Internal Medicine at the Crossroads: Training Subspecialists for the Next Century

In this issue, Langdon and her colleagues from the American Board of Internal Medicine's Task Force on Subspecialty Internal Medicine [1] offer 11 provocative recommendations whose ultimate goal is no less than to transform the current infrastructure of internal medicine subspecialty training. The time is right for this, not only because the new millennium approaches, but also because our graduate medical education system has, with time, become greatly misaligned with the needs of Americans [2-4]. Moreover, the health care system for which most medical subspecialists have been trained—and are still being trained—no longer exists. The changes in fellowship education suggested by the Task Force (and unanimously adopted by the Board) go a long way toward providing a road map for this change. But do they go far enough?

The overarching mission of this respected blue ribbon panel was to suggest how training could be “enhanced” to “better prepare” medical subspecialists for their “future roles.” The premise for the Task Force's deliberation was that in the face of a widely accepted surplus of many medical subspecialists [5, …