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乡村医学院设法让医生扎根于小城镇

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小编摘要:“我们需要更多的医生。所有的在堪萨斯州的医生都是60岁或者以上的老人。所以我们必须注入新鲜血液。”威廉•凯瑟特雷克博士说道,他在堪萨斯大学领导着一个新项目,这个项目的目的就是供给医生。

乡村医学院设法让医生扎根于小城镇

"We need more doctors. A quarter of all of our physicians in Kansas are 60 years or older. So we need to be replacing physicians too," says Dr. William Cathcart-Rake, who directs a new program at Kansas University which is designed to provide those physicians.

The idea is to get medical school students to practice in rural Kansas by educating them in the state's smaller communities.

According to Cathcart-Rake, students from rural areas typically go off to medical schools in Wichita and Kansas City.

"They say they have every intention of coming back to rural Kansas but they meet a soul mate, they get married. Their soul mate happens to be from a big city and we never see them again. They get captured in the big city," he says. "Hopefully, if we train them in smaller communities, they can meet their prospective spouses here, they can network here and they have those connections which can be lifelong."

The program is based in the small town of Salina - population 50,000 - which is about a three-hour drive from Kansas City, past corn and soybean fields and the occasional cattle ranch. The medical school in downtown Salina is housed in a three-story brick building which was refurbished specifically for the program.

The first thing you notice is that the professor is not in the room. Instead, he appears on a flat-screen monitor at the front of the classroom.

"It's set up with interactive TV, so we have two monitors. On one, we see the lecturer's slides, and on the other monitor, we see video of the lecturer," says Claire Hinrichsen, a student in the Salina program. "Most of our lecturers are out of Kansas City. Today, our lecturer was in Wichita."

The professor in Wichita also has a video feed of the Salina classroom. When students have a question, they raise their hand and speak into the microphone built into their desk.

Hinrichsen grew up in Lecompton, Kansas, a town of about 600 people. One of the reasons she chose the Salina program is because of the size of the class. There are only eight students, making it the smallest medical school in the country.

"I really like it. I know everybody in my class," she says. "We are close and it's a nice feeling. It goes back to when I went to KU (Kansas University), so I went to a big school, and I'm getting back to the small feel."

Other classes are taught by professors in Salina, and students will get hands-on training throughout the four-year program. Then each one will go on to a residency in a small community in the surrounding area.

Dr. Kerry Murphy is a family physician at the Clay Center Clinic, about 100 kilometers northeast of Salina. Chances are at least one of the eight students in the program will do a residency here.

"This is a clinic that has currently eight doctors and four mid-level practitioners and we cover this town, but we also have satellite clinics in two nearby towns," Murphy says. "We operate as what I call a cradle-to- grave operation, we deliver babies and go up to doing nursing home care."

It's unlikely that there will ever be enough primary care physicians for every small town to have its own doctor. Cathcart-Rake expects several doctors will work out of a central clinic, like Clay Center, and see patients at satellite clinics spread out around the county, like spokes of a wheel.

"Clay Center is a great model for what I foresee as what a primary care center in Kansas might be," he says.

At the end of their residency, the students will have spent six years in rural communities in Kansas. Cathcart-Rake hopes that will be enough time for them to put down roots.

"And it's gonna hopefully harder for them to break away from those roots and go to bigger cities."

One thing that could lure them away is money. Rural doctors typically serve older, poorer patients and going into a specialty practice in a big city tends to be far more lucrative. And with the high cost of medical school, it's difficult for graduates to turn down those opportunities. So the Salina program is offering extra financial incentives to help them resist.

"It's called the KMS, the medical student repayment program," says Claire Hinrichsen, one of the five medical students who signed up for it. "For every year you give back to a rural area they pay for all our tuition."

That means, if they practice in an underserved county for four years, they will have essentially gotten their medical degree for free. But, Cathcart-Rake says there's a catch.

"If they don't practice primary care in an under-served area, they have to pay that back, with interest. So they have got those hooks in them. We hope this innovative program will keep students close to their roots. But only time will tell."
 “我们需要更多的医生。所有的在堪萨斯州的医生都是60岁或者以上的老人。所以我们必须注入新鲜血液。”威廉•凯瑟特雷克博士说道,他在堪萨斯大学领导着一个新项目,这个项目的目的就是供给医生。
这个想法是通过在国家的小社区教育他们,从而让医学院的学生在偏远的堪萨斯实践。
按照凯瑟特雷克博士的说法,来自偏远地区的学生主要去威奇托和坎萨斯市的医科学校。
“他们表示他们已经打算回到偏远的堪萨斯去,但他们遇到了知音,之后就结婚了。他们的灵魂伴侣碰巧来自大城市,而我们再也看不到他们。他们在大城市里扎了根。”他说道。“希望如果我们在较小的社区训练他们,他们也能够找到自己理想的配偶,他们也可以在这里扎根,这里可以形成网络,而这是终生的。”
该计划是以50000人口的小镇赛利娜为基础——这里离堪萨斯城有3小时的车程,这里曾是过去种植玉米和大豆的田地及偶尔养牛的牧场。赛利娜市中心的医学院是一座专门为这个计划用三层砖翻新的建筑物。
你首先注意到的是教授不是在房间里。相反,他出现在教室前面的平板显示器中。
“我们与互动电视连接,所以我们有两个监视器。第一个,我们看到了讲师的幻灯片,另一个监视器,我们看到讲师的视频。”赛利娜计划的学生克莱尔•海切森说道。“我们大部分的讲师都在堪萨斯城。今天,我们的讲师在威奇塔。”
威奇塔的这位教授在赛利娜的教室也有视频连接。当学生有问题时,他们只要举手对着桌子连接的麦克风说话就会传过去。
海切森在堪萨斯州的雷克普顿长大,这是一个大约有600人的城镇。她选择赛利娜计划的原因之一是这个班的学生设置。只有8名学生,使其成为这个国家最小的医学院。
“我真的非常喜欢它,而且我认识每个人。”她说道。“我们亲密无间,这是一种很美好的感觉。这让我找回了自己去堪萨斯大学的那种感觉,所以我去了一个大学校,然后又找回了这种感觉。”
其他课程由赛利娜的教授负责,学生在整个四年制的学习中将有实际操作机会。然后每个人会去周边地区的小社区行医。
凯利•墨菲博士是在赛利娜东北大约100公里处克雷中心诊所的一位家庭医生。该计划安排至少8名学生中的一位在这里做实习。
“这家诊所目前已有8名医生和4位中等级别的实践人员,我们覆盖了这个城镇,但是我们在附近的城市也有两个卫星诊所。”墨菲说道。“我们管理着我称之为从摇篮到坟墓的方案,我们提供婴儿照顾及登门做家庭护理。”
每一个小的城镇都有自己的医生及足够的初级护理医师是不可能的。凯瑟特雷克博士期望几个医生将会在一家中央诊所工作,就像克雷中心那样,看着卫星诊所里分散在该郡的病人,就像一个轮子的轴那样。
“克雷中心是一个相当好的原型,我可以预见在堪萨斯的初级护理中心就是它这个样子。”他说道。
在他们最后的实习中,学生将在堪萨斯的小社区中度过6年的时光。凯瑟特雷克博士希望会有足够的时间来扎根。
“现在是比较难的,但是希望他们会停下来考虑,不要去大一点的城市,就在这里扎根。”
而一个东西可以诱使他们离开,那就是金钱。村医生通常会为老人,贫穷的病人看病,而在大城市接受更为专业的实践往往是更有利的。花费高额成本从医学院毕业的学生很难拒绝机会。所以,赛利娜计划提供额外的财政刺激来帮助他们抗拒这些诱惑。
“这就是KMS,医学学生还款计划的由来。”克莱儿说道,她是报名参加的五个医学院学生当中的一个。“每一年,你回馈给农村地区,他们会支付所有我们的学费。”
这意味着如果他们在没有服务的地方实践四年,本质上他们已经获得了免费的医学学位。但是, 凯瑟特雷克博士表示这些人如果已经签约,就必须这样做。
“如果他们在没有服务的地方没有进行初级护理实践,他们就必须偿还贷款。所以这等于束缚住了他们。我们希望这一创新计划将使学生扎根于此。但只有时间会检验一切。”

标签:voa standard
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2011-12-22 19:19 编辑:pliny
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