Graduate medical education confronted

Abstract

RECENT changes in the financing of hospital care have precipitated new activity and interest in graduate medical education by calling attention to preexisting forces already affecting the system. Many things are happening simultaneously. Intensive hospital care of patients with increasingly complex cases admitted to teaching hospitals has limited the scope of both graduate and undergraduate medical education. The high cost and increasing organization of medical care already have led to a steady shift of care from the hospital to the ambulatory setting. Because of these changes, several commentators have recommended expansion of the content of graduate and undergraduate medical education to include more primary care and social and behavioral sciences^1,2and a shift in its location to ambulatory settings.^3,4Major changes have been suggested in the specialty mix of graduate medical education, including a new primary care specialty.^5,6Two separate, large task forces have recommended changes in