| Internal medicine training in the 21st century. | |
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MedLine Citation:
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PMID: 18820519 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Many are calling for changes for internal medicine training, arguing that changes in the practice environment mandate changes in how the internal medicine residency is structured. Residency could be shorter, more conducive to role differentiation among general internists, and more supportive of subspecialization. Training could provide more experience in ambulatory care, multidisciplinary team-based care, chronic disease management, and quality improvement. The authors contend that the claim that internal medicine training ought to mirror internal medicine practice is mistaken. Many changes now proposed would likely damage if not destroy the consultant-generalist ideal of traditional internal medicine training which remains critical to effective medical care in the 21st century. The authors propose a model for training similar in structure but different in spirit from contending models. This model, like others, would involve a core experience in the first two years with tracking in the final year; unlike others, it would provide a conceptually coherent experience based on internal medicine's traditional ideal. Outpatient experience would be subsidiary to a predominantly inpatient experience, and it would be structured in blocks rather than continuity clinics. Twenty-first-century internists will continue to face what has always been the internist's task: the resolution of complex and ill-defined patient problems into proper diagnoses and therapeutic options. Contemporary internal medicine training must fit trainees for that task and must, thus, continue to offer the training experience necessary for the realization of the Oslerian ideal: a substantial apprenticeship taking care of inpatients with a wide range of medical illnesses. |
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Authors:
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Thomas S Huddle; Gustavo R Heudebert |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Academic medicine : journal of the Association of American Medical Colleges Volume: 83 ISSN: 1938-808X ISO Abbreviation: Acad Med Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-09-29 Completed Date: 2008-10-24 Revised Date: 2009-11-03 |
Medline Journal Info:
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Nlm Unique ID: 8904605 Medline TA: Acad Med Country: United States |
Other Details:
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Languages: eng Pagination: 910-5 Citation Subset: AIM; IM |
Affiliation:
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Division of General Internal Medicine, University of Alabama School of Medicine, Birmingham VA Medical Center, Birmingham, Alabama 35294, USA. thuddle@uab.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Ambulatory Care / standards, trends Career Choice Clinical Competence* Curriculum Education, Medical, Graduate / methods, trends* Female Forecasting Hospitals, Teaching Humans Inpatients Internal Medicine / education*, trends Internship and Residency / standards, trends* Male Models, Educational Quality of Health Care United States |
| Comments/Corrections | |
Comment In:
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Acad Med. 2008 Oct;83(10):897-9
[PMID:
18820516
]
Acad Med. 2008 Oct;83(10):893-6 [PMID: 18820515 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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