Internal Medicine Clinician-educators Respond to New Challenges in Graduate Medical Education

medical education in this country. New interns entered residency programs transformed by two sweeping reforms from the Accreditation Council for Graduate Medical Education (ACGME), which acted to raise our profession’s accountability for training new physicians. First, the ACGME approved duty hours standards for all accredited programs.1 This regulation reflects growing concerns, dating back to the Libby Zion case in 1984, about the effects of fatigue on resident well-being and patient safety. The ACGME first responded in the 1990s with loosely enforced work hours limitations, which varied widely by specialty. As many programs failed to comply (30 % of reviewed internal medicine programs cited in 19992), the public outcry grew louder and was heard in the Occupational Safety and Health Administration and in the halls o