Focus on Internal Medicine Careers: Hospitalist/Medical Education.
Following is an interview with Robert Trowbridge, MD, ACP Member, Assistant Professor of Medicine at University of Vermont College of Medicine, and the Associate Director of Medical Student Education for the Department of Medicine at Maine Medical Center in Portland, Maine. The interview was conducted by Talia Ben-Jacob, a third-year medical student at University of Vermont College of Medicine and the New England Representative to the ACP Council of Student Members.
IMpact: Why did you decide to go into internal medicine?
Dr. Trowbridge: Perhaps the most important reason was the career possibilities that internal medicine opened up—there is just so much one can do within the field. Training in internal medicine is integral and necessary to everything from the procedure-based practices, such as interventional cardiology, to rural primary care, to public health. Another important reason was that internists are both experts and generalists; they have varied practices and you’re never quite sure who will walk in the door next. Finally, internists get to participate in what I think are the most the most appealing aspects of medicine in general: great intellectual challenge and rewarding patient relationships.
IMpact: If you could go back in time, would you still choose internal medicine?
Dr. Trowbridge: Without question. Although I only finished residency a decade ago, I’ve already had many interesting career experiences as a primary care physician, an academic researcher, a rural internist with the Indian Health Service, and now as a clinician-educator. I can’t imagine any other career choice in medicine being able to provide the training necessary to follow a career path with that degree of choice and variety.
IMpact: What is your special interest within internal medicine and why did you choose it?
Dr. Trowbridge: I have several special interests, including venous thromboembolic disease and rural medicine. I have a special appreciation for pulmonary embolism, since it is the quintessential “internists’ problem,” because it is difficult to diagnose and manage. Although I now practice in a relatively urban setting, I also have a great interest in rural medicine, especially as it relates to the internist’s role in that setting.
IMpact: Who is your most memorable patient and why?
Dr. Trowbridge: A patient from my time on the Navajo Reservation is perhaps the one I remember most keenly. He was an older medicine man with severe coronary artery disease and greatly limiting congestive heart failure as a result. He was a fascinating man who had lived a long interesting life as medicine man, champion rodeo rider, and patriarch. He was tenuous physiologically, but strongly grounded spiritually. He taught me much about medicine and its limitations.
IMpact: You have a multitude of experience in internal medicine. What led you to the decision to become a hospitalist?
Dr. Trowbridge: A large part of the reason I became a hospitalist was the increased teaching opportunities that often come with being a hospitalist at an academic medical center. I've been involved with teaching throughout my career and medical education remains a major interest of mine. I also enjoy the pace and complexity of inpatient medicine, although I greatly miss the longitudinal patient relationships that I enjoyed as a primary care physician. I wouldn't be surprised if at some point in my career, I return to primary care, hopefully in a rural setting.
IMpact: What made you decide to start an internal medicine interest group at Maine Medical Center?
Dr. Trowbridge: We want the students to know how great a career in internal medicine can be. There is just so much one can do with internal medicine training and we want to be sure that students are aware of this.
IMpact: What was the biggest challenge that you had to overcome as an internal medicine doctor?
Dr. Trowbridge: By far the biggest challenge has been balancing career and family. My wife is also an internist and juggling our careers and family has been difficult at times. Because of the flexibility that we’ve found in internal medicine, however, we’ve been able to settle into a routine that provides a good amount of time for all that is important.
IMpact: What advice would you give to third-year students who want to excel on their internal medicine clerkship?
Dr. Trowbridge: Probably the most important things are also the most obvious ones: work hard and become an integral and valued member of the team. As a third-year clerk, you will often have a lighter clinical load than other members of the team and you should take advantage of that by getting to know the patient and his or her problems extremely well. Try to recognize that the patients will teach you quite a bit, if you let them. Above all, take advantage of the opportunity, know your limitations, and enjoy learning while not being overly stressed about how you're being perceived. If you know your patients, work hard, and are truly a member of the team, things will go well.
IMpact: What advice would you give to students who are preparing for the residency application process?
Dr. Trowbridge: Choose a specialty that doesn’t limit your choices, unless you are completely certain of your interest in a specialty field. I would also make a career choice based on your level of interest, not on the relationships you had with the specific attendings and residents during your clerkships. Finally, choose a residency program that fits your personality and your personal preferences, including geographic locations. You will get out of residency what you put into it and if you choose a residency program which does not take into account your personal needs it is likely to make you miserable.
IMpact: Do you recommend that students who are interested in internal medicine fill their elective clerkship time with medicine-related rotations, or is it preferable to gain experience in other areas of medicine?
Dr. Trowbridge: A bit of both. Doing an acting internship in medicine is a great way to be sure that you’re making the right choice and to make the transition to internship a bit easier. In addition, doing a medical subspecialty rotation in an area where you feel your experience is lacking can also be helpful. But doing several rotations in areas outside of internal medicine can also be useful and enjoyable. I completed rotations in ophthalmology and autopsy during my fourth year and loved them both.
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