Residency training in preventive medicine: challenges and opportunities.
Ducatman-AM; Vanderploeg-JM; Johnson-M; Rubin-J; Harber-P; Sokas-R; Harmon-RG; Rumm-P; Nilson-E; Batalden-P; Merchant-G; Krauss-M; Goldberg-RL; Valdez-M; Dismuke-SE; Wagner-GR; Leniek-K; Rosenthal-J
Am J Prev Med 2005 May; 28(4):403-412
With the assistance of senior leadership of the Accreditation Council for Graduate Medical Education (ACGME), the Residency Review Committee (RRC) in preventive medicine and invited guests considered the status of residency training in preventive medicine. Data concerning the number of trainees in preventive medicine document disappointingly small growth rates and underutilization of residency positions, but no crisis. Challenges lie ahead in three domains: quality, clinical competence, and funding for training. Specialty training should focus on quality, particularly in the interface between clinical competence and population health competence. Funding for preventive medicine training is inadequate, particularly in light of federal and state initiatives focusing on an all-hazards approach to disaster preparedness, a strength of the specialty. To address the needs of the public and the future of the specialty, preventive medicine should clearly articulate its values and the value it adds. Two ideas emerged to address quality, clinical competence, and, perhaps, the ongoing problems of inadequate funding. Neither idea is unique to these deliberations. One idea is an increased emphasis on dual boards, so that numerous specialties have increased access to population medicine and prevention skills. This approach augments our current strengths, and relies on other disciplines to supply much of the clinical context, the area where preventive medicine is weakest. This approach links funding to a specific model of training. The other approach is an additional required year (PG-4) of training for residents to ensure clinical outpatient and systems skills. These considerations are not mutually exclusive, nor are they promulgated as policy; other considerations are welcome. They are intended to start a discussion, the goal of which is to "raise the bar" for training. They, and all future suggestions, should increase quality, public confidence, and job market desirability of certificate holders. Both proposed approaches challenge prospective residency candidates to consider careers in population medicine and prevention, and funding agencies to provide the needed support
Preventive-medicine; Training; Health-care-personnel; Health-hazards; Health-care; Disaster-planning; Disaster-prevention; Occupational-medicine; Occupational-health
Alan M. Ducatman, MD, MSc, Professor and Chair, Department of Community Medicine, School of Medicine, West Virginia University, P.O. Box 9190, Morgantown WV 26506
American Journal of Preventive Medicine
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