Internal Medicine Residency: What Medical Students Should Know

Some people knew at an early age that they wanted to be a doctor. Others fall in love with science during their high school or college years and start medical school right after earning their undergraduate degree. Certain physicians feel born into the career, having multiple generations of their family practicing medicine, yet others follow the nonconventional route and venture into medicine after a previous successful career.

While the decision to pursue medicine as a career can be life-changing, the next step after medical school for those who want to be practicing clinicians is to choose an area in medicine to pursue and complete residency training. Medical students declare their desired focus area in the last year of medical school, which can vary from internal medicine, to orthopedics, to surgery, or others.

Internal medicine focuses on the acute and chronic medical care of adults whether it be prevention, diagnosis, and/or treatment. Internal medicine residency is a training program that prepares a new physician for a career in internal medicine, ranging from a general internist, a subspecialist, a policy maker, a practitioner, an educator, or a researcher.

“The overarching goal for residency training is to prepare each resident with a solid knowledge of internal medicine in an environment that fosters intellectual curiosity, a spirit of inquiry, and camaraderie that embraces a biopsychosocial approach to patient care and training,” said John P. Moriarty, MD, FACP, associate professor of medicine (general medicine) and program director, Primary Care Internal Medicine Residency Training Program.

Internal medicine encompasses numerous sub-specialties. Completing residency in internal medicine can prepare the trainee for a career in primary care medicine, or as a hospitalist. An internal medicine resident can also pursue fellowship opportunities in multiple subspecialties, including cardiovascular medicine, digestive diseases, endocrinology, general medicine, geriatrics, hematology, medical oncology, infectious diseases, nephrology, pulmonary and critical care medicine, sleep, rheumatology, allergy, immunology, HIV care, among other areas.

Yale’s Department of Internal Medicine offers four residency programs with numerous training tracks and areas of development within each one, which make the Yale programs unique. During a resident’s PGY-2 year, they can apply for a two-year training experience, called a Distinction Pathway, in areas such as medical education (Clinician Educator Distinction), global health (Global Health & Equity Distinction), research (Investigation Distinction), quality improvement (Quality Improvement & Physician Leadership Distinction), and diversity and advocacy (Race, Bias, and Advocacy in Medicine.)

Naseema Merchant, FCCP, FACP, FHM, MBBS, assistant professor of medicine (general medicine) and co-director, Quality Improvement and Physician Leadership Distinction Pathway, explains the unique program. “Residents often have limited time for longitudinal training in quality improvement (QI), so this pathway provides a focused, hands-on, and practical experience to internal medicine residents for them to understand the practical application of improvement science in health care through structured independent self-study, participation in a mentored, longitudinal QI project, and through educational sessions.” Residents are paired with a distinction advisor and a QI faculty mentor to assist them in selecting appropriate QI projects which helps to provide residents with an individualized learning experience based on structured milestones.

Finding the best residency program is not about looking at the top ranked programs on a national poll but finding the one in which the candidate can best learn and excel.

Traditional Internal Medicine Residency Training Program Director Mark Siegel, MD, professor of medicine (pulmonary, critical care, and sleep medicine), lists what Yale’s Traditional Residency Program considers when reviewing applicants.

“Can they handle the work? Do they have academic potential? Do they have leadership potential? Do they stand out? Will they add to our diversity? And are they kind?

“It does not matter how smart or accomplished a candidate is if they aren’t kind. We only want residents who value and respect colleagues, who prioritize the needs of the community, who know how to listen, and who act thoughtfully and compassionately. We can overcome any challenge when we are surrounded by people who are kind,” he said.

Just like any career training, there are days that can be challenging. The Accreditation Council for Graduate Medical Education (ACGME) allows residency programs flexibility in defining the clinical education structure, but are required to “the 80-hour maximum weekly limit and to utilize flexibility in a manner that optimizes patient safety, resident education, and resident well-being,” says the organization in their ACGME Common Program Requirements (Residency).

“When you are thinking about residency and how tough it is going to be, the long nights, you really want a place where the people are nice and friendly and will support you throughout the way,” advises Ghenekaro Esin, MD, cardiovascular medicine fellow and graduate of the Traditional Internal Medicine Residency Program.

Within internal medicine residency programs, there are different educational tracks, which will determine the length of one’s training experience. Residency programs last for three years, and a combined medicine/pediatrics residency program spans over four years. Additional training, such as a fellowship, can extend the preparation further.

For example, Yale offers the Internal Medicine Physician Scientist Training Program (PTSP). This pathway represents a “short track” into fellowship training; residents in this pathway complete two rather than three clinical years of internal medicine residency, which is followed by their fellowship specialty training of their interest. Because this pathway often requires three years of research training during fellowship training, it shortens overall training by a year for those who plan to pursue intensive research training.

“The PSTP program helps individuals find their research motivation and passion, and ultimately, helps them succeed in achieving their dreams to discover that can impact the patients,” said Charles Dela Cruz, MD, PhD, associate professor of medicine (pulmonary, critical care and sleep medicine) and of microbial pathogenesis, and PSTP director.

To become a board-certified internal medicine doctor, you must complete a residency program, which can vary in length. Plan for three years of residency training. Residents must also pass the American Board of Internal Medicine exam which tests your clinical knowledge in internal medicine.

When choosing a medical specialty, the value is up to the pursuant. There are many different areas of focus within medicine, so a medical student needs to evaluate what is their best next step in their career, and what specialty within medicine will fit their skills, desires, and personality best.

The Department of Internal Medicine at Yale is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.