EditorialModernizing the paths to certification in internal medicine and its subspecialties
Section snippets
Is certification still consistent with the realities of training and practice?
To the extent to which the current approach to board certification is historic, it is worthwhile to remember that internists originally were prepared to be broad-based consultants for the large number of general practitioners whose training was limited to an internship and who would need help for the diagnosis and management of a substantial proportion of the serious acute and chronic conditions of adults. This historic role of internists was squeezed from two directions. Consultative expertise
What are the problems with the current system?
In the current system, I see several problems. One, as emphasized by Blackwell and Powell (4), is that training simply takes too long. For medical subspecialists, the length of training now is often as long as for their surgical counterparts; for example, it takes about as long to become a board-certified interventional cardiologist as to become a board-certified cardiac surgeon. We are discouraging future clinicians, whose investment in training will have far higher economic yields in
What to do?
It is my contention that certification in internal medicine requires more change than the American Board of Internal Medicine has suggested (6). I have proposed that the length of core training, during which the young physician is a pluripotent stem cell, should be reduced to 2 years (7). This 2-year curriculum would be specifically designed to include the fundamentals of inpatient and outpatient medicine, emphasizing training and learning rather than service.
To be eligible for board
How could this proposal accommodate current practitioners?
Whenever a new type of certification becomes available, one question is how to address the large number of physicians whose training antedated its availability. I would assert that recertification provides an ideal opportunity for practicing internists to obtain added qualifications in Adult Office Medicine and/or Adult Hospital Medicine. Current diplomates of the American Board of Internal Medicine could be asked to provide evidence of sufficient postresidency experience in either or both of
Will this new approach fractionate medicine, as has happened in surgery?
The fundamental difference between my proposal and what has happened in surgery is that board certification in internal medicine would remain a prerequisite for all subsequent added qualifications and board certification. Unlike surgery, maintenance of this core of internal medicine training and certification should prevent fractionation. My concern is that the alternative, a stubborn attempt to maintain an increasingly fragile status quo, will be more detrimental to internal medicine. If
Is this idea just too confusing, or can it work?
The range of options in my proposal carries the potential risk of creating too many options and thereby diluting the credentials of internal medicine. However, my suggestion addresses several key issues. Training will generally be shortened. New, descriptive options for added qualifications will help office-based and/or inpatient-oriented physicians distinguish themselves as doctors for adults. Recertification would become a proactive opportunity to add recognition rather than just a defensive
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The future of certification and recertification
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