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Structure of Internal Medicine Residency Training

IM Residency Training Flowchart

Click on the image to view the larger verison of the Internal Medicine Residency Training Flowchart

Basic training in internal medicine is three years of residency (frequently called ‘categorical’ training) following medical school. A number of other specialties have their residents undergo one year of internal medicine training (referred to as ‘preliminary’ training) before moving on to more focused education in their respective fields.

Following completion of three years of training, residents are eligible for board certification in internal medicine. About half of the country’s internal medicine residents choose to practice General Internal Medicine. General internists are capable of functioning in a number of different roles. For example, many focus on ambulatory practice and may serve as primary care physicians, following patients longitudinally for their ongoing medical care. Others may spend a majority of their time caring for hospitalized patients in the role of hospitalist (approximately over 90% of hospitalists are general internists). Many general internists care for both ambulatory and hospitalized patients in a wide variety of practice models.

Others choose to pursue addition training beyond the basic three years of residency training, subspecializing in a particular area of interest within internal medicine. Some of the subspecialties of internal medicine and their associated area of interest include:

  • Allergy & Immunology – the immune system
  • Cardiology – the heart and vascular system
  • Endocrinology – the glandular and hormonal systems
  • Gastroenterology – the digestive system, including the liver and metabolism/nutrition
  • Hematology & Oncology – the blood and neoplastic diseases of the blood and other tissues
  • Infectious Diseases – the broad spectrum of infectious agents, their clinical manifestation of disease and treatment
  • Nephrology – the kidney and associated diseases
  • Rheumatology – the musculoskeletal system, particularly related to systemic and metabolic disorders
  • Pulmonary & Critical Care – the respiratory system and management of extremely ill patients.

The length of this training depends on the area of study and the depth to which one wishes to subspecialize. For example, basic cardiology training is three additional years beyond an internal medicine residency, but may be another 1 to 3 years if an individual is interested in specific activities such as performing invasive or very specialized procedures, such as catheterization or electrophysiology. Many fellowship training programs also include a research component. Eligibility for board certification in a subspecialty area is possible following completion of a specific fellowship.

Internal medicine training may also be combined with training in another specialty, leading to board certification in both fields. These dual training programs are generally structured to be shorter than the time it would take to complete an independent residency in both fields, and graduates of these programs are particularly qualified to care for patients in both areas of focus. Perhaps the most common is in internal medicine and pediatrics, which is a 4 year program leading to eligibility for board certification in both disciplines. Other examples include internal medicine and pediatrics (med-peds), internal medicine and emergency medicine, and internal medicine and psychiatry

Internists may also develop specific skills in other areas of interest, although individuals may achieve qualification in these areas from backgrounds other than internal medicine. Examples include geriatrics, sports medicine, and palliative care medicine.

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