The kaleidoscope of general internist careers: A challenge for internal medicine training

As internal medicine residency programs strug-glc to prcducc general internists in greater numbers and assure that they are adequately prepared for practice, it is imperative that the graduate medical education system have a clcar picture of what competencies will be ex-pcctcd of those entering general internist careers. Feed' back from the practicing community and large managed carc organizations in Minnesota has made it clear that general internists in rhat state are functioning in a variety of positions requiring a wide range of skills depending on the practice description, choice of practicc setting, and the complement of other primary carc providers. General internists functioning in nontraditional careers have spe cial curricular needs. It is imperative that (raining programs constantly monitor the changing practice environment and stay current on the variety of new generalist career choices to adequately prepare their residents for generalist careers. The graduate medical education enterprise needs to be involved in determining the best teaching strategics for the broad range of ambulatory general medicine competencies and in determining how best to preserve the richness of the medical subspecialty experience critical ro the training of excellent general internists.