关键词: 家庭医学, 全科医学, 在职培训, 全职住院医师, 住院医师规范化培训, 美国, 发展史

Abstract: By the middle of 20th century，the major advances and triumphs of biomedical research have led the American medical specialty to develop faster than general practice centered by care continuity，which eventually caused the complexity of the medical behavior.Therefore，the general practice was reappraised and confirmed as a specialty-family medicine，which prioritizes the development of education in family medicine.The history of standardized residency training can be summarized as three stages.The first stage：family medicine residency programs set the fixed rotation curriculum and duration in 1948.The second stage：the Society of Teachers of Family Medicine（STFM）introduced an alternative approach in 1990s，known as the competency-based education in residency training，which emphasized the attainment of competencies rather than the completion of a series of experiences.Afterwards，the Accreditation Council for Graduate Medical Education（ACGME）proposed the outcome project according to the competency-based education approach in 1998，requiring that US "graduate medical education programs fostered resident physicians" competencies in six domains，and changed its accreditation system.The third stage：the two graduate medical education accreditation authorities-the ACGME and the American Osteopathic Association（AOA）eventually signed the historic memorandum of understanding in 2014，which approved to create a single accreditation system for graduate medical education.It is scheduled to be implemented in June 2020 with a five-year transition period.

Key words: Family medicine, General practice, Inservice training, Hospitalists, Standardized resident training, United States, History