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Redesigning Residency Education in Internal Medicine: A Position Paper from the Association of Program Directors in Internal Medicine

John P. Fitzgibbons, MD; Donald R. Bordley, MD; Lee R. Berkowitz, MD; Beth W. Miller, MD; and Mark C. Henderson, MD
[+] Article, Author, and Disclosure Information

From the Association of Program Directors in Internal Medicine, Washington, DC.

Grant Support: Dr. Henderson receives grant support from the U.S. Department of Health and Human Services, Health Resources and Services Administration (D58HP05139).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: John P. Fitzgibbons, MD, Department of Medicine, Lehigh Valley Hospital, PO Box 689, Allentown, PA 18105; e-mail, John.fitzgibbons@lvh.com.

Current Author Addresses: Dr. Fitzgibbons: Department of Medicine, Lehigh Valley Hospital, PO Box 689, Allentown, PA 18105.

Dr. Bordley: Department of Medicine, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box MED, Rochester, NY 14642.

Dr. Berkowitz: Department of Medicine, University of North Carolina School of Medicine, 3018 Old Clinic Building, CB #7005, Chapel Hill, NC 27599-7005.

Dr. Miller: Department of Medicine, University of Texas Medical Branch—Austin, 601 East 15th Street, Austin, TX 78701.

Dr. Henderson: Department of Internal Medicine, University of California, Davis, School of Medicine, 4150 V Street #3100, Sacramento, CA 95817.

Ann Intern Med. 2006;144(12):920-926. doi:10.7326/0003-4819-144-12-200606200-00010
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There has been considerable change in the practice of internal medicine in the past quarter century, including the rise of specialization, increasing time pressure, the hospitalist movement, and the rapidly changing responsibilities of internists in inpatient and outpatient settings. Training programs have not adequately responded to these trends, and there is a consensus that the residency education system urgently needs redesign.





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Still Missing the Main Attraction
Posted on June 19, 2006
David C. Beck
University of Cincinnati
Conflict of Interest: None Declared

Dear Editor,

I read with interest another discussion of what ails internal medicine residencies. It seems that few are willing to accept the apparent. Most competitive applicants are choosing internal medicine as a bridge to the medical subspecialties. The best way to attract the best and brightest to internal medicine is to facilitate an easy transition to the subspecialties for those who choose to pursue them. I would propose a model where internal medicine training is limited to two years for all those interested in pursuing a subspecialty; the third year would be reserved for those residents interested in general internal medicine. The third year could be tailored to either an extensive inpatient experience for those interested in a hospitalist position or ambulatory medicine for those interested in outpatient medicine. Internal medicine would immediately become more attractive. As indirect evidence, I propose a thought experiment. How competitive do you suppose dermatology would be if it required three years of internal medicine first? Similarly, how competitive do you suppose anesthesia or radiology would be if they required three to five years of general surgery first? It is certainly time to rethink how we train internists. I simply feel the authors have missed the best solution.


David C Beck

Conflict of Interest:

None declared

Regarding residency reform
Posted on June 28, 2006
Stephen E. Sandroni
Allegheny General Hospital
Conflict of Interest: None Declared

Reform requires reality. Current reimbursement for cognitive work in internal medicine is insufficient relative to current resident debt levels, and no reform that fails to address this will be successful.

Philosophically we must return to the concept that service to our fellow citizens is one of the great satisfactions of being a physician. It is troubling to see the semantic shift that now links the idea of service to the institution's benefit--and therefore something we must not use as a basis for training-- instead of to the patient who needs our help. "Patient-centered" is only half of the story; physician commitment is the core of professionalism and must be linked for satisfying encounters to occur.

Conflict of Interest:

None declared

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