THE KALEIDOSCOPE OF GENERAL-INTERNIST CAREERS - A CHALLENGE FOR INTERNAL-MEDICINE TRAINING

As internal medicine residency programs struggle to produce general in ternists in greater numbers and assure that they are adequately prepar ed for practice, it is imperative that the graduate medical education system have a clear picture of what competencies will be expected of t hose entering general internist careers. Feedback from the practicing community and large managed care organizations in Minnesota has made i t clear that general internists in that state are functioning in a var iety of positions requiring a wide range of skills depending on the pr actice description, choice of practice setting, and the complement of other primary care providers, General internists functioning in nontra ditional careers have special curricular needs. It is imperative that training programs constantly monitor the changing practice environment and stay current on the variety of new generalist career choices to a dequately prepare their residents for generalist careers. The graduate medical education enterprise needs to be involved in determining the best teaching strategies for the broad range of ambulatory general med icine competencies and in determining how best to preserve the richnes s of the medical subspecialty experience critical to the training of e xcellent general internists.