Redesigning Residency Education in Internal Medicine: A Position Paper from the Association of Program Directors in Internal Medicine

摘要

There has been considerable change in the practice of internal medicine in the past quarter century, including the rise of specialization, increasing time pressure, the hospitalist movement, and the rapidly changing responsibilities of internists in inpatient and outpatient settings. Training programs have not adequately responded to these trends, and there is a consensus that the residency education system urgently needs redesign. nnThe Association of Program Directors in Internal Medicine (APDIM) Council has developed a strategy for redesigning residency training. The Council's recommendations were reviewed and approved by the APDIM membership and form the basis of this official position paper. The Association of Program Directors in Internal Medicine comprises more than 400 internal medicine training programs throughout the United States and Canada. nnThe redesign process will require substantial changes to the educational environment, oversight, curriculum, faculty reward system, and funding of graduate medical education in internal medicine. The Association of Program Directors in Internal Medicine proposes immediate, short-term, and long-term solutions. nnThere is a growing consensus that residency education in internal medicine urgently needs redesign. The education system has failed to respond to dramatic changes in medical practice and health care delivery: It is not patient-centered and is not adequately linked with efforts to improve patient safety (1-10). Medical residents are not sufficiently exposed to internal medicine career options, leading them to make uninformed career choices. Finally, interest among U.S. medical school graduates in internal medicine careers is declining, especially in ambulatory general internal medicine (11-13). nnThe Association of Program Directors in Internal Medicine (APDIM) has begun to reexamine internal medicine residency education. The Association believes that core principles, not criticism, should be the foundation for change. As such, the APDIM Education Committee developed principles for redesigning residency education, emphasizing quality improvement and a renewed commitment to patient-centered care (Table). These guiding principles were used as the foundation of an APDIM Council Retreat to consider options for redesign. Two conclusions were reached: 1) High-quality education and patient care must be inseparably linked within training programs, and 2) redesign will require changes to the educational environment, oversight, curriculum, faculty reward system, and funding of graduate medical education in internal medicine.