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Training

A Trainee's Perspective of General Internal Medicine

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Why choose Internal Medicine?

Interim Trainees in General Medicine

As is well known, many trainees supervised by the Specialist Advisory Committee in General Medicine are not dedicated trainees in Internal Medicine. Some of the reasons trainees will choose to do an interim year of advanced training in general medicine include:

  1. To have a year of accredited training while awaiting a training position in another subspecialty.
  2. To have the year of their FRACP examination accredited as a year of advanced training.
  3. To spend a year trying out a number of subspecialty areas to make a decision regarding the most suitable career path.

These trainees have definite needs that need to be considered by the college before making any changes to the current training structure.

Dedicated Trainees in Internal Medicine

I am aware of 18 current or recently graduated trainees in internal medicine. The reasons for choosing internal medicine training include:

  1. To gain broad experience and procedural skills for rural and provincial practice.
  2. To provide a base for developing special interests in perioperative medicine, obstetric medicine or medicine in disabled people.
  3. To complement research interests in health systems, public health, or evidence based medicine.
  4. To combine with subspecialty training.

Several trainees who initially felt that training in internal medicine was a reasonable option have decided that the best approach is to a keep a “foot in both camps” and pursue combined training in internal medicine and a subspecialty.

Other factors that influence the decision to pursue training in internal medicine include:
  1. An interest in the “breadth” of medicine.
  2. Excellent general physician role models (this is certainly the case in Queensland).
  3. A belief that general physicians have an important role in the provision of health care.
    Many trainees are concerned that the involvement of multiple subspecialists results in fragmented care, which can be overcome by the involvement of a well-trained generalist.
  4. Abundant employment opportunities, both in the private and public sector.
  5. Flexible training, which is particularly suited to those that have special interests, family commitments or other lifestyle requirements.

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Challenges in Training in Internal Medicine

Many trainees who initially decide to pursue a career in Internal Medicine revisit this decision. Some simply “jump ship” and decide that the problems of training in internal medicine are insurmountable, and they will be better served by a well-defined subspecialty. Others “believe” that internal medicine is important, but to keep their sense of self worth intact, decide that they will be best served by combining both internal medicine and a subspecialty.

Some of the major challenges are as follows:
  1. Trainees in internal medicine are usually offered rotations that have not been filled by subspecialty trainees, who are routinely given preference (even when the advanced trainee in internal medicine is a superior candidate).
  2. Trainees in internal medicine have difficulties accessing high quality, well-supervised procedural training.
  3. Trainees who have chosen internal medicine need a robust self-esteem and an unfaltering belief that what they have chosen is worthwhile. Subspecialists frequently denigrate the role of general medicine, and make trainees feel that training in general internal medicine is a waste of time. Advanced trainees in internal medicine require an enormous amount of mentoring and counseling regarding these issues, even in hospitals where internal medicine is well established.
  4. There is a sense that training in internal medicine is for those who have failed to gain a more “prestigious” subspecialty position. In my experience, this is rarely the case, and many excellent trainees choose internal medicine, because they feel that the holistic care they can offer is a worthy pursuit. In addition, almost half the advanced trainees in internal medicine that I know are holders of first-class honours degrees. Despite this, many trainees find the perception that they are academically challenged or unable to gain a subspecialty training position very confronting.
  5. Although many trainees choose internal medicine because it is flexible, and caters to a wide variety of interests, some trainees find that the lack of a clearly defined training program is a barrier,
  6. Usually subspecialty trainees are surrounded by an enthusiastic collegiate environment and have specific educational meetings to cater to their learning needs. In contrast, advanced trainees in internal medicine often lack a sense of “belonging” to a community of senior colleagues and do not have unique educational meetings to cater to the specific needs of a generalist.

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Selection Processes in Internal Medicine

Undergoing a proper interview process to gain a training position in internal medicine is an important component of validating the career choice of the trainee.

Previously, at the Royal Brisbane Hospital, advanced trainees in internal medicine were welcomed with open arms, and there was no formal selection process. The problem with this approach was that it denied trainees the important experience of attending an interview. It also contributed to the sense that internal medicine would accept any trainee, regardless of their suitability.

There is ongoing debate regarding the role of centralized selection processes. One of the considerations in this debate that is important is the issue of “quarantined” subspecialty training positions for advanced trainees in internal medicine. Resolving this issue is a key component in improving the opportunities for trainees in general internal medicine.

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Awards & Scholarhips

There are currently four IMSANZ awards/scholarships open to Advanced Trainees. See Resources > Awards & Scholarships.