THE APPARENT mandate to move to a predominantly managed-care health delivery system is a major concern to all internal medicine residency programs. The consequences of managed care for these programs are profound and include an acceleration of the shifts from the following: hospital to out-patient training; an environment of service use to service conservation; a culture of "cure" to one of "care"; a relatively narrow to a broader patient population base for residents; and a focus on specialism to an emphasis on generalism. The implications of these consequences are far-reaching, requiring curricular changes and placing constraints on programs and residents while potentially enhancing the residency education—career continuum. The challenges of managed care for internal medicine residencies are considerable. While struggling to develop appropriate patient and faculty bases and assure quality control and effective teaching, programs also need to maintain a scholarly approach to care. The resident's traditional focus on the
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