The Future of General Internal Medicine. Report and Recommendations from the Society of General Internal Medicine (SGIM) Task Force on the Domain of General Internal Medicine

University of Toronto, Toronto, Ontario, Canada
Journal of General Internal Medicine (Impact Factor: 3.45). 02/2004; 19(1):69-77. DOI: 10.1111/j.1525-1497.2004.31337.x
Source: PubMed


The Society of General Internal Medicine asked a task force to redefine the domain of general internal medicine. The task force believes that the chaos and dysfunction that characterize today's medical care, and the challenges facing general internal medicine, should spur innovation. These are our recommendations: while remaining true to its core values and competencies, general internal medicine should stay both broad and deep-ranging from uncomplicated primary care to continuous care of patients with multiple, complex, chronic diseases. Postgraduate and continuing education should develop mastery. Wherever they practice, general internists should be able to lead teams and be responsible for the care their teams give, embrace changes in information systems, and aim to provide most of the care their patients require. Current financing of physician services, especially fee-for-service, must be changed to recognize the value of services performed outside the traditional face-to-face visit and give practitioners incentives to improve quality and efficiency, and provide comprehensive, ongoing care. General internal medicine residency training should be reformed to provide both broad and deep medical knowledge, as well as mastery of informatics, management, and team leadership. General internal medicine residents should have options to tailor their final 1 to 2 years to fit their practice goals, often earning a certificate of added qualification (CAQ) in special generalist fields. Research will expand to include practice and operations management, developing more effective shared decision making and transparent medical records, and promoting the close personal connection that both doctors and patients want. We believe these changes constitute a paradigm shift that can benefit patients and the public and reenergize general internal medicine.

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Available from: Lewis G Sandy, Jan 16, 2015
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    • "En el contexto anterior, se planea elaborar el marco conceptual de las competencias profesionales, en particular las que debe alcanzar un residente que va a titularse como especialista de medicina interna. Por tanto, se busca construir un referente conceptual de las diferentes competencias de un internista para Colombia, partiendo del análisis de lo que han planteado, en otros países, autores como Palsson et al (2007), Larson et al (2004), y Epstein y Hundert (2002), y asociaciones como la Accreditation Council for Graduate Medical Education (ACGME) (1999) (1-4). Estas competencias , que le imprimen una caracterización particular, se pueden resumir en clínicas o de cuidado del paciente, de conocimiento práctico, de comunicación e interpersonales, profesionalismo, actividades académicas de educación e investigación y administrativas. "
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    • "In particular, it is regarded as an approach that can meet the increasingly complex health care needs of aging populations (Butler, 1997; Mendelson & Schwartz, 1993). Moreover, increasing professional specialization (Warelow, 1996) and the growing awareness of complex intersections between biological and social determinants of health is leading to a growing need for complex, interprofessional care (Larson et al., 2004; Mulvale & Bourgeault, 2007; Svensson, 1996). "
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    ABSTRACT: Research suggests that health care can be improved and patient harm reduced when health professionals successfully collaborate across professional boundaries. Consequently, there is growing support for interprofessional collaboration in health and social care, both nationally and internationally. Factors including professional hierarchies, discipline-specific patterns of socialization, and insufficient time for teambuilding can undermine efforts to improve collaboration. This paper reports findings from an ethnographic study that explored the nature of interprofessional interactions within two general and internal medicine (GIM) settings in Canada. 155 hours of observations and 47 interviews were gathered with a range of health professionals. Data were thematically analyzed and triangulated. Study findings indicated that both formal and informal interprofessional interactions between physicians and other health professionals were terse, consisting of unidirectional comments from physicians to other health professionals. In contrast, interactions involving nurses, therapists and other professionals as well as intraprofessional exchanges were different. These exchanges were richer and lengthier, and consisted of negotiations which related to both clinical as well as social content. The paper draws on Strauss' (1978) negotiated order theory to provide a theoretical lens to help illuminate the nature of interaction and negotiation in GIM.
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    • "Tailoring of training to the various contexts (example in hospital, academic, outpatients) within which general internists may practice was suggested by the SGIM task force in the United States [19,20] along with the suggestion that general internal medicine residents should have options to tailor their final 1 to 2 years to fit their practice goals, earning a certificate of added qualification in generalist fields [19,20]. Although much less has been written about the fit of general internal medicine into the Canadian health care system [7-9] we would propose a similar training pattern for Canadian general internists. "
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