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INTERNAL MEDICINE
Internal Medicine:
The medical specialty dedicated to the diagnosis and medical treatment of adults. A physician who specializes in internal medicine is referred to as an internist. Subspecialties of internal medicine include allergy and immunology, cardiology (heart diseases), endocrinology (hormone disorders), hematology (blood disorders), infectious diseases, gastroenterology (diseases of the gut), nephrology (kidney diseases), oncology (cancer), pulmonology (lung disorders), and rheumat-ology (arthritis and musculoskeletal disorders).
What is a Doctor of Internal Medicine, or Internist?
Most of the great leaders in medicine in general have come from internal medicine because of the breadth and depth of its academic and clinical work. It draws the best and brightest." -- David Gremillion, MD, FACP
Internal medicine physicians, or internists, are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. They are especially well trained in the diagnosis of puzzling medical problems, in the ongoing care of chronic illnesses, and in caring for patients with more than one disease. Internists also specialize in health promotion and disease prevention.
Internal medicine physicians can be called "internists," "general internists," and "doctors of internal medicine." (But don't mistake them with "interns," who are doctors in their first year of residency training.) Although internists may act as primary care physicians, they are not family physicians, family practitioners, or general practitioners, whose training is not solely concentrated on adults and may include surgery, obstetrics, and pediatrics.
Internists routinely see patients with conditions such as heart disease, hypertension, diabetes, obesity, and chronic lung disease. An internist may consult with doctors in other fields of medicine, or may be called to consult on a patient by another specialist.
To become an internist, a graduate of a four-year medical school must complete a residency in internal medicine, which usually lasts three years. Once general internal medicine residency training is complete, a physician may begin to practice internal medicine, or an internist may then choose to subspecialize in a particular area of internal medicine, for example, cardiology or infectious diseases. Subspecialty training, called fellowship, calls for two to three years of additional training.
Most general internists provide care for their patients in an ambulatory setting (office or outpatient), and follow their patients when hospitalized (inpatient setting). Other internists are known as "hospitalists" and care for patients only in the hospital.
The term internal medicine comes from the German term innere medizin, popularized in Germany in the late 19th century to describe physicians who combined the science of the laboratory with the care of patients. Many early 20th century American doctors studied medicine in Germany and brought this medical field to the United States. Thus, the name "internal medicine" was adopted. As with many words adopted from other languages, it unfortunately doesn't exactly fit an American meaning.
About Medical Procedures Required During Residency Training
The American Board of Internal Medicine (ABIM) procedure requirements for eligibility for board certification focus on understanding and being able to explain a number of specific medical procedures, and having the ability to effectively obtain informed consent with patients when applicable. The ABIM also requires actual demonstration of competence and safe performance of a smaller subset of specific procedures through direct observation.
Procedures for which internal medicine trainees should understand and explain include:
- Abdominal paracentesis
- Arterial and central venous line placement
- Arthrocentesis
- Electrocardiography
- Incision and drainage of an abscess
- Lumbar puncture
- Nasogastric intubation
- Pulmonary artery catheter placement
- Thoracentesis
Procedures requiring demonstration of competent and safe performance include:
- Advanced cardiac life support
- Arterial and venous blood sampling
- Pap smear and endocervical culture
- Placement of a peripheral venous line
Although the ABIM does not specify the exact number of each of the required procedures that must be performed to demonstrate competency, residency training programs are encouraged to teach trainees through initial simulation followed by supervised active participation, with the expectation that trainees should actively perform these supervised procedures at least five or more times.
Although many internists perform other procedures as part of their practice that are not required for board eligibility, it is expected that for these procedures the principles of informed consent will be applied when indicated, and competence in medical knowledge relevant to each procedure will be demonstrated relative to indications, contraindications, patient preparation methods, sterile technique, pain management, proper techniques for handling specimens and fluids obtained, and recognizing and managing complications. It is also expected that the appropriate information and the results of the procedure will be effectively communicated with the patient.
The program director of the residency training program is required to attest to a candidate’s knowledge and competency to perform the specified procedures in order to be eligible for initial board certification.
It is important to note that hospitals and healthcare systems may have requirements for procedural competencies that are different from those required for initial board certification. If you are planning to enter practice or continue training, you may want to check with the institutions where you will be working to understand their procedure requirements and discuss them with your program director to ensure that you meet those criteria before you finish residency.
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