American College of Physicians: Internal Medicine — Doctors for Adults ®

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How ACP is reaching out to all of internal medicine

From the March ACP Observer, copyright 2004 by the American College of Physicians.

My January/February column in ACP Observer addressed the College's efforts to improve reimbursement and the practice environment for internists. (See "ACP's long, continuing fight for better reimbursement.") Together with health care reform, these are key issues for all internists, now and in years to come, and it's appropriate that ACP is investing much of its time and resources in these directions.

However, we must not let these issues eclipse other important priorities. ACP has pledged itself to a broad vision: to be the recognized leader in education, advocacy and enhanced career satisfaction for internal medicine and its subspecialties.

In this column, my last as ACP President, I celebrate the College's educational efforts that are critical to our mission of fostering excellence in medical care. We're all familiar with ACP's educational agenda and activities for practicing internists who work in either community-based or academic settings.

But we may not so readily recognize what the College is doing for the next generation of internists—today's medical students and residents—and for those who teach and lead them. Yet the products and services we offer physicians-in-training are crucial because, among other things, they may help convince the best and brightest among them to choose a career in internal medicine.

Help for students

In recent years, the College has offered its student members a variety of educational programs, products and services.

Student members, for example, receive free online access to Annals of Internal Medicine and ACP Journal Club, as well as to ACP Observer. ACP also gives students free access to several online resources. For example, medical students will find a trove of information about the College, residency programs and other organizations online.

ACP also gives its medical student members access to an online mentoring database to find professional and personal guidance from College members. Individuals listed in the database include clerkship and residency program directors, chairs of internal medicine departments and practicing internists, as well as the internal medicine residents who make up our national Council of Associates.

To help students with medicine clerkship, the College and the Clerkship Directors in Internal Medicine have worked together to develop MKSAP for Students 2. This self-assessment tool consists of more than 400 multiple-choice items and critiques geared to students in their third and fourth years of medical school. It is designed to help students assess their mastery of a nationally recognized internal medicine curriculum.

Students who attend ACP's Annual Session will find program offerings created especially for them. Popular features include both oral presentations and poster competitions and a mentoring breakfast with internal medicine physicians who are nationally recognized leaders.

And for the first time this year, medical students attending Annual Session will have a chance to practice their physical examination skills and receive expert feedback before they take the USMLE Step 2 clinical skills examination.

Resource for residents

While internal medicine residents have access to all of the above services, they can also get help from the College in two important areas: preparing for the American Board of Internal Medicine (ABIM) certification exam and finding a job.

When it comes to preparing for the Boards, nearly 96% of certification candidates say they use the College's MKSAP programs. And every year, the College offers intensive, four-day Board review courses in six cities strategically located across the United States. (More information is online.)

Complementing those courses is MKSAP Prep for Boards, a collection of 500 multiple-choice, self-examination questions with answers and critiques, plus pointers on test preparation and test-taking.

Residents can also take advantage of another key assessment tool, the Internal Medicine In-Training Examination, which is developed jointly by ACP, the Association of Program Directors in Internal Medicine and the Association of Professors of Medicine. This one-day proctored exam gives residents feedback on their strengths and weaknesses in each specialty, and it can accurately predict whether a resident will pass the ABIM certification examination.

The College also offers residents help in preparing for life after training. The Career Resources Center gives ACP Associates a list of job openings, information about certification and licensing, and tips on how to find a job.

Associate members attending Annual Session will also discover oral presentations and poster competitions for research projects and clinical vignettes, a forum on issues in internal medicine practice, and a "Doctor's Dilemma" competition. We also give residents opportunities to practice several common office-based procedures, including skin biopsy, arthrocentesis, casting and splinting, flexible sigmoidoscopy, urine microscopy and thyroid exams.

Academic partnerships

In addition to helping individual students and trainees, the College works with the teachers of internal medicine, as well as the directors of medicine clerkships and residency and fellowship programs in medical schools and teaching hospitals across the country.

We hope that our recent internal medicine revitalization summit will help us develop a closer relationship with the Alliance for Academic Internal Medicine (AAIM), a group that represents the internal medicine departments at the 125 medical schools and almost 400 teaching hospitals in the United States.

The AAIM's membership includes department chairs; division chiefs; the directors of clerkship, residency and fellowship programs; and faculty and staff of departments of medicine. The organization's mission is similar to our own: to preserve, promote and advance the intellectual base of internal medicine by providing leadership and direction to academic internal medicine, including education, research and patient care.

While many of the AAIM's internist members are already College members, we would like them all to join ACP. More important, we want to have our two organizations—which are both institutional advocates for internal medicine—work in partnership for better education in internal medicine, and better medical education overall.

The role of researcher

Most internists and medical educators will agree that internal medicine provides the foundation of clinical medical education, and that internists do the lion's share of medical school teaching.

Internists' educational contributions, however, aren't confined to the classroom and clinic. Departments of internal medicine are also the sites of much of the clinical department-based research taking place in U.S. medical schools. In recent decades, in fact, research by internist-investigators has made important contributions to our understanding of the basic pathophysiology of human illness.

And so the College celebrates the tremendous research achievements of internists—and especially lauds several recent Nobel laureates.

At this year's Annual Session in New Orleans, one exemplary internist-researcher, Joseph L. Goldstein, FACP, will serve as our keynote speaker. He and Michael S. Brown, FACP, both members of the internal medicine faculty at the University of Texas Southwestern Medical Center at Dallas, shared the 1985 Nobel Prize in physiology or medicine for their work on the regulation of cholesterol metabolism. Both will be awarded Mastership at the 2004 Annual Session.

In 1998, another internist-investigator, Ferid Murad, MD, similarly received the Nobel Prize in physiology or medicine for his discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system.

And last year, Peter Agre, MD, an internist-hematologist at Baltimore's Johns Hopkins University School of Medicine, was awarded the Nobel Prize in chemistry for his discoveries concerning water channels in cell membranes.

Future opportunities

The College is committed to our goal of being an important, enriching influence in the professional life of all internists, whether they work in research laboratories, practice in community settings, teach and practice in medical schools, or serve as institutional leaders. By virtue of our diverse membership, we are uniquely positioned to serve as a forum for the entire spectrum of internal medicine.

I call upon all of us in the College to celebrate and continue to invest in our educational efforts.

I also urge all of us to mount new educational initiatives when and where we perceive the need, and to seek opportunities to partner productively with other internal medicine organizations that are dedicated to education and research.

And I call upon internists in other organizations to join the College, either as members or by leading their organizations to work closely with ACP on our common educational goals.

Among the many things I've learned in my year as College President, I've realized just how much the College has to contribute in education and research. These areas are critical to the specialty because they are shaping the internists of tomorrow—and our specialty's future.

We extend those contributions to individuals and institutions alike, all for the lofty goal of improving the learning, teaching and practice of medicine. By doing so, we may well make our esteemed and beloved field even more attractive to the best and brightest of our students.

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