Учебные больницы в США: история и структура

A hospital that trains health professionals

The United States has more teaching hospitals than any other country in the world. A teaching hospital is a hospital or medical center that provides medical education and training to future and current health professionals. Teaching hospitals are often affiliated with medical schools and work closely with medical students throughout their period of matriculation, and especially during their clerkship (internship) years. In most cases, teaching hospitals also offer graduate medical education (GME)/physician residency programs, where medical school graduates train under a supervising (attending) physician to assist with the coordination of care. In addition to offering medical education to medical students and physician residents, many teaching hospitals also serve as research institutes.

The first teaching hospital in the United States was founded at the College of Philadelphia (now the University of Pennsylvania) in 1765. Following that were King's College of New York in 1768, Harvard University in 1783, Dartmouth College in 1798, and Yale University in 1810 to begin the history of notable university affiliated teaching hospitals in America. While the provisions listed above led to closure of many universities, but also an increased quality of teaching at the available medical education schools.

In the initial design of the teaching hospital, universities were given autonomy to appoint medical staff of the hospital and hospital trustees gave consent to physicians and medical students for using their hospital for both clinical and scientific work. Under the same model, students were given smaller responsibilities including changing dressings, taking blood samples and analyzing for specimen, handling catheters and treating patients with minor injuries. As teaching hospitals serve as locations for further medical education, it consists of many levels of doctors/doctors in training. The first of these is completing an internship. Sometimes referred to as first year residents, interns are doctors completing their first year of training after graduating from medical school. This stage is completed under complete supervision, as it is before they are licensed. The next stage is residency. Residency can be anywhere between a four to eight year process, depending on the hospital. A resident completes at least three years of supervised hands on training within these years as a transition into their unsupervised patient care. The level of residency also contains sub levels, being junior resident, senior resident, and chief resident. After this, some doctors move onto fellowship, which is where they declare a focus in a certain type of medicine and work directly under attending physicians. Attending physicians or more simply Attendings are responsible for making most direct patient care decisions in a hospital. They answer to the head of their department. These are all below the overseer of all staff: the medical director. He or she is responsible for policies, practices, and keeping all others in check. This hierarchy exists in each of the departments in a hospital, which are divided into broad specialties, all having more specific discipline (focus) of their own. The structure of these specialties began with the Johns Hopkins Hospital in 1888 and the creation of the Johns Hopkins School of Medicine, with their first four departments being Medicine, Surgery, Pathology, and Gynecology.

While some funding comes from Medicaid for the GME process, teaching hospitals must consider paying residents and fellows within their budgets. These additional costs vary between hospitals based on funding by Medicaid and their general salary for residents and fellows. Despite these costs, they are often offset by the prices of procedures which are elevated in comparison to most non teaching hospitals. Teaching hospitals often justify this additional cost factor by boasting that their quality of care rises above non teaching hospitals, or ensuring the patient that they are improving medicine of the future by having their procedure done with medical trainees present.

Given its orientation to providing hands on clinical work to medical and residency students, teaching hospitals use many physicians in order to treat a single patient. In just a single visit, a patient may be observed and monitored by medical students, hospital residents and the primary physician or caretaker. The practice of having a large team of physicians looking after one patient is at the center of debate regarding teaching hospitals. Some patients are strongly opposed being observed numerous caretakers at once while others are in favor of having many individuals involved in their care. Teaching hospitals are well known for treating rare diseases as well as extremely ill patients, but must do many additional common treatments in order to maintain income. It is often the amount of funding that determines a teaching hospital's perceived quality of care. As the data used to compare quality of care is mainly observational, it is nearly impossible to compare the quality of care between teaching hospitals and non teaching hospitals. Some popular examples of medical dramas that take place in teaching hospitals are St. Elsewhere, Chicago Hope, ER, Scrubs, House, Grey's Anatomy and The Good Doctor.