Modernizing the paths to certification in internal medicine and its subspecialties.

A he training requirements for internal medicine and its subspecialties have remained fundamentally the same over the past several generations. hysicians must first complete core training in internal edicine, and board certification in internal medicine ust precede board certification in the medical subspeialties or eligibility for added qualifications (Table). The initial length of training required for board certication in internal medicine has generally been 3 years, specially recently as the number of competencies to be btained during training has increased. Exceptions to this year expectation were widely granted a generation ago, hen core internal medicine training was overwhelming npatient, and “short-tracking” (i.e., requiring only 2 ears of internal medicine rather than 3 years before subpecialty training) was more common. Now, however, he rare exceptions to the 3-year requirement are reserved or trainees in a physician-scientist track, in which an addiional year of research training would counterbalance, at east in part, 1 less year of internal medicine training. This current approach to training and certification in nternal medicine can be compared metaphorically with ell maturation. Trainees remain pluripotent stem cells or 3 years before either failing to differentiate, and hereby remaining as internists only, or differentiating nto subspecialists. The duration of stem cell training is in art historic and in part driven by the increasing variety f skills and competencies that fall under the broad umrella of internal medicine. Unlike true stem cells, howver, general internists typically forfeit their differentiaion potential soon after the completion of their 3 years of raining.