Internal Medicine Residency Reform : Task Force Report

T he structure, process, and outcomes of internal medicine residency training have concerned the profession for over 20 years. Over the last decade the initiative to move to outcomes-based education redefined the competencies physicians should obtain during training. The core principle of outcomes-based education is the objective demonstration that a graduating trainee, whether from medical school or a residency, possesses the knowledge, skills, and attitudes necessary to progress to the next stage of his or her professional career. The Accreditation Council for Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) have defined core competencies for physicians shown in Table 1. While both the ACGME and IOM provide a framework for the desired outcomes, medical educators bear the burden of designing the structures and processes to achieve them. Educators face several key challenges in redesigning residency programs. First, residency programs must prepare trainees for a variety of general internal medicine and subspecialty careers. Second, the settings and resources for residency training are highly heterogeneous. Third, an aging and increasingly diverse population, combined with rapidly expanding medical information and procedural technology, challenges all internists to acquire and maintain the knowledge, skills, attitudes, and performance necessary to provide highquality care within their chosen discipline. Finally, growing public dissatisfaction, substantial health care disparities, increased acuity but shorter lengths of stay for hospitalized patients, new work hour requirements, increasing medical student debt, and changing student demographics and lifestyle concerns further complicate residency reform. To provide recommendations for residency reform. The Society of General Internal Medicine (SGIM) convened a task force consisting of physicians representing a broad range of views within general medicine, expertise and experience in clinical education, and who represented internal medicine organizations outside of SGIM (Appendix 1). The task force focused on reform in 5 specific areas: ambulatory education, inpatient education, residency curriculum, health disparities, and life-long learning skills. To prepare this report, 4 subcommittees performed literature reviews that guided a prospective, systematic process to develop the final recommendations. The guiding principles, task force timeline, and the specific findings of the 4 subcommittees can be viewed at www.sgim.org. We acknowledge this report cannot cover all important aspects of residency training. The task force enthusiastically welcomes comments from other educators and internal medicine specialty organizations. Only through active collaboration and serious dialogue can we improve residency training.