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E-grāmata: Let Me Heal: The Opportunity to Preserve Excellence in American Medicine

3.39/5 (39 ratings by Goodreads)
(Professor of Internal Medicine and Mabel Dorn Reeder Distinguished Professor in the History of Medicine, Washington University School of Medicine, St. Louis, MO)
  • Formāts: 368 pages
  • Izdošanas datums: 01-Sep-2014
  • Izdevniecība: Oxford University Press Inc
  • Valoda: eng
  • ISBN-13: 9780199392179
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  • Formāts: 368 pages
  • Izdošanas datums: 01-Sep-2014
  • Izdevniecība: Oxford University Press Inc
  • Valoda: eng
  • ISBN-13: 9780199392179
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In Let Me Heal, prize-winning author Kenneth M.Ludmerer provides the first-ever account of the residency system for training doctors in the United States and, by tracing its evolution, explores how the residency system is of fundamental importance to the health of the nation.

In the making of a doctor, the residency system represents the dominant formative influence. It is during the three to nine years spent in residency that doctors come of professional age, acquiring the knowledge and skills of their specialty or subspecialty, forming a professional identify, and developing habitts, behaviors, attitudes, and values that last a professional lifetime. Let Me Heal examines all dimensions of the residency system: historical evolution, educational principles, moral underpinnings, financing and administration, and cultural components. It focuses on the experience of being a resident, on how that experience has changed over time, and on how well the residency system is fulfilling its obligation to produce outstanding doctors. Most importantly, it analyzes the mutual relationship beetween residency education and patient care in America. The book shows that the quality of residency training ultimately depends on the quality of patient care that residents observe, but that there is much that residency training can do to produce doctors who practice in a better, more affordable fashion.

Recenzijas

This thoughtful scholarly treatise on the residency, the most influential learning period for young physicians, is a major contribution to our understanding of how America produces its physician workforce. It notes the educational, scientific, economic, social, legal, ethical, and political influences which produce tensions and conflicts in the training experience. Dr. Ludmerer provides a platform for examining these influences and he proposes ways for the learning environment to be more flexible, while maintaining high standards and the professionalism we all want to retain in our nation's physicians. I heartily recommend this superb book to all who are interested in our nation's healthcare system. * Louis W. Sullivan, MD, President Emeritus, Morehouse School of Medicine, US Secretary of Health and Human Services, 1989-1993 * In engaging and compelling prose, Kenneth Ludmerer vividly chronicles and insightfully analyzes the medical and social history of the residency phase of American medical education. Based on rich observational and documentary data, he brilliantly evaluates the achievements, tensions, and shortcomings of the residency system. Let Me Heal, the entreaty that he chose for the book's title, has contemporary as well as historic significance. It is associated with Ludmerer's stirring analysis of how the present-day struggles with patient care and health care delivery in the United States create challenges for good medical education, and of how the residency system can contribute to making medical care better and more affordable. This landmark book should be ready by all who are concerned with medical education and patient care in America. * Renee C. Fox Annenberg Professor Emerita of the Social Sciences University of Pennsylvania * The complete fascinating story of the graduate education of US physicians, its 19th century origins, its 20th century glories, and now its threatened decline in the hands of a commercialized hospital industry and a for-profit health system. A compelling read that all who would understand our health care problems will enjoy, and a masterful study sure to become the definitive reference in its field. Another notable contribution by Ludmerer to the history of medical education and its relation to contemporary society. * Arnold S. Relman, MD, Professor Emeritusof Medicine and of Social Medicine, Harvard Medical School, and former Editor-in-Chief, The New England Journal of Medicine * Let Me Heal is an eye-opening analysis of residency training and a wonderful exploration of its evolution. This third book in Ludmerer's trilogy on American medicine is a tour de force. I would consider it an indispensable resource for anyone seeking to understand medical education and for those with a stake in what the future might hold. * Abraham Verghese, MD Profesor of Medicine, Stanford University Author of Cutting For Steone * We ... consider this book an invaluable contribution to the field and encourage everyone involved with residency training to read it. * Editors, Journal of Graduate Medical Education * This book represents an important contribution to our understanding of the history and current state of American residency education and of ers a strong foundation for future research. * Science Magazine * [ a] meticulous new book. * Lara Goitein, The New York Review of Books *

Preface ix
Acknowledgments xv
1 Antecedents
1(16)
The Search for Clinical Experience
2(6)
The Quest for Specialty Training
8(4)
The Passion for Discovery and the Birth of Clinical Science
12(5)
2 Johns Hopkins and the Creation of the Residency
17(20)
Graduate Medical Education Enters the University
18(5)
The Scientific Practitioner and the Promise for the Nation
23(5)
Work as Play
28(5)
Diaspora
33(4)
3 The Growth of Graduate Medical Education
37(28)
Completing the Infrastructure
38(4)
The Maturation of the Internship
42(7)
The Spread of the Residency
49(12)
In Search of a System
61(4)
4 The American Residency
65(30)
Educational Principles
66(8)
The Moral Dimension of Graduate Medical Education
74(6)
The Learning Environment
80(7)
Cultural Influences
87(8)
5 The Life of a Pre--World War II House Officer
95(22)
Obtaining a Residency
96(6)
Experiencing the Residency
102(10)
Education and Service
112(5)
6 Consolidating the System
117(18)
The Second Reform of Medical Education
117(5)
The Rise of the Specialty Boards and the Triumph of Residency
122(6)
Graduate Medical Education and the Public Good
128(7)
7 The Expansion of the Residency in an Era of Abundance
135(26)
From Privilege to Right
137(9)
The Maturation of Clinical Science and the Creation of Subspecialty Fellowships
146(5)
The Ascendance of Specialty Practice
151(5)
The Propagation of Wastefulness
156(5)
8 The Evolving Learning Environment
161(24)
The Decline of the Ward Service
162(7)
The Preservation of Educational Quality
169(9)
Maintaining the Moral Mission
178(7)
9 The Life of a Post-World War II House Officer
185(30)
Changes and Continuities
186(15)
Quality, Safety, and Supervision
201(8)
Education and Service, Again
209(6)
10 The Weakening of the Educational Community
215(24)
The Marginalization of House Officers
216(7)
House Staff Activism
223(8)
The Discovery of Burnout
231(8)
11 The Era of High Throughput
239(32)
The New Learning Environment
241(17)
The Subversion of the Moral Mission
258(7)
Changing Attitudes toward Work and Life
265(6)
12 The Era of Accountability, Patient Safety, and Work-Hour Regulation
271(32)
Work-Hour Restrictions
273(14)
Perpetual Dilemmas
287(16)
13 Preserving Excellence in Residency Training and Medical Care
303(32)
Challenges, New and Old
305(12)
Aligning Education and Patient Care
317(18)
Notes 335(76)
Index 411
Kenneth M. Ludmerer is Professor of Medicine, Professor of History, and the Mabel Dorn Reeder Distinguished Professor of the History of Medicine, Washington University, St. Louis, Missouri.