Redesigning Medical Education in Internal Medicine: Adapting to the Changing Landscape of 21st Century Medical Practice

INTRODUCTION Practicing internal medicine in the 21st century has changed. Novel scientific discoveries, diagnostic technologies and therapeutic interventions have evolved rapidly. At the same time, external forces have altered the interactions between internists, their patients and the new healthcare delivery systems incorporating those interactions in ways unforeseen a decade ago. Although most institutions strive to keep the scientific aspects of their curricula current, teaching learners to use this new science effectively in present and future healthcare environments is addressed less commonly. Adopting new models of education can be difficult. Educational change occurs slowly within the confines of the extant system, but the shifting landscape demands rapid change, and many “traditional” medical teachers find themselves on unfamiliar terrain. In the last 10 years, the Society of General Internal Medicine (SGIM), the American College of Physicians (ACP), and the Alliance for Academic Internal Medicine (AAIM) have all published position papers on redesigning Internal Medicine training. The medical education community is recognizing the necessity for learners to demonstrate objectively their ability to care for patients, a so-called “competencybased model” for training and education. Likewise, educational regulatory bodies have deemed that physicians should demonstrate competence for certification. Traditional clinical training, however, inserts learners into established patient care experiences in a fashion that minimally disrupts the system. This current “systemcentered” clinical structure limits the role learners can play and makes assessing their competence a struggle for educators. Thus, an endless loop is created; learners cannot fully participate until they are competent, yet they cannot easily be declared “competent” because there are limited arenas in which they can fully participate. Education is not given as top priority in this “system-centered” structure and adjustments that may be needed to satisfy any new educational requirements are also done in a way that is minimally disruptive for the system. Thus, our learners are having training in a clinical system that is not necessarily designed for education.