Internal Medicine: the Practice Eligibility Route

How training is structured

The Royal College sets out the training for Internal Medicine in the blocks below. An internationally trained specialist is assessed on whether their own training and practice record is comparable in structure and content.

Required experiences

Specific experiences the Royal College names for this discipline.

• A.1 A minimum of thirteen (13) blocks of general Internal Medicine training
• A.1.1 A minimum of six (6) blocks of general Internal Medicine in-patient care in Clinical Teaching Units or preceptorships (a defined period of training organized around focused immersion in a single preceptor's practice)
• A.1.2 A minimum of three (3) blocks or equivalent longitudinal experience in consultations to other services, including all of: A.1.2.1 other in-patient services (e.g. surgery, gynecology, obstetrics, internal medicine); A.1.2.2 emergency department; A.1.2.3 ambulatory care
• A.1.3 A minimum of one (1) block of community-based general Internal Medicine
• A.2 A minimum of four (4) blocks in the care of critically ill patients
• A.2.1 A minimum of two (2) blocks of adult Critical Care Medicine
• A.2.2 A minimum of one (1) block of Cardiology, including acute coronary care in a coronary care unit
• A.3 Fifteen (15) blocks or equivalent of selectives, including at least eight (8) of: 3.1 Cardiology; 3.2 Clinical Immunology and Allergy; 3.3 Clinical Pharmacology and Toxicology; 3.4 Critical Care Medicine; 3.5 Dermatology; 3.6 Endocrinology and Metabolism; 3.7 Gastroenterology; 3.8 General Internal Medicine; 3.9 Geriatric Medicine; 3.10 Hematology; 3.11 Infectious Diseases; 3.12 Medical Biochemistry; 3.13 Medical Oncology; 3.14 Nephrology; 3.15 Neurology; 3.16 Occupational Medicine; 3.17 Palliative Medicine; 3.18 Physical Medicine and Rehabilitation; 3.19 Respirology; 3.20 Rheumatology
• B.1 Up to one (1) year of further residency in Internal Medicine, including: B.1.1 minimum one (1) block of adult Critical Care Medicine; B.1.2 minimum one (1) block of community-based general Internal Medicine; B.1.3 minimum one (1) block (or longitudinal equivalent) of ambulatory care; B.1.4 minimum two (2) blocks in a junior consultant role, in preparation for transition to independent practice

Flexible or selective components

Where the requirements allow a choice.

• A.4 Up to six (6) blocks or equivalent of electives: A.4.1 any of the above selectives; A.4.2 a maximum of three (3) blocks of research; A.4.3 a maximum of three (3) blocks of other approved training
• B.1.5 Up to seven (7) blocks of electives within the further Internal Medicine residency
• B.2 Up to one (1) year of clinical residency in any of the subspecialty areas listed under A.2 or A.3
• B.3 Up to six (6) blocks of approved training in other areas such as health services research, clinical epidemiology, medical education, basic sciences, or clinical/basic research

Common questions

What is the Practice Eligibility Route in Internal Medicine?

The Practice Eligibility Route (PER) is the Royal College process by which an internationally trained specialist can be assessed for eligibility to sit the certification examination in Internal Medicine without repeating a Canadian residency. The Royal College reads your postgraduate training and practice record against the published Specialty Training Requirements for the discipline.

What training does the Royal College expect in Internal Medicine?

The Specialty Training Requirements describe four (4) years of approved residency training. The full block-by-block structure is set out on this page, taken from the Royal College document for this discipline.

Does meeting the training requirements guarantee eligibility?

No. Eligibility is a committee decision made on your individual file, and other factors are considered. This page reproduces the published requirements so you can see how your own training compares before you apply; it is not an eligibility ruling.

Where do I start?

Read the six steps in the PER guide, then have your training mapped against the Specialty Training Requirements before you pay any fees. The free PDF for this specialty carries the steps, the document checklist, and the Internal Medicine requirements in one file.

More on the route itself: the full PER guide covers the six steps and the document checklist. Royal College examination dates for every discipline are on the Deadline Radar, and Canadian clinical fellowships in Internal Medicine are in the Fellowship Finder.