Internal Medicine Training: Putt or Get Off the Green

The following editorial and articles are published in the June 20 issue of Annals of Internal Medicine:

S. A. Schroeder and H. C. Sox. Internal Medicine Training: Putt or Get Off the Green [editorial] Ann Intern Med 2006; 144(12): 938-939.
This issue features 2 position papers on reforming internal medicine residency education (1, 2), 1 from the American College of Physicians (ACP) and 1 from the Association of Program Directors in Internal Medicine (APDIM). Both acknowledge aspects of internal medicine practice—reimbursement, lifestyle, autonomy, managed care hassles, the burden of chronic illness—that contribute to low residency fill rates. But they then correctly point out that educational reforms could make a big difference (1, 2). They argue cogently that the traditional training model lacks many ingredients that are essential preparation for internal medicine practice. Other aspects of residency training are unattractive to students taking internal medicine clerkships: unnecessary stress, devaluation of office-based training, and too little exposure to excellent role models. The proposed reforms are visionary, far-reaching, and appealing. The 2 reports are remarkably similar, except that the ACP also calls for redesign of the internal medicine student clerkship.

1. Weinberger SE, Smith LG, Collier VU. Redesigning training for internal medicine. Ann Intern Med 2006;144:927-32.

2. Fitzgibbons JP, Bordley DR, Berkowitz LR, Miller BW, Henderson MC. Redesigning Residency Education in Internal Medicine: A Position Paper from the Association of Program Directors in Internal Medicine. Ann Intern Med. 2006;144:920-6.

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