title: [Residency: in the hospital or in the community?].
abstract: Over the last two decades larger proportions of medical activity have been transferred from the hospital to the community. Although the reason has been economic and not professional, it has affected medical education and the residency programs. In this issue of Harefuah, Nirel and colleagues, suggest transferring a part of the residency program to the community. They review the necessary setup, the difficulties and offer some solutions. Their message is clear: since the current residency program does not prepare the specialist for "real life", a switch to the community may fill the gap. This editorial deals with this topic and discusses the various aspects related to transferring a part of the residency to the community. In fact, the process has already started both in Israel and in the western world. The classic example is the residency program in family medicine. Other programs are still partial and local. The world experience is also partial and still unclear. The editorial specifies the necessary conditions for performing a successful reform in the residency program: "clinical material", teaching staff, a good program, infrastructure, financial resources and a change in the current ideology and dogmatic concepts of medicine in Israel. Each topic is discussed in light of the current status and the changes required for moving forward towards such reform. The influence of such reform on the work in both the hospitals and the community is also discussed. It is notable that Nirel and colleagues should be congratulated for raising this serious question in the national medical debate.
authors.affiliation: Department of Medicine Tel Aviv Sourasky Medical Center Sackler Faculty of Medicine, Tel Aviv University. moshemt@tasmc.health.gov.il
authors.forename: Moshe
authors.initials: M
authors.lastname: Mittelman
mesh_terms: D003151:Community Health Centers; D005194:Family Practice; D006801:Humans; D007396:Internship and Residency / Q000145:classification*; D008505:Medical Staff, Hospital