The training of the internist with some messages from practice

Area of Science:

• Medical Education
• Internal Medicine Training
• Primary Care Focus

Background:

• Recent recommendations advocate for increased internist focus on primary care.
• This involves more ambulatory patient experience and training in subspecialties like gynecology, orthopedics, ENT, and dermatology.
• These changes are proposed to better reflect general internist practice compared to inpatient care.

Observation:

• Concerns exist that shifting training focus may reduce clinical scope and deep competence.
• This reduction could paradoxically hinder effectiveness in ambulatory patient care.
• Current training trends may not adequately prepare internists for complex cases.

Findings:

• Deep clinical competence should remain the defining characteristic of an internist.
• Internal medicine training programs must prioritize developing this deep competence.
• Overemphasis on specific ambulatory skills may dilute essential broad medical knowledge.

Implications:

• Training programs should balance primary care needs with the development of broad clinical expertise.
• Internal medicine residency should aim to produce physicians with profound diagnostic and management skills.
• Future consultant-level general internists require training in consultative, teaching, and research roles to serve as effective role models.