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Internal Medicine at Your Medical School

Although you may know how internal medicine as a specialty is structured, it is helpful to see what internists actually do at your medical school – this may help you better understand the breadth and scope of internal medicine as a specialty.

At most institutions, internal medicine is organized as a Department of Medicine or Department of Internal Medicine. However, you should be aware that the terms "medicine" and "internal medicine"are frequently used interchangeably which can be confusing, but when used in an academic or hospital setting, the term Department of Medicine is almost always referring specifically to internal medicine. Although the structure of Departments of Medicine may vary, particularly in schools that have more than one teaching hospital, they typically are made up of multiple divisions, often based on the different subspecialties of internal medicine (such as Division of Cardiology or Division of Rheumatology). Because of this structure, Departments of Medicine tend to be the largest departments in most institutions.

The majority of inpatient care in most academic and academically-affiliated institutions is overseen by the Department of Medicine. This includes care of general medical patients (often by general internists functioning as hospitalists), subspecialty services (such as cardiac care units, gastroenterology, and hematology/oncology services), and those requiring intensive care (medical intensive care units usually overseen by pulmonary/critical care faculty). Ambulatory/outpatient care is also provided by general internists (often providing longitudinal primary care) and by the different subspecialties of internal medicine seeing patients in their area of expertise, sometimes in "centers" or "institutes", such as a "cancer center" or "cardiovascular institute").

Because of this breadth of clinical care, Departments of Medicine are particularly well suited to teach clinical medicine to students, residents, and fellows. Many internists teach in the preclinical years at medical schools, particularly in those courses involving their area of expertise (you may have already encountered some of these individuals!). Many course directors and faculty in 'introduction to clinical medicine' courses are internists. During your clinical training, the basic medicine clerkship is usually one of the longest core rotations and is considered ‘foundational’ because of the nature of the learning that is applicable to all disciplines of medicine. Internal medicine electives and acting or subinternships in internal medicine later in medical school are a key learning experience for many students in their preparation for residency. Internal medicine residency programs are also usually the largest training programs in most institutions, and you will certainly interact with many internal medicine residents over the course of your clinical training on different rotations. You will also likely encounter internal medicine fellows, who are internists pursuing advanced subspecialty training, during your clinical experiences.

What may be less clear is the role of Departments of Medicine in research in many medical schools. Departments of Medicine frequently oversee basic science and particularly clinically-oriented research. Because of their extensive patient care activities and the nature of their training, internists are particularly well-suited as clinician-investigators, and departments frequently lead efforts toward studying the application of different treatments and other interventions to patient care.

And finally, members of Departments of Medicine usually occupy significant leadership positions in most institutions. For example, general internal medicine physicians may serve as leaders of institutional clinical programs, or infectious disease internists may work as hospital epidemiologist, among other important roles.

In medical school you only need to look around you to see internists and what they do. If you are interested, this may be one of the best ways to learn about the breadth and depth of internal medicine!

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