Medical education, research, and practice are increasingly influenced by improvements in the general standard of living and by the enormous increases in funds available for medical research, teaching, and patient care. With this improved economic status have come pronounced changes in the general educational level, philosophy, and social status of the average patient. The number of nonpaying patients is rapidly declining everywhere, including in the university hospitals. These factors, along with better communication and transportation, have prompted improved medical care of all patients. The medical literature in recent years has reflected great interest in the critical evaluation of training programs for students and interns, but with few exceptions1,2 residency training programs in internal medicine have received little attention.
Whereas there are many factors which are modifying residency training in medicine, some of the most prominent are: (a) a great increase in medical knowledge with an accompanying increase in specialists in
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