Abstract
The call to change comes from restlessness stirred by a core value of medicine—to learn continually from experience and to improve for its own sake. When it comes to making changes in medical training, we are often prompted to make changes when we fall short of our intended goals, when these goals fail to meet the needs of a changed environment, or when the goals of medicine change. For graduate medical education in the subspecialties of internal medicine, the call for enhancement comes not from dramatic shifts in the goals of medicine or from a failure of the present educational process, but from a changed environment. In this paper we will discuss some of the indicators that point to opportunities to better align subspecialty training with important changes in the external environment of health care, medical education, and accreditation.
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