Internal medicine or general internal medicine (in Commonwealth nations) is the

medical specialty dealing with the prevention, diagnosis, and treatment of adult
diseases. Physicians specializing in internal medicine are called internists, or
physicians (without a modifier) in Commonwealth nations. Internists are skilled in
the management of patients who have undifferentiated or multi-system disease
processes. Internists care for hospitalized and ambulatory patients and may play a
major role in teaching and research. Of note is that internal medicine and family
medicine are often confused as equal in the Commonwealth nations (see below).

Because internal medicine patients are often seriously ill or require complex
investigations, internists do much of their work in hospitals. Internists often
have subspecialty interests in diseases affecting particular organs or organ
systems.

Internal medicine is also a specialty within clinical pharmacy and veterinary

medicine.

Education and training of internists

Main article: Medical education
The training and career pathways for internists vary considerably across the world.

Many programs require previous undergraduate education prior to medical school

admission. This "pre-medical" education is typically four or five years in length.
Graduate medical education programs vary in length by country. Medical education
programs are tertiary-level courses, undertaken at a medical school attached to a
university. In the United States, medical school consists of four years. Hence,
gaining a basic medical education may typically take eight years, depending on
jurisdiction and university.

Following completion of entry-level training, newly graduated medical practitioners

are often required to undertake a period of supervised practice before the
licensure, or registration, is granted, typically one or two years. This period may
be referred to as "internship", "conditional registration", or "foundation
programme". Then, doctors may finally follow specialty training in internal
medicine if they wish, typically being selected to training programs through
competition. In North America, this period of postgraduate training is referred to
as residency training, followed by an optional fellowship if the internist decides
to train in a subspecialty.

In the United States and in most countries, residency training for internal
medicine lasts three years and centers on secondary and tertiary levels of care. In
Commonwealth countries trainees are often called senior house officers for four
years after the completion of their medical degree (foundation and core years).
After this period, they are able to advance to registrar grade when they undergo a
compulsory subspecialty training (including acute internal medicine or a dual
subspecialty including internal medicine). This latter stage of training is
achieved through competition rather than just by yearly progress as the first years
of postgraduate training.[21][22]

Certification of specialists
In the United States, three organizations are responsible for certification of
trained internists (i.e., doctors who have completed an accredited residency
training program) in terms of their knowledge, skills, and attitudes that are
essential for excellent patient care: the American Board of Internal Medicine, the
American Osteopathic Board of Internal Medicine and the Board of Certification in
Internal Medicine.
United States
In the United States, two organizations are responsible for certification of
subspecialists within the field: the American Board of Internal Medicine and the
American Osteopathic Board of Internal Medicine. Physicians (not only internists)
who successfully pass board exams receive "board certified" status.

American Board of Internal Medicine

The following are the subspecialties recognized by the American Board of Internal
Medicine.[23]

Adolescent medicine
Allergy, Asthma and Immunology, concerned with the diagnosis, treatment and
management of allergies, asthma and disorders of the immune system.[24]
Cardiology, dealing with disorders of the heart and blood vessels*
Clinical cardiac electrophysiology
Critical care medicine
Endocrinology, dealing with disorders of the endocrine system and its specific
secretions called hormones
Gastroenterology, concerned with the field of digestive diseases
Geriatric medicine
Hematology, concerned with blood, the blood-forming organs and its disorders.
Hospital medicine
Infectious disease, concerned with disease caused by a biological agent such as by
a virus, bacterium or parasite
Interventional cardiology
Medical oncology, dealing with the chemotherapeutic (chemical) and/or
immunotherapeutic (immunological) treatment of cancer
Nephrology, dealing with the study of the function and diseases of the kidney
Pulmonology, dealing with diseases of the lungs and the respiratory tract
Rheumatology, devoted to the diagnosis and therapy of rheumatic diseases
Sleep medicine
Sports medicine
Transplant hepatology
American College of Osteopathic Internists
The American College of Osteopathic Internists recognizes the following
subspecialties:[25]

Allergy/Immunology
Cardiology
Critical care medicine
Endocrinology
Gastroenterology
Geriatric medicine
Hematology/Oncology
Infectious diseases
Nuclear medicine
Nephrology
Pulmonology
Rheumatology
United Kingdom
In the United Kingdom, the three medical Royal Colleges (the Royal College of
Physicians of London, the Royal College of Physicians of Edinburgh and the Royal
College of Physicians and Surgeons of Glasgow) are responsible for setting
curricula and training programmes through the Joint Royal Colleges Postgraduate
Training Board (JRCPTB), although the process is monitored and accredited by the
General Medical Council (which also maintains the specialist register).

Doctors who have completed medical school spend two years in foundation training
completing a basic postgraduate curriculum. After two years of Core Medical
Training (CT1/CT2) and attaining the Membership of the Royal College of Physicians,
physicians commit to one of the medical specialties:[26]

Acute medicine (with possible accreditations in stroke medicine or pre-hospital

emergency medicine)
Allergy
Audiovestibular medicine
Cardiology (with possible accreditation in stroke medicine)
Clinical genetics
Clinical neurophysiology
Clinical Pharmacology and Therapeutics (with possible accreditation in stroke
medicine)
Dermatology
Endocrinology and diabetes mellitus
Gastroenterology (with possible accreditation in hepatology)
General (internal) medicine (with possible accreditation in metabolic medicine or
stroke medicine)
Genito-urinary medicine
Geriatric medicine (with possible accreditation in stroke medicine)
Haematology
Immunology
Infectious diseases
Medical oncology (clinical or radiation oncology falls under the Royal College of
Radiologists, although entry is through CMT and MRCP is required)
Medical ophthalmology
Neurology (with possible accreditation in stroke medicine)
Nuclear medicine
Paediatric cardiology (the only pediatric subspecialty not under the Royal College
of Paediatrics and Child Health)
Palliative medicine
Pharmaceutical medicine
Rehabilitation medicine (with possible accreditation in stroke medicine)
Renal medicine
Respiratory medicine
Rheumatology
Sport and exercise medicine
Tropical medicine
Many training programmes provide dual accreditation with general (internal)
medicine and are involved in the general care to hospitalised patients. These are
acute medicine, cardiology, Clinical Pharmacology and Therapeutics, endocrinology
and diabetes mellitus, gastroenterology, infectious diseases, renal medicine,
respiratory medicine and often, rheumatology. The role of general medicine, after a
period of decline, was reemphasised by the Royal College of Physicians of London
report from the Future Hospital Commission (2013).[27]