International perspectives on general internal medicine and the case for “globalization” of a discipline

Abstract

General internal medicine (GIM) has flourished in the United States (U.S.). Unlike other subspecialties of internal medicine, however, GIM's evolution has not been global in scope, but rather appears to have occurred in isolation within countries. Here, we describe international models of GIM from Canada, Switzerland, Australia/New Zealand, Argentina, and Japan, and compare these with the U.S. model. There are notable differences in the typical clinical roles assumed by General Internists across these 7 countries, but also important overlap in clinical and academic domains. Despite this overlap, there has been a relative lack of contact among General Internists from these and other countries at a truly international GIM meeting; the time is now for increased international exchange and the "globalization" of GIM.

Variation in the Practice of Preoperative Medical Consultation for Major Elective Noncardiac Surgery

“…In Canada, adult primary care is almost exclusively provided by family physicians, whereas general internists and specialists principally perform a consultative role. 16,17 As opposed to the mandatory preoperative history and physical, referrals for preoperative consultations by internal medicine specialists are left to the discretion of the responsible surgeon or anesthesiologist. The responsible surgeon may also refer a patient for preoperative anesthesia consultation, which is distinct from the routine in-hospital evaluation by the responsible anesthesiologist on the day before or the morning of surgery.…”

The Evolution of General Internal Medicine (GIM)in Canada: International Implications

“…34 We suggest that sharing successes and challenges in GIM education worldwide will further promote revitalization of GIM through an international community striving for optimal education in teamwork, chronic disease, patient-centered care and innovation in the health care system. 34 Expanding to include an international network of GIM academics [48][49][50] and researchers will optimize the ability of GIM to further expand. We believe that initiatives such as this call for international papers by JGIM will assist GIM in developing an international perspective in clinical practice and research.…”

“…Despite different nomenclature and operational models among countries, there are many more similarities and common challenges for GIM (Table 2). Therefore, as Ghali suggested, 34 the time is right for the development of a strong international GIM community. 34 We suggest that sharing successes and challenges in GIM education worldwide will further promote revitalization of GIM through an international community striving for optimal education in teamwork, chronic disease, patient-centered care and innovation in the health care system.…”

“…Therefore, as Ghali suggested, 34 the time is right for the development of a strong international GIM community. 34 We suggest that sharing successes and challenges in GIM education worldwide will further promote revitalization of GIM through an international community striving for optimal education in teamwork, chronic disease, patient-centered care and innovation in the health care system. 34 Expanding to include an international network of GIM academics [48][49][50] and researchers will optimize the ability of GIM to further expand.…”

“…[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] General internal medicine has evolved in terms of its operationalization across the world (primary care vs. consultant, ambulatory vs. inpatient), but the values inherent in GIM remain the same. 34 In Canada, as we have defined and implemented GIM within the educational structure of the national accrediting body (RCPSC), we have been able to standardize educational outcomes with an enhanced ability to describe and advocate for the role of the generalist specialist within the health care system.…”