美国神经内科专科设置及对我国神经内科专科培训的启示

American neurology fellowship setup and its enlightenment to specialized training in China

目前我国神经内科住院医师规范化培训已逐步规范成熟,专科培训是下一步要深入开展的工作。如何合理设置神经内科专科,制定相关规范和标准,保证培训质量,有待研究。美国神经内科专科医师规范化培训已开展近30年,目前美国毕业后医学教育认证委员会(ACGME)认证的神经内科专科有9个,包括临床神经电生理、疼痛、神经发育障碍、脑血管病、神经肌肉病、睡眠障碍、血管内介入治疗、癫痫和脑损伤,其中脑血管病、临床神经电生理、癫痫是相对平稳或持续发展的专科,而神经发育障碍和脑损伤专科则发展停滞甚至倒退。提示我国在进行神经内科专科设置时应充分权衡各种因素,考虑专科患者数量、临床应用、专科未来发展前景等,可先从ACGME已经认证并且发展稳定的专科开始实施,根据专科发展情况,再考虑逐渐增加其他专科设置。

In view of the recent advancements in the standardized neurology residency training in China, standardized neurology fellowship training has become a crucial next step for China′s graduate medical education. The design of the fellowship and development of relevant norms and standards to ensure quality training constitute key areas in need of further consideration. The United States has established a standardized neurology fellowship training for nearly 30 years and has been successful in ensuring high quality physician training. Currently there are 9 accreditation council for graduate medical education (ACGME) accredited neurology fellowship programs in the USA, including clinical neurophysiology, pain medicine, neurodevelopmental disabilities, vascular neurology, neuromuscular medicine, sleep medicine, endovascular surgical neuroradiology, epilepsy and brain injury medicine. Among them, the number of fellowship training programs in vascular neurology, clinical neurophysiology, and epilepsy are relatively stable or show continuous growth, while neurodevelopmental disabilities and brain injury medicine remain stagnant or even retrogressive. It indicates that design of the neurology fellowship training calls for full weight of a wide array of factors, taking into account the number of subspecialty patients, clinical applications, prospects for future development of the subspecialties, and lessons learned from the United States. We can start with ACGME accredited steady growth fellowship programs and then add others in the future accordingly.