公立医院改革中医学教育面临重大挑战的思考

Reflections on challenges for medical education in public hospitals reform

基于国家医药卫生体制改革的需要,公立医院的改革作为医改进程中,目前能够考虑到的重要改革项目之一,在解决"看病难,看病贵"的假设前提下,处于强力的推进过程中。对于这一尚在进程中的改革本无可厚非,但是注意一下公立医院改革的目标与措施,就不难看到这个强力改革,就是要全面提高公立医院的医疗关怀效率和效益,但没有关注到公立医院群体中有一类特殊医院存在的需要。这就使高等医学教育不得不产生了强烈的忧虑:"公立医院改革中大学医院路在何方"?本文作者基于医学教育与医学教育管理多年的实践,基于对于15年前高等教育管理体制改革对于医学教育冲击的反思,从医院分类和我国医院发展趋势切入,对于我国公立医院改革与大学医院建设,进行了比较深入的分析和思考,明确提出在公立医院改革中应该关注大学医院建设的特殊规律和需求,为高等医学教育发展留下必需的基础,为实现医教协同、医教共赢留下足够的空间,这是医学教育又面临的一个生死存亡的问题。

Reform in public hospitals,a crucial component in the national medical and health system reform,has been forging ahead to solve the problems in the difficulty and high cost of getting medical treatment as well as to provide fair and affordable services for all citizens.It is obvious to identify that the objectives and measures in public hospitals reform are to enhance the medicare efficiency and effectiveness in all-around ways.However,the needs of the university hospitals are overlooked,hence there raises the question：where is the way for the university hospitals in the public hospitals reform？ This paper takes into consideration the following factors：rich personal experiences in medical education and medical education management,personal reflections about the impact of the higher education management system reform on medical education for the past 15 years,different categories of hospitals and the trends in hospital advancements.As regards the reforms in public hospitals and the university hospitals,the author argues that increasing attention and importance should be attached to the needs and particular rules of the university hospitals to provide a solid foundation for medical sectors in higher education and better future for the coordination and the win-win of medicine and education.