History of Residency Training in Family Medicine in the United States

doi:10.12114/j.issn.1007-9572.2019.00.136

Abstract

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

摘要： 20世纪中期伴随生物医学技术的迅猛发展，美国医学专科化迅速发展，远超过全人连续性照顾理念的发展，导致医疗行为复杂化。因此，发展全科医学被重新提出，并被确立为医学专科——家庭医学；重中之重在于发展家庭医学教育。总结美国家庭医学住院医师规范化培训发展史，经历了以下3个阶段：阶段一，1948年首先提出“固定时间固定科室轮转”。阶段二，20世纪90年代美国家庭医学教师协会首次将能力本位教育理论引入家庭医学住院医师规范化培训，实现培养方式由关注时间向关注能力的转变；1998年美国毕业后教育认证委员会在此基础上进一步提出“培训效果计划”，并且提出以“6项核心能力”为考核标准的全新认证体系。阶段三，认证标准的转变促使美国毕业后教育认证委员会和美国骨科协会于2014年共同就“建立全国统一认证体系”达成谅解备忘录，拟于2020年6月实行，转型过渡期5年。

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

DU Lixue,CHEN Jialin. History of Residency Training in Family Medicine in the United States　[J]. Chinese General Practice, 2019, 22(16): 1908-1914. DOI: 10.12114/j.issn.1007-9572.2019.00.136.
杜丽雪,陈嘉林. 美国家庭医学住院医师规范化培训发展史[J]. 中国全科医学, 2019, 22(16): 1908-1914. DOI: 10.12114/j.issn.1007-9572.2019.00.136.

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