师也需要长期、明确的连续性护理经验。
结论
家庭医学、内科和儿科项目帮助住院医生掌握初级保健实践所需的广泛能力。为了培训有能力的全科医师，我们建议住院医师计划要求接受 60 个组成部分中 90% 或以上的培训，以及七个类别中每个组成部分的 50% 或以上的培训，并在整个住院医师培训期间至少 10% 的时间内为一组患者提供连续性护理经验。
OBJECTIVE
To determine the extent to which various specialties prepare residents in the broad competencies required for primary care practice and to propose guidelines for improving generalist physician training.
DATA SOURCES
Leading causes of morbidity and mortality, 1991 National Ambulatory Medical Care Survey data, expert reports, and the special requirements for residency training.
DESIGN
From the data sources we identified the common presenting conditions and diagnoses that broadly trained generalist physicians could be expected to manage in primary care practice. We then compiled a list of 60 requisite residency training components grouped according to seven practice criteria for generalist physicians. Using the special requirements for residency training for family practice, internal medicine, pediatrics, obstetrics and gynecology, and emergency medicine, we determined the extent to which the requirements addressed the 60 components and continuity-of-care training.
RESULTS
Almost all of the 60 generalist training components were required by family practice (95%), internal medicine (91%), and pediatrics (91%), compared with emergency medicine (42%) and obstetrics and gynecology (47%). Family practice, internal medicine, and pediatric residencies also require lengthy, well-defined continuity-of-care experiences.
CONCLUSION
Family practice, internal medicine, and pediatric programs prepare residents in the broad competencies necessary for primary care practice. To train competent generalist physicians, we recommend that residency programs require training in 90% or more of the 60 components, 50% or more of the components in each of the seven categories, and a continuity-of-care experience for a panel of patients during at least 10% of the entire residency training period.