Consultations make up a major component of the clinical practice of all medical specialists including General Internists. In the 1970’s, Hollenberg and Langley predicted that the major future roles for Canadian General Internists would include:
Providing consultations for primary care physicians and for other specialists.
Providing continuing care for patients with complex serious illness.
Participating in intensive care, particularly in community hospitals.
Despite the changes that have occurred in the health care system in the interim, their predictions have proven to be remarkably accurate. More recently Canadian General Internists have been described as patient centered specialists, functioning primarily as consultants, with expertise in dealing with both acute and chronic medical problems. General Internists are particularly well prepared to assess patients with undifferentiated problems, or problems that encompass more than one system or subspecialty area, ranging from initial evaluations to providing comprehensive management. In turn there has been a growing demand for General Internists to provide pre-operative assessments and peri-operative care for high risk surgical patients with complex medical problems. General Internists have also begun to play a central role in obstetrical medicine, and in the investigation and management of medical complications in pregnancy.
With the progressive closure of beds over the last 20 years, elective hospital admissions effectively have been eliminated. Admissions today, particularly admissions to tertiary care referral centers, usually involve acutely ill patients with undifferentiated and/or multisystem medical problems. Within this environment, there has been a growing demand for General Internists to take on an expanding role not only in inpatient care, but also as gatekeepers for assessing potential medical admissions, to help promote the optimal utilization of limited acute care beds . In response, the RCPSC has specifically stated in both its Specialty Training Requirements and its Accreditation Guidelines for Internal Medicine Training Programs, that all medical residents must receive supervised experience in performing medical consultations, both for inpatients and in outpatient settings . The competent performance of medical consultations continues to form the basis for the RCPSC final oral examination for certification in Internal Medicine.
Within the University of Alberta Internal Medicine Residency Training Program, all internal medicine residents are required to complete a mandatory two week rotation assigned to each the General Internal Medicine Ward Consultation Service at the UAH. The General Internal Medicine (GIM) Ward Consultation service at the UAH is made up of medical residents under the supervision of a full time faculty member from the Division of General Internal Medicine. Since September 2002, the GIM Consultation Service has offered 2‐4 week elective rotations for medical students who have completed their clinical clerkship in Internal Medicine. Approximately 10‐12 students participate per year.
Original contributions from Dr. Bruce Fisher