The Evolution of General Internal Medicine (GIM)in Canada: International Implications

Abstract

General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community.

Keywords: Canada; Education; General internal medicine.

Fig. 1

Canadian path to licensure. All Canadian education is offered by universities. The national college for all specialty postgraduate training is the Royal College of Physicians and Surgeons of Canada (RCPSC). The national college for family physicians is the College of Family Physicians of Canada (CFPC).

Fig. 2

Educational content of GIM training leading to variability in scope of practice adapted to future training locale. The center indicates those skills all residents attain, while the outside areas are examples of areas of concentrated education for individual graduates, depending on their future practice location.