Director’s Blue Ribbon Times Boise VA Medical Center

My Perspective - Internal Medicine Residency Training at the VAMC

Jacob Alexander, MD (R2, Boise Track, 2008-2009)

As a resident physician in Internal Medicine, I view the residency track at the VAMC, Boise as perfectly complementing the training and experience we get at our Seattle locations.

While the training in Seattle exposes us to a clinical environment where different subspecialists are actively involved in the care of a given patient, we get to experience in Boise a more traditional approach to medical care, where the generalist is almost completely responsible for all aspects of patient care. The former experience acquaints us to the cutting edge of modern therapeutic advances, and allows us to work in collaboration with subspecialists with advanced expertise in different organ systems. On the other hand, the training in Boise gives us a first-hand experience of being the traditional ‘consultant-generalist’. The combination of the exposure to these two slightly different approaches to the practice of Internal Medicine contributes tremendously to the wholesomeness of our training.

The most enduring feature of the Boise training is that it fosters the Oslerian ideal of internists as clinicians who are familiar with, and interested in, the broad spectrum of adult nonsurgical disease. At a time when most medical institutions are increasingly becoming dominated by subspecialists, we are fortunate in having an Internal Medicine department of ‘true internists’. Though this deprives us of some much-needed subspecialist expertise, there is no denying the fact that this allows us to work with seasoned clinicians who have a broad outlook to thepractice of medicine.

Equally important, and somewhat corollary to the attribute mentioned above, is the degree of independence that we enjoy within the program. This is true in patient care as well as education. When it comes to clinical training, nothing is as important as the opportunity to think independently and make one’s own decisions. We also cherish the opportunities to be actively involved in shaping the ways we work and learn.

Finally, having to work with a rather small circle of colleagues is a welcome change for most of us who are used to the relatively impersonal environment of large academic medical centers. The result is a remarkable degree of collegiality which is definitely the most important factor responsible for the upbeat attitude that pervades our work.