Training

A Trainee's Perspective of General Internal Medicine (cont...)

What do Trainees in Internal Medicine Need?

1. A well defined set of training options, which provides both a clear training pathway, but is also flexible enough to cater to the unique requirements of some trainees.
2. “Quarantined” access to procedural and subspecialty training.
3. A sense of “belonging” to a worthwhile community of likeminded colleagues.
4. A sense that general internal medicine is a worthy career choice.
5. Regular meetings that address the specific educational needs of advanced trainees in internal medicine.
6. Formal selection processes, recognizing that not all applicants will be suited to the “subspecialty” of internal medicine.

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Should all trainees spend part of their advanced training in rural or provincial locations?

This is obviously a difficult issue. If trainees in internal medicine were the only advanced trainees who have a “compulsory” component of rural training, then I would predict that a substantial number of trainees would choose another specialty.

Trainees who harbour thoughts of rural and provincial practice should be pro-actively identified, and nurtured. They should be provided with first class training opportunities, and have significant efforts spent on tailoring the perfect training program. The Victorian Rural Physicians Network seems to have made excellent progress with this model. Forcing unwilling trainees to rural and provincial locations is unlikely to result in any long-term workforce solutions.

Parenting is a major issue for many trainees, who have already endured the difficulties of rural secondments during basic training and the complete life disruption associated with RACP examinations. Given that nearly 50% of trainees are women in their late 20’s and early 30’s, serious consideration needs to be given to the impact of decisions about the nature of advanced training on the issues of child bearing and raring. This is particularly important for general medicine, as many trainees choose general internal medicine because it seems to be a reasonable solution to achieving “work life balance”.

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Should training in Internal Medicine be increased to four years?

Given the reduction in working hours, and increasing medical knowledge, this may be a reasonable consideration. In addition, strengthening training in internal medicine may help to overcome some of the problems with the perception that this is an “easy option”.

However, there is currently NO evidence regarding how long one should train to practice as an independent physician. Clearly there are many flaws in prescribing a period of “time”, but this has been a practical approach, given that the much more useful, but elusive problem of defining competence is a difficult issue.

Australian physicians already spend more time in training than virtually anywhere else in the world (with the exception of the United Kingdom). In the face of emerging workforce shortages, there would need to be very clear evidence of benefit to justify lengthening of the training program. I am not aware of any recently graduated trainees who clearly needed a longer period of training.

The college has enormous power over trainees, who are consumers of the “training and educational products” of the college. If training was lengthened, this would have implications regarding income, family planning, research and other pursuits. I strongly believe that if an “intervention” such as increasing the period of training is enforced by the college on its relatively powerless consumers (trainees), that there should be very good evidence that there is clear educational benefit. The problem that all educationalists grapple with is that some trainees will be competent after two years of training, whereas others might never be competent. We need to develop innovative training solutions to deal with this problem.

If training in internal medicine took longer than training in other subspecialties, this would make internal medicine much less attractive.

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Should all trainees in Internal Medicine do dual training?

Many trainees are choosing this approach. The advantage of insisting on dual training is that this raises the profile of general medicine, and makes it clear that specialists in internal medicine are capable of subspecialty work.

One of the problems is that many tend to end up predominantly practicing in their area of subspecialty, and general internal medicine comes a distant second or is lost altogether.

There is plenty of demand for well-trained specialists in internal medicine. To gain employment, or work in the private sector, there is currently no need for additional subspecialty training.

Once again, proscriptive training requirements such as this may mean that even fewer trainees choose internal medicine. One of the challenges is to ensure that training meets the requirements of the individuals who want to practice internal medicine. One of the risks is that developing a well constructed, flexible, attractive training program may fall prey to a variety of political agendas, which although important, do little to improve the attraction of general medicine.

Dr Leonie Callaway
3rd Year Advanced Trainee in Internal Medicine
Obstetric Medicine Fellow, Mater and Princess Alexandra Hospitals, Brisbane

This article was published in the June 2003 IMSANZ Newlsetter.

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Awards & Scholarhips

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