Internship In Internal Medicine Research Articles

Charles A. Janeway, Jr. (1943-2003)

Charles A. Janeway, Jr. (1943-2003)

Robert Pickett Scruggs Iii, MD: A Conversation with the Editor

Robert (‘Pick’) Scruggs (Figure ​(Figure11) was born in Memphis, Tennessee, on January 24, 1944, and he grew up there. He graduated from the University of Mississippi in 1966. He attended medical school at the University of Tennessee, graduating in December 1969. His internship in internal medicine began at Baylor University Medical Center (BUMC) in January 1970. From January 1971 until January 1973, he was a medical officer in the US oncology was at Duke University Medical Center in Durham, North Carolina, from February 1973 until February 1976. He then came to BUMC as a radiation oncologist and has been here ever since. He has been medical director of radiation oncology and assistant chief of the Department of Oncology since 1995. He has been chairman of the cancer center medical committee and vice chairman of the cancer center executive committee since 1990. He was president of the medical staff in 2001 and chairman of the medical board of BUMC in 2002. Pick Scruggs has been a leader at BUMC for 25 years. His impact on the medical center has been substantial. Both he and his wife are splendid human beings.

Clinical judgment

It was July 1, 1957. I had received my medical degree from Harvard medical school and was starting the first day of my internal medicine internship. I was called that day to see an 80-year-old woman, whom I had not previously seen, for a cardiac arrest. This was the era before cardiopulmonary resuscitation, defibrillation, and “Do not resuscitate” orders. I gave the woman a blow to her chest and injected intracardiac epinephrine. The woman immediately converted to sinus rhythm, regained consciousness, and was able to answer questions. I felt very proud of myself at that moment. However, I had just resuscitated a woman with breast carcinoma who had extensive metastases. She lived another 17 days, requiring narcotics for severe pain. Prolonging her life also wreaked havoc on a very emotional family. My successful resuscitation had resulted in prolonging suffering for the patient and for her family. Clinical judgment involves not only providing the best possible medical care but knowing when not to provide medically futile measures. A physician should make medical decisions as if the patient was a member of his or her own family. Sometimes, palliative care is the best care for a suffering patient.

Medical students' experiences of diseases in internal medicine in university and community hospitals

Because medical students in The Netherlands should achieve common national objectives, it is important to know whether clinical experiences in different hospitals are comparable. The research questions were: (1) Do students achieve learning experiences of the required diseases during the internship in Internal Medicine and to what extent do they achieve these experiences? (2) Are there differences between the diseases experienced at a university hospital and at community hospitals? Completed logbooks of students were analysed; the percentage of students that achieved the required diseases and the mean number of experiences of diseases were calculated. A t-test was done to test for differences. Medical students in the university and in community hospitals get broad experience (76-131%) of the required diseases. In both hospitals there are many students who are not achieving the requirements, but the mean number of experiences of students at the community hospitals is higher than those at the university hospital. To eliminate the differences between students from the university hospital and the community hospitals, the educational programmes within both hospitals should be adjusted.

Objectives for an internship internal medicine: from the Dutch Blueprint (Raamplan 1994) to implementation into a practical logbook

Background: The Dutch Blueprint 1994 (Raamplan 1994) describes the objectives of undergraduate medical education. The Blueprint, developed in order to improve medical education in the Netherlands, is accepted by all Dutch medical schools and has been legislated. Aim: Translation of global objectives of the Blueprint into specific requirements of a Logbook (guideline and evaluation tool) for the internship Internal Medicine. Description: The Blueprint as such is impracticable as a guideline during the Internal Medicine internship. The content covers the objectives for the entire field of medicine, and the volume dedicated to Internal Medicine is too large to fit in with a twelve week internship. The practicability of the Blueprint leaves much to be desired because it is complex, and not easily accessible. So, the Blueprint was adapted on three points: (1) selecting those objectives out of the whole content, which are specifically relevant to Internal Medicine; (2) decreasing the volume Internal Medicine by clustering and defining the requirements; (3) making the Logbook usable as a guideline and evaluation instrument. Conclusion: The Logbook is a good starting-point to evaluate whether students meet the objectives of the Blueprint related to the discipline Internal Medicine. (See Editorial p. 165)

The ESMO programme of certification and training for medical oncology

ESMO has designed a programme of certification and training in medical oncology. In this paper the background of these programmes is given, and the programme of graduate education is described in greater detail. The standard requirements are a total training period of six years, beginning with a common internship in internal medicine of at least two years, followed by a training programme in oncology for three to four years, which must include at least one year of full-time clinical training in the diagnosis and management of neoplastic diseases, accompanied by one year of experience in an ambulatory care setting.

Jeannette M. Smith, MD, Comes to JAMA as 11th Fishbein Fellow in Medical Journalism

HCFA's LOSS will be<i>JAMA</i>'s gain when Jeannette M. Smith, MD, MPH, leaves her position as an analyst in the Office of Research, Health Care Financing Administration (HCFA), to become the 11th Morris Fishbein Fellow in Medical Journalism. The yearlong fellowship honors Morris Fishbein, MD, editor of<i>JAMA</i>for a quarter century (1924 to 1949). Smith received her bachelor of science degree, with honors in biology, from Andrews University, Berrien Springs, Mich, in 1977, and her MD degree from Loma Linda (Calif) University School of Medicine in 1981. She completed the residency program in anatomic and clinical pathology and an internship in internal medicine at Kettering Medical Center, Dayton, Ohio, before graduate study at Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md, from which she received the MPH degree in 1986. <h3>Active in Ohio</h3> During her 4 years in Dayton, Smith held various positions. She spent

Changes in the internal medicine internship from 1967 to 1987: explanations for decreasing interest in the discipline?

We compared the schedules and responsibilities of medical interns at an urban university hospital in 1967 with those in 1987. We analyzed admissions, length of stay, diagnostic problems, demographic data on interns, changes in diagnostic and therapeutic options, and number and type of consultations. The intern in 1987 spent less time in the hospital but had more admissions, more interruptions, more clerical responsibilities, and more therapeutic and diagnostic options, and was more dependent on senior colleagues with special expertise. For these reasons the intern in 1987 had less time with individual patients and less autonomy than his 1967 counterpart. Recognition and modification of the negative aspects of medicine interns' experience will increase the attractiveness of internal medicine residencies.