While it does not directly address the specific point, the 20 June 2006 issue of the Annals of Internal Medicine has two position articles (the ACP and the Assoc of Program Directors in IM) and then an editorial-type piece discussing the issue and the two papers.
I haven't read them closely, just skimmed them really, but the conclusions and recommendations they made were very much supporting a full three year IM residency; increased exposure to specialties in medical school; changes in program administration, curriculum, funding, and a more robust integration of in-pt and ambulatory care with healthcare teams and mid-level practitioners incorporated more than they are currently; and an increased attention to faculty and hospitalists as mentors to med students and residents.
They are very focused on training clinician-teachers (which makes sense), while leaving the research and specialty-oriented procedures and such to the physician-scientists and sub-specialists, respectively. To directly address the thread subject, they all three call for a continued IM residency of 3 yrs. Their reasoning is far better elaborated upon in the journal, so I will leave them to that (I felt it to be very substantial for the amount that I skimmed). It is also mentioned/suggested that sub-specialty programs remove some research time to thin down the time frame of their program, leaving the resulting lab space and time to physician-scientists. This is not the first time I've heard comments resembling this. The MD/PhD-DO/PhD programs seem to be having a harder time and the programs would like to refocus graduates clinically and research-wise. Makes some sense, but I don't know the slightest bit other than what I just wrote.
It appears to make sense. I really don't agree with the suggestion made by some that Cardiology (for instance) should become a 5 yr residency or that IM should be shortened for the sake of the fellowship. First, this will not increase the number of cardiologists soon or drastically enough, the programs will be shorter, but the same number will come through each year. In addition, from the clinical and practical standpoint, what is needed is a general clinical cardiologist. Not EP, interventional, nuclear, etc. A general and clinical cardiologist will need a thorough and firm background in medicine. All of medicine. Even that point aside, a graduate physician who has had a 2 yr residency (internship + 1yr) might be more inclined to further specialize in those sought after sub-fellowships, leaving general cardiology, where that doctor would be need more, according to projected statistics.
This is a much longer post than I meant, so I'll leave it here. To be honest, while I do think they have good ideas and I support them so far that I understand them, I am extremely interested in cardiology (esp HF and EP) and research, so the result will likely affect me.
Hopefully the articles will be noticed. As for the rest of the text...I'm an MS1, don't be too hard on me. 😳
