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2006年6月28日 (水)

アメリカの研修評価方法

New ACGME Competencies

ACGME mandates that residents develop competencies in six areas to the level expected of a new practitioner. To accomplish this, residency programs must define the specific knowledge, skills, and attitudes that are necessary, and provide educational experiences as required in order for their residents to demonstrate competency in each of
the following areas:

・Patient care
・Medical knowledge
・Practice-based learning and improvement
・Interpersonal and communication skills
・Professionalism
・Systems-based practice

上記のうち始めの二つは我々の意識するところであり、4つ目のところがER医に特に大事なさまざまなコミュニケーション能力であると理解しました。

また、実際の臨床で非常に大切で強く求められるが、教育目標にあがることが少ないプロフェッショrナリズムも指摘しています。
(その意味で林先生の当直裏御法度は大変貴重です。)

また耳慣れれない二つに関してはこのような説明がありました。

Systems-based Practice:
Residents must demonstrate their knowledge of the environmental context and health care systems within which they function. The scope of systems-based practice includes

familiarity with financing structures, the organization and capacities of provider entities and delivery systems;
tools and techniques for controlling costs and allocating resources;
systems for improving the quality of care; and
the roles and contributions of other professionals in caring for individual patients and populations.

Residents must use their knowledge of system resources to provide care that is of optimal value.

Practice-based Learning and Improvement:
Residents must know and apply scientific methods and analytic tools to improve their patient care practices.

They must be able to:
locate and appraise scientific evidence and clinical studies related to their patients' health problems;
apply information about the panels and populations from which their patients are drawn;

use information technology including online resources; and analyze practice experience in order to perform systematic improvement activities.

Quality improvement, evidence-based medicine, and informatics are among the content areas that fall within this
competency.

長文失礼いしました。実際はいろいろと問題の多い米国の卒後研修ですが、今のところはそれにかける情熱にいい印象をもっています。

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