Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “INTERNAL MEDICINE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed2004

Which primary care specialty? Factors that relate to a choice of family medicine, internal medicine, combined internal medicine-pediatrics, or pediatrics.

BACKGROUND AND OBJECTIVES: This study was conducted to examine factors used by medical students to select a primary care specialty that may differentiate students who choose the primary care specialties of family medicine, internal medicine, pediatrics, and combined internal medicine-pediatrics. METHODS: A questionnaire was sent to all family physicians and an equal number of other primary care physicians graduating from one of 24 medical schools in 1997-1999. Twelve schools had increasing proportions of graduates choosing family medicine in this study period, and 12 had decreasing proportions. The questionnaire asked about factors related to choice of specialty, which could be grouped into the specialty domains of type of patients, process, content, and setting. RESULTS: For family physicians, the most important factor was patient relationships, and the second most important was wanting an approach to the practice of medicine similar to that of family physicians. Internists indicated as most important wanting to work with adults and as the next most important an "internal medicine approach" to the practice of medicine. Most important for pediatricians was working with children and next most important was having patient relationships like other pediatricians. Those in combined internal medicine-pediatrics most often indicated a desire to work with children and next most important was an approach to medicine like others in their specialty. CONCLUSIONS: The most important reasons for choice of specialty were similar for all primary care specialties and related to congruence between the graduate and the physicians in the specialty or the process of providing care within that specialty. The factors that differentiated the four specialties related to the content of the specialty.

Adult↗
PubMed2002

Performance-based assessment of internal medicine interns: evaluation of baseline clinical and communication skills.

OBJECTIVE: To assess baseline clinical and communication skills of entering internal medicine interns in performance of the medical interview and in written documentation of the clinical encounter. DESCRIPTION: Over three years, entering internal medicine interns at the University of New Mexico Health Sciences Center have taken an OSCE during their first week of training. Each year the process was refined based on feedback from both residents and faculty. This year, the intern examination consisted of four standardized cases. Twenty-two interns performed a focused interview and physical examination on each actor patient. For three of the cases, the intern wrote a chart note following the interview. After the fourth case, a trained faculty member who had watched the interview via a television monitor gave immediate feedback to the intern about his or her communication skills. The standardized patients were trained to complete checklists that included history, physical exam, and communication items for each intern. The written notes were graded using templates devised for each case that covered key historical and physical exam findings, problem identification, differential diagnosis, clinical reasoning, and logical diagnostic or treatment plans. The interns filled out an anonymous evaluation of the exercise where they were asked about whether the cases were appropriate for their level of training, and about how prepared they felt for the examination. The results for each set of skills were then reported to the interns and their supervising clinic attendings. For comparison, they were given the performance standards expected of fourth-year medical students at our institution. The videotaped encounters and the written notes are available for the faculty and trainees to review either together or independently. DISCUSSION: This exercise has given the faculty a detailed view of baseline clinical and written documentation skills of our entering interns. Overall, the residents demonstrated at least minimal competency in history taking and communication skills, but not in performing the expected focused physical exam. Their written reports showed adequate documentation of historical items but not of pertinent physical findings. The interns did not consistently make a problem list, provide a differential diagnosis, or show clinical reasoning despite being instructed to do so. There was great variation in performances between interns. Analysis of the interns' evaluations of this exercise showed that they felt it covered appropriate material, and they felt sufficiently prepared. Several interns had never done an OSCE prior to this exam. Written comments were positive about getting structured feedback early in their training. This format has allowed the identification of specific deficiencies in clinical skills for each of our interns, and this information will be used to guide our clinic preceptors in their teaching and in future evaluations. It would be ideal to design a second OSCE based on cases specific to internal medicine for the third-year residents, and compare skills developed over time.

Clinical Competence↗
PubMed1989

An assessment of the doctorate of medicine (internal medicine), University of the West Indies.

The outcome is described of 48 entrants to a postgraduate degree course (DM) in Internal Medicine established at the University of the West Indies in 1974. Contact by postal questionnaire was established in 96% of 26 graduates and 82% of 22 non-graduates. 22 of 25 DM graduate responders have remained in the Caribbean, working in six Caribbean territories. All graduate responders developed a subspecialty interest. The graduates' primary employers are the University (9) and the Government (12). However, failure to graduate did not necessarily preclude qualification as consultant physician (7 of 18 responders). Major difficulties with the DM programme included: (1) in practice, lack of recognition by contributing territories of individual DM (Internal Medicine) graduates; (2) incomplete regional coverage; (3) lack of adequate funding for the programme; (4) an inadequate research training input; and (5) difficulties with seniority for staff who trained in Jamaica to go to work in another territory. All these problems have solutions. Overall, the international recognition of the new degree programme has been satisfactory and the graduates' own assessment of the training was complimentary. At last a system has been devised that enables postgraduates to train as internal medicine specialists in the Caribbean to practise effectively within the Caribbean health system.

Adult↗
PubMed1980

[General medicine, internal medicine in hospitals].

The great progress that has been made in medical knowledge in the last fifty years has led to the birth of various new medical specialities and, consequently, to the institution within hospitals of specialised departments and services. A little at a time, General Medicine has lost responsibility for almost all the main sectors of medical pathology, with the result that there has been a serious deterioration in the importance and prestige of the discipline. Today there is a tendency to consider General Medicine departments as a direct hospital projection of everyday medical practice and hospital medicine is required to fill in the serious gaps in extra-hospital welfare and medical structures. The image and functions of General Medicine within hospitals need reassessing. Major hospitals, which already house the main specialist wards, should be given specialist Internal Medicine departments too. A limitation should also be set on the number of unjustified admittances (which mainly go to General Medicine wards) by means of efficient registration services able to filter patients. General Medicine has a number of important tasks outside the diagnosis and treatment of hospitalised patients. It has an important didactic function geared to the practical medical training of students in their final years, of newly graduated doctors, of those specialising in internal medicine, those specialising in clinical and scintific research, and in the updating of general practitioners outside the hospitals.

Hospital Departments↗
PubMed1989

Evaluating the interview performance of internal medicine interns.

Limited primary data are available to indicate in which areas physicians' interview performances are deficient. Videotaped recordings of 48 house officers performing a complete medical history were evaluated using a checklist to assess content, questioning technique, and interview style. Frequent deficiencies included inadequate social, psychiatric, and drug reaction histories. Several house officers demonstrated a marked tendency toward an overly directed interview style. The use of a detailed checklist during the observation of a complete medical history facilitates both accurate evaluation and specific detailed feedback to house officers.

Clinical Competence↗
PubMed1992

General internal medicine in internal medicine: at the core or on the periphery?

In the past decade, faculty in sections of general internal medicine have assumed responsibility for training residents, for staffing clinical practices, and for developing new domains of health services and effectiveness research. These activities form the core of internal medicine: They are integral to the role of internal medicine as an academic and patient care discipline, and they complement the activities of the internal medicine subspecialties. The effect of general internal medicine on internal medicine, therefore, has been to shift the focus away from the subspecialty services--which compartmentalize a patient's medical problems--and back to the concept of the patient as a "whole" person. The role and territory of the general internist are changing as a result of this shift in focus, and general internal medicine is emerging as the new core discipline in internal medicine. These changes have allowed for an expanded capacity of internal medicine to provide new services, modified curricula, and innovative research.

Holistic Health↗
PubMed2006

[What is Internal Medicine?].

Internal Medicine can be defined as a medical specialty devoted to the comprehensive care of adult patients, focused in the diagnosis and non surgical treatment of diseases affecting internal organs and systems (excluding gyneco-obstetrical problems) and the prevention of those diseases. This position paper reviews the history of Internal Medicine, the birth of its subspecialties and the difficulties faced by young physicians when they decide whether to practice as internist or in a subspecialty. In Chile as in most occidental countries formal training in a subspecialty of internal medicine requires previous certification in internal medicine but the proportion of young physicians who remain in practice as general internists appears to be considerably lower than those who choose a subspecialty. The main reasons for this unbalance can be related to financial advantages (by the practice of specialized technologies) and the patients' tendency to request direct assistance by a professional thought to be better qualified to take care of their specific problems. Training programs in internal medicine should consider a greater emphasis in comprehensive outpatient care instead of the traditional emphasis for training in hospital wards.

Adult↗
PubMed1992

Inpatient resource use: a comparison of family medicine and internal medicine physicians.

BACKGROUND: It is not known whether differences exist between the use of inpatient resources by family medicine and internal medicine physicians when patient demographic and complexity variables are statistically controlled. METHODS: The study population was all patients in 13 higher volume diagnosis-related groups (DRGs) discharged from the family medicine (n = 306) and internal medicine services (n = 2374) of the University of Cincinnati Hospital during 1985 and 1986. The dependent variables were length of stay and inpatient readmission within 2 weeks. Stratification by DRGs was used to control for the effects of age and case mix on these variables. RESULTS: With the exception of findings regarding one DRG, the results do not indicate that differences exist in average length of stay between patients of family medicine and internal medicine physicians after adjustment for other variables. Furthermore, almost all of the explained variance in length of stay was attributed to patient complexity and not to physician specialty or patient race or sex. For all discharges, the proportion of patients readmitted within 2 weeks was about 4% higher for the internal medicine service. However, multivariate analysis did not support the importance of physician specialty (family medicine or internal medicine) as a predictor of whether readmission occurred within 2 weeks. CONCLUSIONS: General indicators of resource use (such as length of stay or readmission occurrence) without adjustment for patient case mix, demographics, and complexity are inadequate for comparison of health care providers. Further research regarding interspecialty differences should use longitudinal data from large populations, which would permit more detailed examination of resource utilization.

Family Practice↗