Length of IM Residency

[oops_letstryagain]

I was browsing the CaRMS website looking at the different programs and I noticed that while Dal, UBC, and Mac all have 4 year IM residency programs, the U of T program is only 3 years. Am I missing something here?

 

https://w1c.e-carms.ca/pdws2012R1-1/jsp/pd.do?p=504047&f=1&m=1

[justletmein]

Every program is 3 years + subspecialty (2-3 yrs) = 5-6 years total

OR 4 years total for GIM (some programs are 5)

[BigM]

By the time you get there general internal medicine will be a 5 year residency.

[Med0123]

in quebec it is already 5 years

[oops_letstryagain]

If GIM is going to 5 years, will specializations like gas and cardiology go up to 6 or 7?

[Lactic Folly]

Cardiology is already 6 (+ more with subspecialty fellowships).

[thebouque]

in quebec it is already 5 years

 

It used to be, now it's back to 4 (same for general peds).

[thebouque]

If GIM is going to 5 years, will specializations like gas and cardiology go up to 6 or 7?

 

Gas will never go up to 6.

[tooty]

I don't get this. Why are they extending GIM? It makes no sense.

 

i believe the thinking is that GIM is its own demanding specialty

[oops_letstryagain]

i believe the thinking is that GIM is its own demanding specialty

 

Was it not considered demanding before? My plan was to shadow IM in the coming year and then do at least one elective in it, but now I'm confused between GIM and the specialties themselves.

[Med0123]

Well it's more useful and less expansive to have a well trained GIM in a community hospital than a cardiologist, a gastroenterologist, a respirologist, etc.

 

It has been 5 years for a long time in quebec and the compensation of GIM is competitive to IM subspecialties (except for cardio and GI of course)

[Med0123]

Gas will never go up to 6.

 

lol so true, it's 3 years in USA... (1 year of internship in IM or surgery, and 3 "real" years of anesthesiology)

[oops_letstryagain]

lol so true, it's 3 years in USA... (1 year of internship in IM or surgery, and 3 "real" years of anesthesiology)

 

gastroenterology has to do 3 years of anesthesiology? what?

[Lactic Folly]

gastroenterology = GI for short

anesthesiology = gas for short

[Med0123]

gastroenterology has to do 3 years of anesthesiology? what?

 

ohhhh by gas you meant GI haha my bad...

 

gastroenterology = GI for short

anesthesiology = gas for short

 

yea thats the abbreviations I use lol

[thebouque]

Lol I thought he meant anesthesiology as well

[oops_letstryagain]

My bad. In my mind: anes = anesthesiology, gas = gastroenterology.

 

Back to the question at hand: will the length of GI (gastroenterology) go up if GIM goes up to 5?

[leviathan]

GI will not go up. Your base IM training will still be 3 years, followed by whatever subspecialty you want to do (GIM now being 2 years instead of 1).

 

I really hope they don't extend GIM to 5 years. I know they have some programs that are now 5 but you can still get a license with only 4, as +1 programs still exist.

[thebouque]

GI will not go up. Your base IM training will still be 3 years, followed by whatever subspecialty you want to do (GIM now being 2 years instead of 1).

 

I really hope they don't extend GIM to 5 years. I know they have some programs that are now 5 but you can still get a license with only 4, as +1 programs still exist.

 

There's this tendency in the US to have short residencies but trust me GIM is better off with 5 years. Why? Because a lot of GIMs work in community hospitals and have to master advanced techniques (GI endoscopies, bronchoscopies, echocardiography etc) that they can learn in their 5th year. Those working in university centers act mostly as hospitalists and have their own outpatient clientele but they have a key role in teaching. Last year, GIM went from 5 to 4 years in Quebec, with the option of doing a 5th year. Most of the residents chose to do the 5th year (and I'm talking about an actual PGY5, not a fellowship).

[leviathan]

There's this tendency in the US to have short residencies but trust me GIM is better off with 5 years. Why? Because a lot of GIMs work in community hospitals and have to master advanced techniques (GI endoscopies, bronchoscopies, echocardiography etc) that they can learn in their 5th year. Those working in university centers act mostly as hospitalists and have their own outpatient clientele but they have a key role in teaching. Last year, GIM went from 5 to 4 years in Quebec, with the option of doing a 5th year. Most of the residents chose to do the 5th year (and I'm talking about an actual PGY5, not a fellowship).

That's a good point. I know lots of GIMs in Canada who do extra procedures and it was mostly on the job training. I'd prefer that way, but only if I can learn it safely and properly.

[cheech10]

I don't know any GIM docs that do endoscopy or bronchocopy; maybe some do echocardiography. Holter interpretation, stress tests, that sort of thing I'm well aware of, but not invasive procedures (how many internists are comfortable intubating a patient if a bronch goes wrong?). The 2 year GIM programs are at university hospitals, so I wouldn't expect a lot of training doing those kinds of procedures; there are usually many fellows and subspecialty residents lining up for them first.

[Med0123]

there are already enough general surgeons and GI docs to perform those endoscopies, even in rural areas (in very rural there will still be a general surgeon to do them)

[A-Stark]

I don't know any GIM docs that do endoscopy or bronchocopy; maybe some do echocardiography. Holter interpretation, stress tests, that sort of thing I'm well aware of, but not invasive procedures (how many internists are comfortable intubating a patient if a bronch goes wrong?). The 2 year GIM programs are at university hospitals, so I wouldn't expect a lot of training doing those kinds of procedures; there are usually many fellows and subspecialty residents lining up for them first.

 

Intensivists do bronchoscopy at the bedside, but as a corollary, how many gastroenterologists are comfortable intubating a patient who's gotten too much sedation in the endoscopy suite?

 

I think ensuring more technical skills among generalists is key - and internists in the community need to be able to place central lines and presumably deal with their complications.

[leviathan]

There are lots of general internists that manage ICUs in community hospitals and intubate, place central lines etc.

[thebouque]

I don't know any GIM docs that do endoscopy or bronchocopy; maybe some do echocardiography. Holter interpretation, stress tests, that sort of thing I'm well aware of, but not invasive procedures (how many internists are comfortable intubating a patient if a bronch goes wrong?). The 2 year GIM programs are at university hospitals, so I wouldn't expect a lot of training doing those kinds of procedures; there are usually many fellows and subspecialty residents lining up for them first.

 

Maybe it was an exception then, but at one of the big hospitals of my medical school, there were 2 GIM who scoped (GI). Where I did my rural family med rotation, one of the GIM performed brochoscopies.