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Residency Training in Internal Medicine: Time for a Change?

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Grant support: in part by the Task Force on Academic Health Centers. The views expressed are those of the authors and are not necessarily those of the Task Force or its individual members.

▸Requests for reprints should be addressed to Steven A. Schroeder, M.D.; Division of General Internal Medicine, A-405, University of California, San Francisco, 400 Parnassus Avenue; San Francisco, CA 94143.

San Francisco, California

©1986 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1986;104(4):554-561. doi:10.7326/0003-4819-104-4-554
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Internal medicine residencies risk becoming obsolete if they are not adjusted to changing patterns of medical practice. Declining length of hospital stay, increased intensity of hospital care, movement of critical management decisions to outpatient settings, increased proportions of admissions for specific diagnostic procedures, and increased needs for perioperative consultations all erode the foundation of traditional internal medicine training. Furthermore, demographic shifts, the move to prepaid care, and a projected oversupply of subspecialists warrant more exposure to generalism and geriatrics. To prepare internists for clinical practice, some training should shift from medical wards and intensive care units to outpatient settings and surgical consultation, additional process skills must be taught, and the epidemiologically important non-internal-medicine disciplines should be included in the curriculum. These shifts will require changes in methods to pay for residency training, accreditation procedures for residency programs, and the residency certifying process. Most importantly, the model and organization of internal medicine training need to be reconsidered.





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