A national survey of department of medicine chairmen was conducted to learn their views of the status of academic general internal medicine. Developing a research program in general internal medicine was considered a high priority by 60% of the department chairmen at the time their general internal medicine divisions were established, and by 1981, 83% considered this a high priority. However, only 17% stated that significant progress had been made by the division at their institutions toward achieving this goal. Chairmen identified problems with funding for research, their faculty's ability to do research, and available time of faculty to conduct research. They stated their intention to assist the division of general internal medicine in developing a research program through financial and organizational support. At least two thirds planned to recruit selectively general internal medicine faculty who had research backgrounds and interests and to require the existing faculty to do research as a condition for continued appointment.

By 1979, 77% of medical school primary teaching hospitals had functioning general internal medicine units; less than 5% had existed before 1970. These units were established to meet institutional needs for primary care internal medicine teachers and clinicians. By the end of the decade they had achieved major administrative and staffing responsibility for a wide variety of general education and service activities. The scope of general internal medicine units goes beyond the narrow definition of primary care internal medicine, to include activities traditionally considered those of the entire department of medicine.

There has been no evidence that primary-care pathways, a recent innovation in internal medicine residency programs, have affected the career choices of their trainees. We report the experience of the first four cohorts of primary-care trainees in internal medicine compared with traditional-pathway trainees at Boston City Hospital. Primary-care residents remained committed to their plans for a career in general internal medicine throughout training. In contrast, two thirds of the traditionally trained residents who were planning a career in general internal medicine at the beginning of their training changed their plans to subspecialty medicine. Thus, the primary-care pathway reinforced the career plans of trainees in general internal medicine, whereas traditional training influenced potential generalists toward subspecialty medicine.

As part of the long-term evaluation of BCH'a primary care residency program, entering interns in pediatrics (N=13) and medicine (N=36) are assessed to see whether there are significant differences between primary care (PC) and regular trainees (PC) as they begin residency. Areas of assessment include cognitive knowledge (scores on the American Board of Pediatrics Pretest Exam, and Parts B and C of the American Board of Internal Medicine's Certifying Exam), and a training goals questionnaire. Aggregating board scores for 3 cohorts ( N=147 ), median distribution analysis shows no consistent differences between PC and PC pediatric interns. For the 3 medicine cohorts, no consistent differences emerged on Part B (factual recall knowledge), while on Part C (patient management) PC interns scored somewhat lower as a group than PC interns. An important finding from the training goals questionnaire (1974, 1975) is the high degree of comparability among PC and PC interns, Including similarity between cohorts and between departments. One difference was the interest of 17/28 PC medicine interns in subspecialty and research training. These findings tend to contravene the suggestion that those entering primary care have different attitudes and cognitive knowledge than their peers in traditional pathways. Further evaluation will show whether significant differences do develop between PC and PC trainees during their 3-year residency.