LETTER
Training More Generalists
Irwin J. Schatz, MD
1 January 1994 | Volume 120 Issue 1 | Pages 92-93
TO THE EDITOR:
Dr. Rivo's contribution is timely and important [1]. However, his statement that "the Special Requirements (for Internal Medicine Training) only call for 10% continuity-of-care experience," is not a direct quotation from the special requirements, and probably represents his interpretation of the language. As such, it may mislead many readers.
The current Special Requirements state that "at least 25 percent of the three years of residency training must be in the ambulatory care setting," to include "first contact, comprehensive and continuing care ... through at least two of the three years ..." [2]. The new Special Requirements, effective 1 July 1994, are even more rigorous. They emphasize that ambulatory training must include first-contact, comprehensive, and continuing care covering the broad spectrum of disease, that at least 25% of the 3 years must be in this setting, and that half of the residents' ambulatory experience should deal with general internal medicine patients.
The Residency Review Committee for Internal Medicine agrees with Dr. Rivo's call for more and better training of general internists. The Special Requirements vigorously reinforce this message. Simultaneously, educational standards must be maintained at a level ensuring that the general internist is trained as an expert in clinical diagnosis and is able to provide competent care to most patients with complex illness, whether in the doctor's office or in the hospital.
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Author and Article Information
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Residency Review Committee for Internal Medicine; Honolulu, HI 96813
1. Rivo M. Internal medicine and the journey to medical generalism. Ann Intern Med. 1993; 119:146-52.
2. American Medical Association. Special requirements for internal medicine training. In: Directory of Graduate Medical Education Programs: 1992-93. Chicago: American Medical Association; 1993.
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