Evolving practice of general internal medicine in the current medical landscape.

General internal medicine is a specialty that is heterogeneously implemented across the world. In some places, it includes physicians who have undergone basic internal medicine training with no subspecialisation, whereas in other places, these physicians undergo further training to become 'advanced internists' (with the corollary name of advanced internal medicine). General internists run inpatient medical wards and ambulatory care services, provide consultation to general practitioners and/or have their own primary care practice. Within the hospital, the role of the general internist had traditionally been ambiguous - often serving as a 'catch-all' medical service for patients deemed unsuitable to be managed under subspecialty teams. Over the years, different models of care within general medicine have been trialled to varying effects, ranging from the 'generalist-specialist' model (also known as the hospitalist model, where the general internist coordinates care for multimorbid patients with liaison with relevant subspecialties) and 'acute medicine' model (general medicine care only for the first 72 h of admission in an acute medical unit, after which patients who require continued admission go to a subspecialty) to the 'specialist-generalist' model (where all specialists are to care holistically for general medical issues beyond the specific condition that warrants subspecialty review). In this article, we advocate for a renewed framework of general internal medicine that focusses on managing undifferentiated, complex and multimorbid patients, providing clinical care that addresses prevailing gaps in hospital-based practice, developing robust hospital-at-home services and championing quality improvement, education and administrative excellence within the medical ecosystem.