Defining the Essence of Internal Medicine

Transcription

1 Defining the Essence of Internal Medicine Education Redesign Task Force 2 Karen Hauer, MD Professor of Medicine University of California, San Francisco Essence of IM Subcommittee Karen Hauer, MD, UCSF (Chair) Bob Anderson, MD, University of Colorado Lee Berkowitz, MD, University of North Carolina at Chapel Hill Mark Geraci, MD, University of Colorado

2 Charge Recommendations regarding defining the essence of internal medicine A definition/document to disseminate to medical students Some linkages to the core competencies Why define the Essence of IM? Students: pipeline of future internists Residents: debates about teaching continuity care in IM, primary care workforce shortage, need to incorporate lifelong learning as a key aspect of IM. Practicing physicians: the essence of internal medicine should be a core that persists into practice. Incorporate lifelong learning.

3 ACP: What's an "internist"? Simply put, internists are Doctors of Internal Medicine. Doctors for Adults. But you may see them referred to by several terms, including "internists," "general internists" and "doctors of internal medicine. icine/ ACP: What's an "internist"? But don't mistake them with "interns," who are doctors in their first year

4 What does "internal medicine" mean? From the German term Innere Medizin, a discipline popularized in Germany in the late 1800s described physicians who combined laboratory science with patient care Many early 20th century American doctors studied medicine in Germany and brought it to the US Like many words adopted from other languages, it unfortunately doesn't exactly fit an American meaning. ABIM ABIM certifies one out of every four practicing physicians in the US More than 200,000 ABIM Board Certified physicians A patient s most frequent encounter is with an internist Certification by ABIM means that internists have Certification by ABIM means that internists have demonstrated to their peers and to the public that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care

5 The evolving state of internal medicine The core: science based, diagnostic experts The evolution: Early 1900 s: consultant diagnostician Mid 1900 s: subspecialists Late 1900 s: primary care general internist ~ 2000: generalists become hospitalists What is the core of Internal Medicine?

6 Purpose of defining Essence of IM To inform the teachers (faculty subcommittee) Teach and assess it (CBT subcommittee) Explain internal medicine to trainees and teachers Threats to the essence of IM reimbursement dysfunctional primary care practice environment increased specialization/fragmentation of the field perceptions of uncontrollable lifestyle for internists the name of the field is confusing

7 Defining the Essence of IM 2010 Literature review Review of ACGME competencies and ABIM milestones Task force generated draft definition Task force members shared definition with local faculty (12), trainees (17) Draft refined, finalized Essence of Internal Medicine (1) Intellectually-stimulating field Expertise in care of complex patients presenting diverse clinical challenges of high medical and social acuity Application of evidence-based practice and pathophysiologic-based approaches to diagnosis and treatment Ability to participate in discovery through research Expertise in and commitment to lifelong learning and competency-based advancement

8 Essence of Internal Medicine (2) Leadership in patient care Skill in team-based and continuity care for patients and families throughout acute and chronic illnesses, while cultivating meaningful relationships and advocating for patients through the duration of their illness Provision of the highest quality care through development and implementation ti of quality management programs and application of evidence to insure optimal quality outcomes and maintenance of skills Essence of Internal Medicine (3) Excellent training platform for diverse and flexible career pathways Diverse career pathways Primary care/ambulatory care; Inpatient, Hospitalist and Critical care; Specialty care, including procedural specialties Research, both basic and translational; Administration; Public Health/public policy; Education Value placed on balance of personal and professional success

9 Expert perspectives 1. What drew you to IM? 2. What has sustained you in IM? 3. How has your training in IM served as a foundation for your career? 4. How has your training in IM contributed to your career success? 5. What do you see in terms of future opportunities for/within IM? 6. Do you recommend IM training to young physicians? Why? 7. Is training in IM a good career choice for women? Why?

10 The Essence of Internal Medicine 5/12/09 Bob Anderson, Mark Geraci, Karen Hauer, Lee Berkowitz THE ESSENCE OF INTERNAL MEDICINE Intellectually-stimulating field Expertise in care of complex patients presenting diverse clinical challenges of high medical and social acuity Application of evidence-based practice and pathophysiologic-based approaches to diagnosis and treatment Ability to participate in discovery through research Expertise in and commitment to lifelong learning and competency-based advancement Leadership in patient care Skill in team-based and continuity care for patients and families throughout acute and chronic illnesses, while cultivating meaningful relationships and advocating for patients through the duration of their illness Provision of the highest quality care through development and implementation of quality management programs and application of evidence to insure optimal quality outcomes and maintenance of skills Excellent training platform for diverse and flexible career pathways Diverse career pathways o Primary care/ambulatory care; Inpatient, Hospitalist and Critical care; Specialty care, including procedural specialties o Research, both basic and translational; Administration; Public Health/public policy; Education Value placed on balance of personal and professional success

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