美国肾内科专科医师规范化培训模式的探析及启示

doi:10.16138/j.1673-6087.2026.01.15

摘要/Abstract

摘要：

肾内科专科医师规范化培训是完成住院医师规范化培训后进入专科医师阶段的重要环节。肾内科作为三级临床学科，涵盖肾小球和肾小管疾病、移植后管理、遗传性肾病以及各类急、慢性肾功能衰竭的预防、诊断和治疗，专业性强，与众多临床学科和基础医学研究联系密切。为患者提供更优质的医疗服务，切实提高肾脏内科医师的临床诊治与学术水平是当前专科医师培训的核心目标。本文通过分析美国肾内科专科医师的培训模式，并结合上海市肾内科专科培训现状和存在问题，以期为优化本市肾内科专科医师培训体系提供参考和启示。

关键词: 肾内科, 专科医师规范化培训, 美国模式, 启示

Abstract:

The standardized nephrology fellowship is a crucial phase following standardized residency training. As a tertiary clinical discipline, nephrology encompasses the prevention, diagnosis, and treatment of glomerular and tubular diseases, post-transplant care, hereditary kidney diseases, and acute and chronic renal failure. It is a highly specialized field closely linked with many clinical disciplines and basic medical research. The core objective of the fellowship is to enhance nephrologists’ clinical expertise and academic competence, thereby delivering higher-quality medical services to patients. This article analyzes the training model of nephrology fellowship in the United States and discusses it in the context of the current status and challenges of nephrology fellowships in Shanghai, with an aim to provide references and insights for optimizing the local nephrology fellowship system.

Key words: nephrology, standardized fellowship, American model, implication

中图分类号:

陈美含, 秦岭. 美国肾内科专科医师规范化培训模式的探析及启示[J]. 内科理论与实践, 2026, 21(01): 98-102.

CHEN Meihan, QIN Ling. Analysis and implications of the standardized nephrology fellowship training model in the United States[J]. Journal of Internal Medicine Concepts & Practice, 2026, 21(01): 98-102.

图/表 1

参考文献 20

[1]	黄蕾, 郑加麟, 靳令经, 等. 美国毕业后医学教育认证体系及其启示[J]. 中华医学教育杂志, 2020, 40(12):1031-1035.
	Huang L, Zheng JL, Jin LJ, et al. American accreditation on graduate medical education and its inspiration[J]. Chin J Med Edu, 2020, 40(12):1031-1035.
[2]	上海市卫生和计划生育委员会, 上海市财政局, 上海市教育委员会. 上海市专科医师规范化培训实施办法(试行)[EB/OL]. (2013)[2025-01-25]. https://wsjkw.sh.gov.cn/kjjy1/20180815/0012-60708.html.
	Shanghai Municipal Health and Family Planning Commission, Shanghai Municipal Finance Bureau, Shanghai Municipal Education Commission. Implementation measures for standardized fellowship in Shanghai (trial)[EB/OL]. (2013)[2025-01-25]. https://wsjkw.sh.gov.cn/kjjy1/20180815/0012-60708.html.
[3]	国家卫生计生委, 国务院医改办, 国家发展改革委, 等. 关于开展专科医师规范化培训制度试点的指导意见[EB/OL]. (2015)[2025-01-25]. https://www.nhc.gov.cn/qjjys/c100016/201601/d1d1b98e3b57484984af3e0bc459a25d.shtml.
	National Health and Family Planning Commission of the People's Republic of China, Leading group overseeing medical and healthcare reform under the State Council, National Development and Reform Commission, et al. Guiding opinions on launching the pilot program for the standardized fellowship system [EB/OL]. (2015)[2025-01-25]. https://www.nhc.gov.cn/qjjys/c100016/201601/d1d1b98e3b57484984af3e0bc459a25d.shtml.
[4]	Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in nephrology[EB/OL]. (2025)[2025-01-25]. https://www.acgme.org/globalassets/pfassets/programrequirements/2025-reformatted-requirements/148_nephrology_2025_reformatted.pdf.
[5]	黄红东, 孙蔚明. 肾病专科医师培训体系的构建——美国哈佛医学院附属麻省总医院专科教育工作启示[J]. 西北医学教育, 2015, 23(1):48-50. doi: 10.13555/j.cnki.c.m.e.2015.01.018
	Huang HD, Sun WM. Construction of fellowship training system for nephrologists: enlightenment during working in Massachusetts General Hospital of Harvard Medical School[J]. Northwest Med Edu, 2015, 23(1):48-50. doi: 10.13555/j.cnki.c.m.e.2015.01.018
[6]	AAMC. ERAS® program for institutions [EB/OL]. (2025)[2025-01-30]. https://www.aamc.org/services/eras-for-institutions.
[7]	AAMC. Apply to residencies with the ERAS® system [EB/OL]. (2025)[2025-01-30]. https://students-residents.aamc.org/applying-residencies-eras/apply-residencies-eras-system.
[8]	National Institutes of Health. Ruth L. Kirschstein national research service award (NRSA) institutional research training grant (parent T32) [EB/OL]. (2024)[2025-01-25]. https://grants.nih.gov/grants/guide/pa-files/PA-25-168.html.
[9]	孟煜, 夏人青. 美国专科医师培训制度体系探析及启示[J]. 复旦教育论坛, 2020, 18(2):99-105. doi: 10.3969/j.issn.1672-0059.2020.02.017
	Meng Y, Xia RQ. A probe into specialist training system in the United States and its implications for China[J]. Fudan Education Forum, 2020, 18(2):99-105. doi: 10.3969/j.issn.1672-0059.2020.02.017
[10]	白琼, 韩江莉, 张祺, 等. 美国肾脏内科专科医师培训评估工具及分析[J]. 中华医学教育探索杂志, 2021, 20(8):874-877. doi: 10.3760/cma.j.cn116021-20200426-00568
	Bai Q, Han JL, Zhang Q, et al. Evaluation tools and analysis of the nephrology specialist training in the United States[J]. Chinese Journal of Medical Education Research, 2021, 20(8):874-877. doi: 10.3760/cma.j.cn116021-20200426-00568
[11]	戴若莲, 王刚. 非神经病学专业住院医师在神经内科轮转培训的现状和提升对策思考[J]. 内科理论与实践, 2024, 19(4):283-286. doi: 10.16138/j.1673-6087.2024.04.13
	Dai RL, Wang G. Current situation and improvement strategies of rotation training for non-neurologic residents in department of neurology[J]. J Intern Med Concepts Pract, 2024, 19(4):283-286. doi: 10.16138/j.1673-6087.2024.04.13
[12]	木卡大斯·热合曼, 叶晨静, 周淑颖, 等. 计算机辅助教学模式在全科医学住院医师血脂异常临床教学中的初步应用[J]. 内科理论与实践, 2023, 18(3):183-187. doi: 10.16138/j.1673-6087.2023.03.009
	Rahman M, Ye CJ, Zhou SY, et al. Application of computer-aided teaching mode in clinical learning dyslipidemia for general practice residents[J]. J Intern Med Concepts Pract, 2023, 18(3):183-187. doi: 10.16138/j.1673-6087.2023.03.009
[13]	中国医师协会. 住院医师规范化培训内容与标准(2022年版)[EB/OL]. (2022)[2025-01-25]. https://www.pkufh.com/Html/News/Articles/52635.html.
	Chinese Medical Doctor Association. Standardized residency training: content and standards (2022 edition) [EB/OL]. (2022)[2025-01-25]. https://www.pkufh.com/Html/News/Articles/52635.html.
[14]	Mayo Clinic College of Medicine and Science. Nephrology fellowship [EB/OL]. (2025)[2025-01-25]. https://college.mayo.edu/academics/?keywords=Nephrology+Fellowship&location=&type=.
[15]	孟煜. 中美专科医师培养模式比较研究[D].上海: 上海师范大学, 2018.
	Meng Y. A comparative study of specialist physician training models between China and the United States[D].Shanghai: Shanghai Normal University, 2018.
[16]	王林, 马翔宇, 马真胜, 等. 中美骨科医师培训体系的比较[J]. 中国矫形外科杂志, 2015, 23(16):1485-1488. doi: 10.3977/j.issn.1005-8478.2015.16.09
	Wang L, Ma XY, Ma ZS, et al. Comparison of orthopedic surgeon training system between China and the United States[J]. Orthopedic Journal of China, 2015, 23(16):1485-1488. doi: 10.3977/j.issn.1005-8478.2015.16.09
[17]	章倩莹, 戎殳, 李艳, 等. 肾脏内科专科医师规范化培训需求调查及对策[J]. 中国毕业后医学教育, 2023, 7(10):818-821. doi: 10.3969/j.issn.2096-4293.2023.10.016
	Zhang QY, Rong S, Li Y, et al. Survey and solutions on the demand for standardized training of specialists in nephrology department[J]. Chinese Journal of Graduate Medical Education, 2023, 7(10):818-821. doi: 10.3969/j.issn.2096-4293.2023.10.016
[18]	杨威, 马鑫月, 康凯, 等. 重症医学专科医师规范化培训指导下情景模拟教学法在住院医师规范化培训中的应用[J]. 中国临床医生杂志, 2024, 52(10):1251-1254.
	Yang W, Ma XY, Kang K, et al. Application of scenario-based simulation teaching guided by critical care standardized fellowship in residency standardized training[J]. Chin J Clin, 2024, 52(10):1251-1254.
[19]	董睿, 徐茂锦, 郭志勇, 等. PBL联合诊治指南教学法在肾内科专科住院医师培训中的应用探索[J]. 卫生职业教育, 2013, 31(24):158-159.
	Dong R, Xu MJ, Guo ZY, et al. Exploring the application of PBL combined with clinical guideline-based teaching in nephrology fellowship training[J]. Health Vocational Education, 2013, 31(24):158-159.
[20]	贺文广, 杨积昌, 彭娴婧, 等. 美国放射科住院医师胜任力评价系统: 肌骨放射学milestone解读与思考[J]. 中国毕业后医学教育, 2020, 4(3):283-288. doi: 10.3969/j.issn.2096-4293.2020.03.022
	He WG, Yang JC, Peng XJ, et al. Milestone competency evaluation framework for American radiology residency: the musculoskeletal radiology milestone project[J]. Chinese Journal of Graduate Medical Education, 2020, 4(3):283-288. doi: 10.3969/j.issn.2096-4293.2020.03.022