Another reason not to short change internal medicine training

Some subspecialists are agitating to decrease the length of time in internal medicine training so that trainees can more quickly start their subspecialty fellowships. I have many problems with this concept. Third year residents take better care of patients than second year residents. Expertise takes time to acquire. I am not considering pure knowledge (most second year residents can “pass the test”) but rather clinical acumen. While we cannot test for clinical acumen, the great majority of seasoned attendings can recognize these differences.

If we tried to shorten internal medicine training, then we would have to leave things out. In recent years palliative care has become an important part of many training programs. The nephrologists are worried that they do not have a strong background in palliative care. Many Nephrologists Feel Ill-Equipped to Make End-of-Life Decisions

“We need a greater clinical and research focus on end-of-life care, and this needs to start right at residency and fellowship training, so this becomes an important aspect of how we care for our patients,” Dr. Davison summarized. “To improve nephrologists’ comfort with end-of-life decision-making, fellowship programs should teach the recommendations in the RPA/ASN guideline and position statement,” the authors conclude.

End of life care transends subspecialty. All training programs should focus on these issues.