Postgraduate Medical - Page 1
12 Postgraduate
Medical
Education
Incorporating the residency and
internship
Resident matching program
Residency training
Medical specialties
Fellowship training
Improving postgraduate training
Challenges in training
New trends in medical specialties
Physician employment opportunities
INCORPORATING THE RESIDENCY AND
INTERNSHIP
When the internship first became an established
part of postgraduate medical education
in the early part of this century, its purpose
was straightforward and uniform: a rotating
internship, with nearly equal portions devoted
to medicine, surgery, pediatrics, and
obstetrics-gynecology, which provided the first
extended clinical experience and the
first supervised responsibility for the welfare
of patients. These experiences were
deemed essential and usually sufficient to
complete the preparation of a younger physi-
cian for independent practice.
With advances in medicine, the purpose of an
internship was no longer obvious nor
uniform. The internship did not provide the
student's first practical experience with
problems of diagnosis and treatment; that
function is served by undergraduate clinical
clerkships. Nor was it adequate to provide the
final educational experience preceding
independent practice; the additional training
of a residency is generally considered nec-
essary to fulfill that purpose.
The nature of the internship also changed over
the years. Aside from the original rotat-
ing format, in time two other types came into
use: mixed internships--providing training
in two or three fields with prolonged
concentration in one of them; and straight intern-
ships--devoting time entirely to single areas,
such as medicine, surgery, or pediatrics.
While medical school curricula are the
corporate responsibilities of faculties, internship
programs were not the corporate
responsibilities of hospitals. The responsibility of
ensuring
a truly educational internship was usually that
of an individual head of a service or heads of
several independent services. An inevitable
result of such highly individualized and frag-
mented responsibility was that internship
programs varied widely in the extent to which
they duplicated the experience already gained
in the clinical clerkship, in the amount of
routine and sometimes menial service required,
and in their educational quality.
As a result of the highly questionable value of
the internship in the educational
process and the very high percentage of
physicians taking residencies, its usefulness as a
distinct program came into serious question. At
its annual convention in December 1968,
the AMA adopted a resolution that "an ultimate
goal is unification of the internship and
residency years into a coordinated whole."
Further steps toward implementation of this
resolution were subsequently adopted and the
goal was set that by July 1, 1978 all intern-
ship programs would be integrated with
residency training to form a unified program of
graduate medical education which has taken
place. This means that the internship year
now is the first year of residency and that one
person, who is assigned as program direc-
tor in a specialty at a given institution, is
responsible for the entire program. That person
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