To the Editor.
—I have read with great interest your editorial "Standards for Graduate Medical Education," in the July Archives of Internal Medicine. It is an excellent review of some pressing current and future problems facing medicine residency programs.I fully agree with the need to establish a formula for determining a "service-to-education (S/E) value." Perhaps, however, it would not be necessary for all programs to have the same S/E ratio. For example, a community hospital training general internists might have a higher ratio for third-year residents (80% service, 20% education) than a university hospital training residents to become academic physicians (50% service, 50% education). A minimum acceptable lower limit should be established for the amount of education, however. Before any of this can be accomplished, we must develop a method to determine the ratio in any given program.Although you make a very reasonable case for establishing a standard