Now that you have reached the residency stage in your journey, you may be wondering what the best program is. Internal medicine involves foundational medicine training for the prevention, diagnosis, and treatment of internal diseases. Residents are trained heavily in related subspecialties like endocrinology, rheumatology, and infectious diseases. There are quite a few and Canada that offer internal medicine residency programs, so in this article, we’ll discuss what makes a residency program the best and the best internal medicine residency programs across the US and Canada. We’ll also provide some tips on how to match with residency programs.
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There are a lot of factors that determine how good a residency program is, so to name one program as the best is not possible. The unique selling proposition of a specific residency program may not be what you as a resident want, which means the “best internal medicine residency program” is quite subjective. You will need to first decide what you want from a residency program and then figure out which medical school focuses on that. This way, you can prioritize schools on your residency rank order list. There are a lot of factors to consider while reviewing and the US to make your decision, such as their acceptance rates, notable faculty, research programs, student life, curriculum, facilities, and more.
In the US, medical schools use the Electronic Residency Application Service (). This is a centralized application system that allows applicants to create an application with all their documents in one place and apply to residency programs of their choice. The actual matching is carried out by the National Resident Matching Program (NRMP).
1. Massachusetts General Hospital
The Massachusetts General Hospital offers an Internal Medicine Residency Program that has been creating internists for the past 75 years. It aims to help students reach their goals and become the best physicians they want to be. Faculty guide the residents in their professional development through academic advising, intense mentoring, and engagement in a coaching program.
The internal medicine residency program includes the Categorical Program and the Primary Care Program, both of which take three years to complete and offer core clinical training in internal medicine. Residents who complete either of the programs become board-eligible in internal medicine. The main difference between the two is the amount of time residents spend in training in the ambulatory setting.
The Categorical Program is designed to inculcate professional skills. The intern year or PGY-1 focuses on clinical skills and team building, while the junior year or PGY-2 adds advanced clinical skills in ICU settings and leadership building to teamwork. The senior year or PGY-3 teaches management skills at the hospital and systems level and prepares residents for the future.
Rotations for the first year include General Medicine (Bigelow-Flex) for 3 months, Ambulatory Rotations for 1.5 months, Medical Intensive Care Unit for 1 month, among others. Core rotations in the second year include General Medicine (Bigelow-Flex) for 1.5 months, Ambulatory Rotations for 1.5 months, Cardiac Step-Down Unit for 0.5 to 1.5 months, among others. The senior year or third year includes Night Teach for 1 to 1.5 months, Ambulatory Rotations for 1.5 months, Oncology for 0.5 to 1 month, among others.
The Categorical Program also includes the Stanbury Physician-Scientist Pathway, designed to train, educate, and guide physician-scientists through residency, fellowship, and beyond. It differs from the Categorial Program in three areas: mentorship; a curriculum targeting physician-scientists; and residency structure.
The Primary Care Program emphasizes robust clinical training, exposure to innovations improving the health of vulnerable populations, and skill building to become an agent of change in the health system. Over the three years, residents will complete 16.5 months of ambulatory rotations and benefit from elective time to dedicate to ambulatory learning. PGY2 includes special Primary Care Designer Blocks that allow residents to pursue specific pathways in primary care.
The unique electives offered by this internal medicine residency program are what make it stand out from the competition. It has a myriad of clinical, community, and classroom-based electives that are driven by residents’ interests, along with exposure to point-of-care ultrasound (POCUS). Residents have access to six Butterfly iQ handheld ultrasounds, along with cart-based ultrasound machines, as part of POCUS. The program has a longitudinal curriculum, which involves bedside ultrasound rounds twice a month. Residents can choose a two-week POCUS elective, in which they will be introduced to what point-of-care technology in internal medicine entails.
2. University of California
The Internal Medicine Residency Training Program offered by the University of California has four main training tracks: the Categorical Medicine Track, Physician-Scientist Training Program (PSTP), Combined Medicine/Pediatrics Track, and Primary Care Track.
The Categorical Medicine Track is a traditional three-year training track that has a curriculum designed to provide broad exposure to general internal medicine as well as subspecialties.
The Physician-Scientist Training Pathway offers a combined internal medicine, integrated research, and optional subspecialty fellowship training experience. Candidates interested in basic science research should choose this pathway. It includes three years of categorical internal medicine residency experience, two to three years of mentored research experience, and an optional subspecialty track with training in an internal medicine subspecialty fellowship at UC San Diego.
The Combined Medicine/Pediatrics Track is a four-year program that is split evenly into internal medicine (24 months) and pediatric rotations (24 months). Graduates can pursue primary care, hospitalist positions, academic medicine, international health, or subspecialty fellowships after completing this track.
The Primary Care Track has three annual primary care blocks that provide exposure to primary care environments, primary care skills training, and high-yield subspecialty clinic sessions. The primary blocks have a weekly didactic curriculum, which consists of clinical and non-clinical topics, along with hands-on experience in community agencies.
Residents in the Categorical Medicine Track, PSTP, or Combined Medicine/Pediatrics Track can further modify their training by applying for any of the five optional specialized pathways during their first year. These include the Primary Care Pathway, Resident as Clinician Educator (RACE) Track, Hospital Medicine Pathway, Global Medicine Pathway, and Integrative Medicine Pathway.
The UC internal medicine residency program touts itself as a highly academic training program with excellent research and clinical faculty. It focuses equally on training in clinical medicine and the scientific basis of diagnostic and therapeutic interventions. Each resident takes on a scholarly project that is presented to peers. They also take in other teaching activities in journal club, evidence-based medicine, clinical reasoning conferences, and Excellence in Quality Improvement and Patient Safety (eQIPS) conferences. A two-month research elective can be chosen in the third year, and students get to present the results at the Medicine Grand Rounds series; however, there are only four slots, so participation is competitive. At the end of each year, research results are presented at the annual Resident Research Symposium.
The focus on research and scholarly activities is what makes this internal medicine residency program stand out. Many students in the University of California Department of Medicine have presented their research at national meetings and have been included in peer-reviewed publications. If you’re very interested in research, this program should be ideal for you.
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3. Duke University
The Department of Medicine at Duke University offers an internal medicine residency program that includes five pathways: the Categorical Program, the Preliminary Program, Research Pathways, Global Health, and Health Care Leadership.
The trainees that Duke University recruits to its Internal Medicine Residency program are considered potential future faculty. Therefore, faculty pay close attention to residents, as shown by its Residency Professional Development Coaching Program, which offers individual professional development for residents throughout their training by pairing them with faculty. The coaching relationship differs from mentorship, as it focuses more on individual professional development than career development.
The individualized and personal learning experience offered at Duke makes it unique. It supports each resident as a medical provider, community member, and unique individual.
Medical schools in Canada use the Canadian Resident Matching Service (), which matches applicants to the residency program of their choice and residency program directors with applicants that fit them best.
1. University of Toronto
The University of Toronto’s Internal Medicine (Core) Residency Program is said to be one of the largest programs in the specialty in North America, as it accepts around 70 residents in each Core year. This large gathering of residents and faculty creates a pool of diversity that promotes a broader yet more inclusive learning experience. The program accepts Canadian Medical Graduates, International Medical Graduates, and Internationally Funded Trainees, each valued for their unique perspectives.
The curriculum includes general medicine training that consists of a minimum of 15 blocks of general internal medicine rotations. All trainees complete a minimum of four blocks managing critically ill patients. Trainees also complete a maximum of five blocks in one subspecialty. Residents need to complete a scholarly project as part of their research and can take up to six blocks of electives with a maximum of three per year. These electives include cardiology, clinical immunology and allergy, clinical pharmacology and toxicology, dermatology, emergency medicine, and hematology, among others.
The program aims to train future leaders of Canadian medicine who are competent across all the roles. Furthermore, managing critically ill patients gives them experience with more challenging situations. Residents have the potential to get hands-on experience with a diverse population, including patients of all ages, patients from different population groups, such as those identifying as LGBTQ2S+, immigrants and refugees, and medically underserved groups such as Indigenous Canadians.
This program is distinguished by the extensive learning opportunities and diversity across the community of residents, faculty, and patients. It also offers a Black and Indigenous Resident Application and Mentorship Program that aims to support minority communities.
2. McGill University
The Internal Medicine Residency Training Program offered at McGill University has a strong focus on curriculum and producing capable internists. Residents of the program get to train at three major teaching centers in Montreal. The program aims to produce residents that are medical experts, strong communicators, collaborators, leaders, health advocates, scholars, and professionals. Residents will also be exposed to teaching sessions with clinical ethicists throughout their clinical experience. Furthermore, residents are also trained in Quality Assurance/Improvement, Ambulatory Care, and rotations.
The curriculum for the Internal Medicine Residency Training Program includes 12–20 weeks in the Clinical Teaching Unit (CTU) and General Internal Medicine Consultation Service in ER (ERC) every year. There are four weeks in the Intensive Care Unit (ICU) per year, four weeks in the Coronary Care Unit (CCU) per year, four weeks of ambulatory clinic in PGY2 and PGY3 only, and two to four weeks of Night Float per year.
Residents also get access to special rotations, which include the Community Hospital Internal Medicine Experience (CHIME), Research/Scholarly Activity Rotation (SAR), and Epidemiology. CHIME allows residents to experience internal medicine in a community setting. SAR gives residents the opportunity to explore their potential interests, which could include clinical research, medical education (including simulation), quality improvement, or others (subject to approval by the program). Epidemiology is an optional, four-week course offered as an elective to residents interested in enhancing their understanding of epidemiological and statistical methods. The program allows students to carry out their electives or “selectives” at any McGill University training site.
This strong focus on curriculum is what makes the Internal Medicine Residency Training Program at McGill University stand out. The program’s mission is to develop well-rounded internists with the help of a robust curriculum.
Understanding what matching is can help you curate your application. Broadly speaking, pair students with residency programs and vice versa. They assess an applicant’s candidacy using multiple factors, like academic accomplishments, professional journey, dedication to the specialty, and communication skills, and match them with the residency programs on their .
Depending on which country you are applying to (US or Canada), the components of the application can vary slightly, so pay attention to the program requirements to increase your chances of being matched.
The following are some of the application components you will need to prepare:
- Letters of recommendation
- Residency personal statement or residency letter of intent
- Medical student performance evaluation ()
- Medical licensing exam scores
With the right , you can develop a strong CV that appropriately highlights your employment history, including volunteer work, extracurriculars, research, awards, publications, and elective experiences. Make sure to state your academic background in reverse chronological order.
Letters of recommendation
Letters of recommendation play a vital role in your application. Once you have identified how many letters are required by the residency program of your choice, dedicate some time to think about who you ask for reference. It should be someone you have worked closely with for a long time, as they will be able to speak of your achievements and skills that are essential for the program. Make sure you ask for an or a 2–3 months before you start applying.
Personal statement/personal letter
From your personal statement or personal letter, the admissions committee wants to see your commitment to the field. You can highlight this by describing any personal experiences that influenced you to pursue the specialty. If there was something interesting about your rotations that stuck with you, share it. You should also look at some to get an idea of how to frame your statement.
Medical Student Performance Evaluation
The MSPE or Medical Student Performance Evaluation informs the residency program directors of your academic performance, strengths, weaknesses, and accomplishments in a comprehensive and objective way. You should start thinking of your MSPE early and try to ensure good evaluations during clerkships and electives. Speak with your supervisors and incorporate their feedback in your performance.
Medical licensing exam scores
Medical licensing exam scores such as the United States Medical Licensing Examination (, , ) scores are another major requirement in a residency application. To improve your chances of scoring high, you may want to consider a or one dedicated to the other levels. Understanding will help you tailor your application and stand out from the competition.
The interview stage is just as important for residency as the application stage. Whether you are focusing on your or , make sure to first take a moment to introspect and think about what you have achieved, what your goals are, and how you plan on achieving those goals. Once you have this part figured out, move on to reviewing resources, starting with and sample answers to get an idea of what can be asked and how you should answer those questions. Taking on will give you the confidence for when you sit for your actual interview, be it in person or virtual. It will also help you time your answers and make them more succinct if needed.
1. How do I apply to Duke University’s internal medicine residency program?
Duke University follows the ERAS application process. The ERAS application includes your USMLE Step 1 report, medical school transcript, personal statement, three or four letters of recommendation, and MSPE (Dean's letter). Those accepted into the program will need to successfully complete both USMLE Step 2 CK and CS before the program starts.
2. Does the University of California have any specialized pathways?
Yes, University of California offers five specialized pathways. These include Primary Care Pathway, Resident as Clinician Educator (RACE) Track, Hospital Medicine Pathway, Global Medicine Pathway, and Integrative Medicine Pathway.
3. What matching service is used in Canada, and what does the application entail?
Canada uses the CaRMS system. Required components of the application are your curriculum vitae (CV), transcripts, Medical Student Performance Record (MSPR), reference letters, and personal statements (PS).
4. How many letters of recommendation does Massachusetts General Hospital’s internal medicine residency program ask for?
You are required to submit three letters of recommendation for Massachusetts General Hospital’s internal medicine residency program. You will need one from a medical school dean (Dean’s letter), one from the Department of Medicine chair or clerkship director, and 1–2 letters from faculty members or other individuals who can assess your skills and abilities.
5. Can I apply to Duke University without a USMLE Step 2 score?
You can apply to Duke University without a USMLE Step 2 score, but you will need to submit both Step 2 CK and CS scores before the program starts.
6. How many residents does the University of Toronto accept into its internal medicine residency program?
The University of Toronto accepts around 70 residents in each Core year of its internal medicine residency program.
7. I am a Black student applying to the University of Toronto. How do I participate in the Black and Indigenous Resident Application and Mentorship Program?
Students who want to participate in the Black and Indigenous Resident Application and Mentorship Program will need to start their CaRMS personal statement with “I wish to be considered for the Black & Indigenous Pathway.” The personal statement should highlight how the candidate’s identity impacts their view of medicine and career goals.
8. What are some factors I can use to find out which medical school is the best?
There are a lot of factors to consider, such as acceptance rates, notable faculty, research programs, student life, curriculum, facilities, and more. The “best” medical school is always the one that fulfils your own objectives and goals for your career in medicine.