SPECIAL COMMUNICATION Reforming Graduate Medical Education

THE CURRENT FUROR OVER RESI-dent working hours has thrustgraduate medical education(GME) into the spotlight. In view of its centrality to the education of physicians, GME appropriately re-ceives such attention. It is residency that prepares physicians for the indepen-dent practice of medicine and plays a crucial role in shaping their habits, be-haviors, attitudes, and values. However,GMEhasalways fallen short of itspotential.Today’sproblems inGME do not reflect new developments but rather a continuation of issues that have plagued the enterprise for more than a century. This article will trace the evo-lution of GME as a way to place current issues inahistorical andeducational con-text. This background will be used as a means to suggest reformsandactions that might finally invigorateGME.The over-arching theme is that what matters in residency training is not the hours of work alone but what residents do dur-ing those hours. Throughout the his-tory of GME, the delicate balance be-tween education and service has been heavily tilted toward service. This bal-ance must be redressed and the educa-tional component of residency training reaffirmed if we are to produce the best physicians possible to serve the public in the century ahead