International Perspectives on General Internal Medicine and the Case for "Globalization" of a Discipline

Ghali, William A.; Greenberg, P. B.; Méjía, Raúl; Otaki, Junji; Cornuz, Jacques

doi:10.1111/j.1525-1497.2005.00289.x

Cited by 7 publications

(4 citation statements)

References 19 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unlike in the United States where a general internist is often an outpatient-based primary care physician, in Canada the general internist acts as a consultant for primary care physicians for a wide variety of medical conditions. Thus the Canadian general internist more often sees patients with multisystem diseases and undifferentiated problems compared to his/her American counterpart [ 16 ]. Given the difference in roles between the countries, it would not be surprising if residents had different reasons for pursuing General Internal Medicine as a specialty/career in Canada.…”

Section: Discussionmentioning

confidence: 99%

Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

Daniels

Kassam

2011

BMC Med Educ

View full text Add to dashboard Cite

BackgroundThere is currently a discrepancy between Internal Medicine residents' decisions in the Canadian subspecialty fellowship match (known as the R4 match) and societal need. Some studies have been published examining factors that influence career choices. However, these were either demographic factors or factors pre-determined by the authors' opinion as possibly being important to incorporate into a survey.MethodsA qualitative study was undertaken to identify factors that determine the residents choice in the subspecialty (R4) fellowship match using focus group discussions involving third and fourth year internal medicine residentsResultsBased on content analysis of the discussion data, we identified five themes:1) Practice environment including acuity of practice, ability to do procedures, lifestyle, job prospects and income2) Exposure in rotations and to role models3) Interest in subspecialty's patient population and common diseases4) Prestige and respect of subspecialty5) Fellowship training environment including fellowship program resources and length of trainingConclusionsThere are a variety of factors that contribute to Internal Medicine residents' fellowship choice in Canada, many of which have been identified in previous survey studies. However, we found additional factors such as the resources available in a fellowship program, the prestige and respect of a subspecialty/career, and the recent trend towards a two-year General Internal Medicine fellowship in our country.

show abstract

Section: Discussionmentioning

confidence: 99%

Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

Daniels

Kassam

2011

BMC Med Educ

View full text Add to dashboard Cite

show abstract

“…Because this study was done with Canadian residents, it is worth noting the similarities and differences in the practice of general internal medicine in Canada compared to other countries. Ghali and colleagues [ 29 ] reviewed the clinical profile of general internal medicine in Argentina, Australia, Canada, Japan, New Zealand, Switzerland, and the United States. General internal medicine in Canada is a consultative service to primary care practitioners and is often hospital based caring for complex, multisystem patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of personal goals on the internal medicine R4 subspecialty match: a Q methodology study

Daniels

Kassam

2013

BMC Med Educ

View full text Add to dashboard Cite

BackgroundThere has been a decline in interest in general internal medicine that has resulted in a discrepancy between internal medicine residents’ choice in the R4 subspecialty match and societal need. Few studies have focused on the relative importance of personal goals and their impact on residents’ choice. The purpose of this study was to assess if internal medicine residents can be grouped based on their personal goals and how each group prioritizes these goals compared to each other. A secondary objective was to explore whether we could predict a resident’s desired subspecialty choice based on their constellation of personal goals.MethodsWe used Q methodology to examine how postgraduate year 1–3 internal medicine residents could be grouped based on their rankings of 36 statements (derived from our previous qualitative study). Using each groups’ defining and distinguishing statements, we predicted their subspecialties of interest. We also collected the residents’ first choice in the subspecialty match and used a kappa test to compare our predicted subspecialty group to the residents’ self-reported first choice.ResultsFifty-nine internal medicine residents at the University of Alberta participated between 2009 and 2010 with 46 Q sorts suitable for analysis. The residents loaded onto four factors (groups) based on how they ranked statements. Our prediction of each groups’ desired subspecialties with their defining and/or distinguishing statements are as follows: group 1 – general internal medicine (variety in practice); group 2 – gastroenterology, nephrology, and respirology (higher income); group 3 – cardiology and critical care (procedural, willing to entertain longer training); group 4 – rest of subspecialties (non-procedural, focused practice, and valuing more time for personal life). There was moderate agreement (kappa = 0.57) between our predicted desired subspecialty group and residents’ self-reported first choice (p < 0.001).ConclusionThis study suggests that most residents fall into four groups based on a constellation of personal goals when choosing an internal medicine subspecialty. The key goals that define and/or distinguish between these groups are breadth of practice, lifestyle, desire to do procedures, length of training, and future income potential. Using these groups, we were able to predict residents’ first subspecialty group with moderate success.

show abstract

“…Attainment of knowledge in this area can be achieved in program specific ways but could include community GIM rotations, junior attending on GIM rotations, pre-assessment clinics, and GIM "fellows" clinics. GIM is distinctly different throughout the world and there is little previous literature which examines the perceived areas of knowledge that a Canadian General Internist should attain [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Determining specific competencies for General Internal Medicine residents (PGY 4 and PGY 5). What are they and are programs currently teaching them? A survey of practicing Canadian General Internists

2011

View full text Add to dashboard Cite

BackgroundGeneral Internal Medicine (GIM) has recently been approved as a subspecialty by the Royal College of Physicians and Surgeons of Canada. As such, there is a need to define areas of knowledge that a General Internist must learn in those two years of training. There is limited literature as to what competencies are needed in a GIM practice. Draft competencies for GIM (4th and 5th year residents in internal medicine) training were developed over eight years with input from many stakeholders. Practicing General Internists were surveyed and asked their perspective as to the level of importance of each of these competencies for GIM training. They were also asked if training gaps exist in current training programs. The survey was offered widely online in both English and French to gain perspectives from as many different contexts as possible.Results157 General Internists, in practice on average for 15 years, responded from all of Canada's provinces and territories. Practice profiles were diverse (large urban centers to rural centers). The majority of the competencies surveyed were perceived as important to attain at least proficiency in. Perioperative care, risk reduction, and the management of common, emergent, and complex internal medicine problems were identified as key areas to focus training programs on, with respondents perceiving these should be mastered to an expert level. Training gaps were identified, most frequently in that of the manager role (example managing practice).ConclusionsThis is the first study we are aware of to attempt to isolate the opinions of practicing Canadian General Internists as to the major competencies that should be mastered as a General Internist. We suggest that "generalism" in the context of GIM, does not mean a bit of knowledge about everything but that defined objectives for training in this 'newest' of Royal College subspecialties can be identified. This includes mastery of core areas such as perioperative care, risk reduction, and management of common, emergent and multiple internal medicine problems. The training gaps identified need to be addressed to ensure that General Internists continue to provide excellence in health care delivery.

show abstract

International Perspectives on General Internal Medicine and the Case for "Globalization" of a Discipline

Cited by 7 publications

References 19 publications

Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

Impact of personal goals on the internal medicine R4 subspecialty match: a Q methodology study

Determining specific competencies for General Internal Medicine residents (PGY 4 and PGY 5). What are they and are programs currently teaching them? A survey of practicing Canadian General Internists

Contact Info

Product

Resources

About