What residency training is necessary, what could be changed?

[shaggy alfresco]

So I was just looking at how various countries train their physicians, and I was thinking, if we had to start from scratch in terms of residency training, how would it be different?

Let me give an example: in some countries, Neurology is a fellowship after Internal Medicine whereas here, it's of course a residency by itself (with a year of internship).

Do you think it would be 'better' if neurologists for example had IM training? On the other hand, I was speaking with an Oncologist recently and he commented that he felt that his IM training was unnecessary since Oncology is very different in practice from IM and that a single year of internship followed by a residency in Heme/Onc would work just as well (sort of like how Rad Onc is now)? On the other hand, my grandfather's nephrologist (a family friend) thought his IM training was essential.

Any other residencies that you could get rid of/change how it works to either streamline the process (make it shorter) or add more training as it would be useful in patient care (make it longer)?

Yes I'm bored . But just wondering on what you guys think.

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[MossPoh]

They used to have internal medicine followed by a neurology fellowship. You get the relevant internal medicine exposure as is. Our graduate medical education is generally considered on the higher end around the world. Many nations have very long programs for training, but smaller numbers when they are done. I know (at least at one time) it wasn't uncommon for a surgery resident in German to not even set foot in an OR or perform more than intern level stuff by their 3rd year. Some places don't even require a true fellowship to call yourself a cardiologist (Italy).

We get excellent graduate medical training here overall. The pre-med and medical school part could probably be streamlined a bit.

 

[shaggy alfresco]

I didn't say that our training is bad, I'm just asking if you'd change anything. Surely, it's not perfect in every way?

For example (just going by what a physician said to me), do you think the full IM residency is necessary to practice as an oncologist?

For example, a fellowship like sports medicine - any reason why people from IM can't also apply for it? Or Pain fellowships - perhaps a few other residencies could also allow you to go into pain? Things like that....

Another I could think of is integrated plastics...maybe all plastic surgery (if you had to start from scratch) should be integrated?