Perspective: Creating the Next Generation of General Internists: A Call for Medical Education Reform

ArticleinAcademic medicine: journal of the Association of American Medical Colleges 86(11):1443-7 · September 2011with4 Reads
DOI: 10.1097/ACM.0b013e3182303a32 · Source: PubMed
The United States is faced with an increasing shortage of physicians in the primary care workforce. The number of medical school graduates selecting careers in primary care internal medicine has fallen dramatically since 1985. Although political, financial, and organizational reform of the medical system is necessary, these changes will address only part of the problem. Endeavors designed to ameliorate this current crisis in primary care practice must also address the education and training of future primary care internists. Learners require specialized training in primary care internal medicine to be able to provide high-quality, patient-centered, outcome-oriented care. This article examines the impact of educational interventions in undergraduate medical education (UME) and graduate medical education (GME) on primary care internal medicine career choice and makes suggestions for future educational changes. Suggested UME changes include providing early longitudinal clinical experiences and providing the option for an integrated ambulatory third year of training. Suggested GME changes include early, sustained exposure to general internal medicine and differentiated training tracks for residents interested in primary care. Key among these changes are that medical students and residents must have adequate mentorship from primary care internists and clinical experiences in highly functioning primary care settings established as patient-centered medical homes. Academic centers have a unique opportunity to contribute to these imperatives by reengineering the practice of primary care in a way that embodies the core values of effective, patient-centered care.
    • "Despite the growing prominence of the PCMH as effective models for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Studies show that few medical students are exposed to this model in their formal education or have opportunities to gain hands-on experience using this model of care.4–6 Only 41% of family medicine departments in one survey reported implementing a PCMH curriculum for students, and teaching modalities largely focused on educational conferences rather than longitudinal exposure.5 "
    [Show abstract] [Hide abstract] ABSTRACT: As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH) as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC), a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87% were very or extremely satisfied with their care, and 96% of the patients would recommend the WCCC to others. Students who participate in the WCCC gain hands-on experience in coordinating care, providing continuity of care, addressing issues of accessibility, and developing quality and safety metrics. The WCCC experience provides an integrative model that links service-learning with education on health care delivery in a primary care setting. The authors propose that adoption of this approach by other student-run clinics provides a substantial opportunity to improve medical education nationwide and better prepare future physicians to practice within this new model of health care delivery.
    Full-text · Article · Sep 2014
    • "Neurology (13.4%) and Dermatology (11.3%). This can reflect the fact that these are the main specialties that are focused on by the curriculum just as reported in a previous study(Julian et al. 2011). As well as the fact that most of the doctors that teach in Medicine are specialized in these areas, keeping in mind that to specialize in Cardiology for example, a doctor must also specialize in Internal Medicine(Al Kadri et al. 2012). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Medical students are the future doctors in any country. The lack or surplus of medical school interest in specialties influences and affects the health services in a country. Objective: In our study we evaluated the interest of medical students in Internal Medicine at a University in Sudan. Methods: A cross-sectional study was conducted in September 2013 at Faculty of Medicine, University of Medical Sciences and Technology (UMST), Khartoum, Sudan. A self-administered questionnaire was given to 887 male and female students enrolled at UMST. Results: A total of 887 questionnaires were handed out, of these 647 questionnaires were returned (response rate of 73%). Of the returned questionnaires 604 were valid and considered. Table 1 shows the general characteristics of the valid responses. The majority of our respondents were females 371 (61.4%) and 233 students were males (38.6%). There were 142 students interested in internal medicine. Of them, 95(21.3%) were in pre-clinical years, 47(29.6%) clinical, 25.3% were male and 22.4% were female. Amongst the subspecialties within medicine, 33.1% of students chose Cardiology as their first choice subspecialty, followed by Internal Medicine (26.8%), Neurology (13.4%) and Dermatology (11.3%). Conclusion: Medicine is second most popular specialty selected by medical students. The highest selected sub-specialty was cardiology. The main reasons for selecting Medicine as a career is personal interest, followed by being helpful to the community, and lastly job opportunities.
    Full-text · Article · Jun 2014
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