Redesigning Residency Education in Internal Medicine

TO THE EDITOR:

I read with interest the article by Fitzgibbons and colleagues (1)—another discussion of what ails internal medicine residencies. It seems that few people 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 2 years for persons interested in pursuing a subspecialty. The third year would be reserved for residents who are 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 an extensive ambulatory medicine experience for those interested in outpatient medicine. Internal medicine would immediately become more attractive. I propose a thought experiment as indirect evidence. How competitive do you suppose dermatology would be if it required 3 years of internal medicine first? Similarly, how competitive do you suppose anesthesia or radiology would be if 3 to 5 years of general surgery were required first? It is certainly time to rethink how we train internists. I simply feel that the authors have missed the best solution.