Internal medicine practice in transition. Implications for curriculum changes.

The curriculum for internal medicine needs to be changed to eliminate the dichotomy between training and practice. At the same time, changing medical needs and the actual conditions of medical practice must be taken into account. The new curriculum, at the very least, needs to emphasize the central position of general internists in health care delivery. To accomplish this, several subjects must be added to the curriculum, including additional training in ambulatory care, management of chronic disease, medical procedures, and the doctor-patient relationship. Learning to direct a coordinated health care team should also be included. A more definitive restructuring would require reorganizing medical centers around three major departments: primary care, subspecialty medicine, and surgery.