Monday, September 19, 2005

American Journal Medicine article paints alarming picture of current Internal medicine residency

The September 2005 of AJM features an article (Internal medicine residency training in the 21st century: Aligning requirements with professional needs, Charap MH et al. Amer J med. 118, number 9, pg 1042, sept 2005) in their APM Perspectives section that characterizes current IM residency training as an almost mission- impossible type situation. The authors from New York University Department of Medicine describe in detail changes made by the ACGME and Residency Review committees (RRCs) since 1980. In 1980, IM training was 3 years as it is now, although at some earlier date (when I trained in the 60s) training was an internship and then three years of IM residency so that total post med school education was 4 years. There was more time then and clearly less to learn . Now the total time in training is less and the amount of time "allowed" during that time frame (i.e. "duty hours") has been mandated to be less.
The entire article is worth reading if you are involved in teaching residents or interested in post graduate education.(I am sent the journal but am unable to download the articles on line so I didn't give the URL).
I found the article very troubling. Most disconcerting to me was that the following statement is no longer included in the current RRC documentation."Physicians must have a keen sense of personal responsibility for continuing patient care and must recognize that their obligation to patients is not discharged at any given hour or any particular day of the week. In no case should the resident go off-duty until the proper care and welfare of the patient is ensured." Previously the RRC-IM was careful to include this caveat that the authors consider it the " touchstone " of the internist's world. This admonition apparently went south when , in 2003, resident duty hours were further restricted by the ACGME. The RRC-Im Program requirements documents for IM residency is now 21 pages having been a single page in 1980. In the last year, training for 6 "core competencies" was mandated including training is "system-based" practice and " practice-based learning" and scholarly activity is also required. The authors make the following alarming statement : "the reality is that residency programs simply cannot satisfy these ever-increasing requirements other than as paper achievements responding to paper audits."
They make several recommendations which include : Restoration of the above quoted "touchstone" statement, not adding more requirements unless they are linked to equivalent reductions, convening a blue ribbon panel ( not affiliated with ACGME) to review all of the RRC-IM requirements, allowing more flexibility in the program to meet the diverse career interests of current day residents.The authors definitely believe that changes must be made because " there is simply insufficient time to educate internal medicine residents in the present regulatory environment"

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