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In response to residency match data showing declining student interest in internal medicine (IM) careers, the Clerkship Directors in Internal Medicine (CDIM) Council charged the Task Force on Internal Medicine as a Career to examine
factors influencing students’ specialty choices, specifically their perceptions of IM careers, and to recommend how leaders in medical education could enhance the attractiveness of IM careers. Created in 2004, the task force included Karen Hauer, MD, (Chair), Eric Alper, MD, Charles Clayton,Warren Hershman, MD, Alison Whelan, MD, and James Woolliscroft, MD.
The task force recognized that the IM clerkship earns consistently high ratings from students, suggesting that factors beyond the clerkship influence students’ career choices. Students commonly perceive that the lifestyle and anticipated income in other specialties are superior to IM. In addition, negative role models in IM, especially general internists, may expose
students to the frustrating administrative hassles and the challenges of caring for chronically ill patients inherent in many IM practices. Previous literature suggests that primary care experiences in medical school, particularly with excellent teachers, may promote interest in generalist careers, although the applicability of this older literature in today’s
environment is unclear.
The task force published its findings in, “Educational Responses to Declining Student Interest in Internal Medicine Careers” (Am J Med, 2005;118(10):1164-70). The article outlined recommendations to enhance student interest in IM careers for key constituencies:
- Clerkship directors (CDs): The IM clerkship should provide comprehensive and adequate exposure to inpatient, ambulatory, and subspecialty IM. CDs should encourage student interest in IM, but should not explicitly recruit students to the field.
- Residency program directors (PDs): PDs and CDs should work collaboratively to understand respective program goals. PDs should promote a positive residency climate that will facilitate beneficial teaching and provide role models for students.
- Department of internal medicine chairs: Department chairs should be visible to students and support teaching time for clinician-educator faculty who serve as prominent teachers for medical students.
- Deans: Medical school deans should support equitable distribution of teaching responsibilities across departments rather than relying on the department of internal medicine to shoulder an undue teaching burden of orphan topics.
- National societies: The task force endorses discussions about shorter, more efficient training paths to internal medicine subspecialty careers. In addition, national societies should promote advocacy for fair reimbursement and improvements to the practice environment for internists.
- Researchers: A national study of the factors currently influencing students’ career choices would update the literature and provide valuable insight that could facilitate interventions to enhance the attractiveness of IM careers.
Karen Hauer, MD
Director of Internal Medicine Clerkships
Department of Medicine
University of California, San Francisco
School of Medicine
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