The internal medicine clerkship and the national debate on primary care education

The required internal medicine clerkship has a mission greater than most educational experiences within the medical school. It is being looked upon to enhance student interest in and training for generalist careers. In the rush to meet this mandate, the centrality of the clerkship to educating all physicians cannot be violated. Achieving an effective balance among the competing educational demands will require creative thinking on the part of clerkship directors, chairs, and faculty. The types of patients students interact with and learn from must embody the clerkship's learning objectives. The "core curriculum" for internal medicine clerkships must be defined and differentiated from a generalist curriculum. The faculty must be chosen for their teaching effectiveness and commitment. Teaching medical students is a privilege, not an entitlement for medical school faculty. Learning must occur in a context representative of the practice of internal medicine and in an environment conducive to education. It is truly a time of change in internal medicine clerkships. CDIM is working to provide a foundation upon which the education of the physicians of tomorrow can be built.