上一期，我们聊了美国急诊科的人员构成：「急诊科只需要医护？美国医生：还有他们！」这次让我们谈一谈中美急诊科住院医师培养。
本期我们来聊聊美国急诊科医生培训制度。
想知道，美剧《ER》中的急诊科医生都经历了哪些？
来听 Dr.Hou 聊聊……《美国急诊科医生培训制度》
中美医生介绍
美国医生：侯全益医生，哈佛医学院急诊科讲师, 布列根和妇女医院急诊科医生，外科 ICU 重症监护专家。
U.S. doctor: Dr. Peter Hou is an Instructor in Emergency Medicine at Harvard Medical School, an Emergency Physician at Brigham and Women’s Hospital, and a critical care specialist in the Surgical ICU.
中国医生：宋瑞医生，曾在中国和新加坡担任内科住院医师，现为自由作家，同时在波士顿进行相关临床研究。
Chinese doctor: Dr. Rui Song, former resident physician of internal medicine in China and Singapore, freelancer and she is doing clinical research on Autism in Boston.
Dr. 宋：几年前我在北京大学附属的一家三级甲等医院轮转时，听说我们医院的急诊医学住院医师培训的时间大概是 36 个月。住院医师在急诊科的不同亚专科轮转 18 个月，并会在剩下的时间中轮转其他专业，如麻醉科、外科、内科、妇产科、儿科等。那么美国的急诊医学住院医师培训是怎样的呢？
When I was rotating in my hospital in Beijing, a Grade A Tier 3 hospital affiliated with Peking University several years ago, I heard that the length of emergency medicine (EM) residency training was about 36 months. The resident would rotate in different areas of the ED for 18 months and would spend the rest of the time rotating in other specialties such as anesthesiology, surgery, internal medicine, OB/GYN, pediatrics, etc. How about that in the US?
Dr. 侯：美国目前有 237 个急诊医学住院医师培训项目，其中 160 个为 3 年期，77 个为 4 年期。我们的布列根和妇女医院（BWH）/麻省总院（MGH）哈佛附属急诊医学住院医师培训（HAEMR）项目是 4 年。
There are currently 237 EM residency programs with 160 that are 3-years and 77 that are 4-years. As for our combined Brigham and Women’s Hospital (BWH)/Massachusetts General Hospital (MGH) Harvard Affiliated Emergency Medicine Residency (HAEMR) program, it is 4 years.
Dr. 宋：您能和我讲讲每一年的培训计划是怎样的吗？
Can you tell me more about each year’s schedule?
Dr. 侯：第一年的培养目标是为实习医生（注：第一年住院医师统称实习医生）提供基本技能和知识的训练。实习医生在 BWH 和 MGH 的急诊室轮转 5 个月，在波士顿儿童医院（BCH）儿科急诊轮转 1 个月，儿科重症监护病房（ICU）轮转 1 个月，MGH 内科 ICU 轮转 1 个月。此外，他们在实习医生训练营、内科、妇产科、麻醉科和超声科（US）轮转。
The goals of the first year are to provide interns with underlying skills and a fund of knowledge. Interns rotate in the EDs at BWH and MGH for 5 months, in Pediatric ED at Boston Children’s Hospital (BCH) for 1 month, and Pediatric ICU for 1 month, and Medical ICU at MGH for 1 month. Additionally, they have rotations in intern boot camp, internal medicine, OB/GYN, anesthesia, and ultrasound (US).
在第二年，住院医师的培养重点是掌握患者的个体化治疗，并在 BWH 和 MGH 急诊轮转 5 个半月，在 BCH 和 MGH 的儿科急诊各轮转 1 个月，并在 BWH 和 MGH 的外科 ICU 上各轮转 1 个月。其他轮转科室包括心脏加强病房（注：加强病房介于重症监护病房和普通病房之间）、整形外科、毒理学、眼科、耳鼻喉科、急救医疗服务（EMS）和自选科室。
In the 2nd year, residents focus on mastering individual patient care and rotate at BWH and MGH EDs for 5 1/2 months, in pediatric ED at BCH and MGH, in Surgical ICUs at BWH and MGH, each for 1 month. Other rotations include Cardiac step-down unit, Orthopedics, Toxicology, Ophthalmology, Otolaryngology, Emergency Medical Services (EMS), and Elective block.
第三年的主要目标是掌握管理多个患者所必要的技能，并在 BWH 和 MGH 的 8 个急诊轮转单元中担任监督（低年资住院医师）角色，并为实习医生和医学生提供教学。其他轮转包括社区医院轮转，BCH 的急诊科 和 2 个自选科室单元。
The primary goals of the 3rd year are to acquire the skills necessary to manage multiple patients and to assume a supervisory role in the 8 ED rotations at BWH and MGH and to teach junior house-staff and medical students. Other rotations include a community hospital ED rotation, ED at BCH, and 2 Elective blocks.
在第四年，高年资住院医师担任监督性质的急诊科医生（EP），在急诊科主治医师指导下指挥主要的抢救、病人治疗，以及急诊科病人流量和流向，为期 8 个月。其他轮转包括行政管理、眼科学、耳鼻喉科、毒理学、教学单元和 2 个自选科室单元。
In the 4th year, senior residents function as the supervisory emergency physician (EP) and directs major resuscitations, patient care, and ED flow under the guidance of the EM attendings for 8 months. Other rotations include Administration, Opthalmology, Otolaryngology, Toxicology, Teaching block, and 2 Electives.
最后也最重要的是，四年培训中每年都有一个月的假期。
Last and most importantly, there is a vacation month in each of the four years.
Dr. 宋：谢谢。他们真的得到了不同专业的多种培训。
Thank you. They really receive a wide variety of training among different specialties.
Dr. 侯：是的，我们这个培训项目为期四年的一个原因是让住院医师从第二年开始就在他们的自选科室轮转中探索其对亚专科的兴趣。
Yes, one reason ours is a 4-year program is to allow the residents starting in their 2nd year to explore further interest during their Elective rotations.
Dr. 宋：确实，那么您能和我们介绍一下自选科室轮转吗？
Exactly, could you tell us more about these Electives?
Dr. 侯：住院医师可以选择利用这段时间从各种专业中了解自己的兴趣。例如，高年资住院医生在毕业之前需要提交一个学术项目，所以很多人利用自选科室轮转的时间来做这个项目。项目需要与研究、教育、创新、质量和流程改进等有关，可以是国内的也可以是国际的。
Residents can choose to use this time to learn about their own interest from various specialties. For example, senior residents are required to present an academic project before they graduate so many use this time to work on theirs. Projects are related to research, education, innovation, quality- and process-improvement, both domestically and internationally.
Dr. 宋：我明白了，急诊医学还有进一步的进修吗？
I see, are there further advance training in emergency medicine?
Dr. 侯：是的，住院医师可以申请重症监护、儿科、毒理学、EMS、运动医学、疼痛医学、临终关怀和姑息治疗医学，以及海底和高压医学这些美国急诊医学资格认证委员会的亚专科认证。此外，还有其他不需要亚专科认证的进修项目，如国际医学、全球健康、超声、研究、模拟、中风、公共政策和行政管理。
Yes, residents can apply for fellowships with American Board subspecialty certification in Critical Care, Pediatrics, Toxicology, EMS, Sports Medicine, Pain Medicine, Hospice and Palliative Care Medicine, and Undersea and Hyperbaric Medicine. Additionally, there are other fellowships without subspecialty certification such as International Medicine、 Global Health、Ultrasound, Research、Simulation、Stroke、Public Policy、and Administration.
Dr. 宋：谢谢你的时间和宝贵见解。那么，下次我们聊些什么呢？
Thank you for your time and insight. So, what should we talk about next time?
下一期讲什么？
what will we talk about?
你想听侯全益医生与宋瑞医生聊什么呢？欢迎在文章下方留言，说出你的疑问，让他们给你解惑！机不可失，失不再来～还不赶快留言加入！
参考资料
1.Emergency Medicine Residency Association (EMRA, 美国急诊医学住院医师协会网站）
网址：https://webapps.emra.org/utils/spa/match#/search/map)
2.American Board of Emergency Medicine (ABEM, 美国急诊医学资格认证委员会网站）
网址：http://www.abem.org/public/docs/default-source/publication-documents/subspecialties-at-a-glance.pdf?Status = Temp&sfvrsn = 28)
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