美国全科医生亚专科培训现况及对我国全科医学教育的启示

Fellowship training of family medicine in the United States and its implications for China

本研究主要采用横断面研究。对美国家庭医师学会官方网站的亚专科培训名录所涉及的培训项目进行数据收集,数据收集截至2021年12月,包括项目名称、项目涉及领域、培训时长、项目描述等。数据收集整理完毕后,对项目涉及的领域及培训时长进行分类统计;并将项目描述部分的内容导入Nvivo12软件进行词频及主题分析。共计532个项目纳入研究。其中美国毕业后医学教育认证委员会(ACGME)认证的学科共有295个(55.5%)项目,非ACGME认证的学科共有237个(44.5%)项目。名录含临床型项目共有468个(87.9%),非临床类项目共有64个(12.1%)。ACGME认证的项目中,项目最多的为运动医学,共包含121个项目,其次为老年医学,共包含52个项目。在非认证项目中,数量最多的为产科学,共66个。美国全科医学亚专科培训项目呈现多样性,且根植于社会需求,许多培训项目强调基于全科的教学及科研能力。结果提示美国家庭医师亚专科培训项目涵盖的学科领域丰富,兼顾医生的执业兴趣及患者的需求。可借鉴相关培训经验,并结合我国国情开展全科医学亚专科培训。

The study utilized a cross-sectional design.Data was retrieved from the American Academy of Family Physicians fellowship training directory,including program names,areas of focus,program length,and program descriptions.The collected data was categorized and analyzed based on areas of focus and training duration.The program descriptions were also analyzed qualitatively using Nvivo12 software.A total of 532 programs were included in the study:295 programs(55.5%)were ACGME-certified,while 237 programs(44.5%)were not.The majority of programs,468(87.9%),were clinically oriented,while 64 programs(12.1%)were non-clinical.Among ACGME-certified programs,the largest number of programs were in sports medicine(121 programs),followed by geriatrics(52 programs).Among non-certified programs,the largest number of programs was in obstetrics(66 programs),accounting for 27.8%of all non-certified programs.Qualitative research found that fellowship programs were diverse,reflecting the societal demands of healthcare service.Moreover,a significant emphasis was placed on empowering teaching and research abilities.The family medicine fellowship programs in the United States cover a wide range of disciplines and meet both the professional interests of doctors and the needs of patients.As China continues to implement its tiered medical system,it can learn from the experience of the United States and develop general practice subspecialty training programs,thereby improving the service capacity of general practitioners and improve the quality of healthcare.