11. The Curious Career of Internal Medicine: Functional Ambivalence, Social Success

Stevens, Rosemary

doi:10.9783/9781512804294-015

Cited by 5 publications

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“…Their scores were significantly lower than those of seniors who chose anaesthesiology, surgery, radiology and the surgical subspecialties. Our results support the comment ‘Internists are past masters at dealing with uncertainty’ (Stevens 1988).…”

Section: Discussionsupporting

confidence: 90%

Uncertainties and ambiguities: measuring how medical students cope

et al. 1994

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To develop psychometric measures specific to the ambiguities encountered in medicine and determine their value in predicting medical students' attitudes towards patients and their choice of residency, we administered to senior and first-year medical students a 25-item Likert-type questionnaire to assess their intolerance of ambiguity (ITA). Factor analysis yielded two dimensions that were converted to scales: 'Aversion to uncertainties in clinical medicine' (ITA1) and 'Preference for highly structured training environs' (ITA2). First-year students scored higher on ITA1 and lower on ITA2 than seniors. An excessive reliance on high-technology medicine, a negative orientation toward psychological problems, and Machiavellianism predicted ITA1. ITA1 was the best predictor of senior medical students' negative attributional style toward hypochondriac, geriatric and chronic pain patients. The following rank order of seniors' career choice was predicted by ITA1 scores: internal medicine, psychiatry and family medicine (lowest); radiology, surgery and anaesthesiology (highest). And by ITA2 scores: surgery, obstetrics and gynaecology, and surgical subspecialties (lowest); radiology, psychiatry and anaesthesiology (highest). We concluded that personality traits and role characteristics which predict 'Aversion to uncertainties in clinical medicine' are maladaptive to managing many primary care patients, and this mismatch is reflected in seniors' residency choice.

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Section: Discussionsupporting

confidence: 90%

Uncertainties and ambiguities: measuring how medical students cope

et al. 1994

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“…Internal medicine might not have kept its subspecialties had not the College ensured their retention in what was becoming internal medicine's big tent by planning to issue subspecialty certificates when the American Board of Internal Medicine was set up in 1936. That plan ensured that postgraduate training in internal medicine would take on the now familiar pattern of generalist internal medicine residency, followed either by generalist practice or by further training leading to subspecialization 2 …”

Section: Early 20th Century Internal Medicinementioning

confidence: 99%

American internal medicine in the 21st century

Huddle

Centor²,

Heudebert³

2003

J Gen Intern Med

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American internal medicine suffers a confusion of identity as we enter the 21st century. The subspecialties prosper, although unevenly, and retain varying degrees of connection to their internal medicine roots. General internal medicine, identified with primary care since the 1970s, retains an affinity for its traditional consultant‐generalist ideal even as primary care further displaces that ideal. We discuss the origins and importance of the consultant‐generalist ideal of internal medicine as exemplified by Osler, and its continued appeal in spite of the predominant role played by clinical science and accompanying subspecialism in determining the academic leadership of American internal medicine since the 1920s. Organizing departmental clinical work along subspecialty lines diminished the importance of the consultant‐generalist ideal in academic departments of medicine after 1950. General internists, when they joined the divisions of general internal medicine that appeared in departments of medicine in the 1970s, could sometimes emulate Osler in practicing a general medicine of complexity, but often found themselves in a more limited role doing primary care. As we enter the 21st century, managed care threatens what remains of the Oslerian ideal, both in departments of medicine and in clinical practice. Twenty‐first century American internists will have to adjust their conditions of work should they continue to aspire to practice Oslerian internal medicine.

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“…As departments of internal medicine became ever bigger (even by 1972, a department of 32 would have seemed small), there was less communication between divisions, less interest in being a single, unified group. Internal medicine departments became fragmented based on topic, on size, on earning power (94,95). Subspecialties became the center of the academic universe, and the number of attendees at subspecialty meetings swelled to as many as 30,000.…”

Section: "The Centre Cannot Hold"mentioning

confidence: 99%

A history of the American Society for Clinical Investigation

Howell¹

2009

J. Clin. Invest.

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One hundred years ago, in 1909, the American Society for Clinical Investigation (ASCI) held its first annual meeting. The founding members based this new society on a revolutionary approach to research that emphasized newer physiological methods. In 1924 the ASCI started a new journal, the Journal of Clinical Investigation. The ASCI has also held an annual meeting almost every year. The society has long debated who could be a member, with discussions about whether members must be physicians, what sorts of research they could do, and the role of women within the society. The ASCI has also grappled with what else the society should do, especially whether it ought to take a stand on policy issues. ASCI history has reflected changing social, political, and economic contexts, including several wars, concerns about the ethics of biomedical research, massive increases in federal research funding, and an increasingly large and specialized medical environment.Citation for this article:

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11. The Curious Career of Internal Medicine: Functional Ambivalence, Social Success

Cited by 5 publications

References 0 publications

Uncertainties and ambiguities: measuring how medical students cope

Uncertainties and ambiguities: measuring how medical students cope

American internal medicine in the 21st century

A history of the American Society for Clinical Investigation

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