EDITORIALS Training Internists for the Changing Medical Scene

substantive questions about the need for changes in internal medicine training. By their observation, internal medicine departments historically have been the "flagship units " at most medical schools and have been viewed as "the specialty that most effectively integrated the science and art of medicine, " thereby attracting the best and brightest of medical students. Because the authors believe internal medicine is in a maelstrom of changing practice patterns, they contend that significant changes in focus must occur within internal medicine training programs if the programs are to remain relevant to the practice of medicine and stay attractive to potential trainees. Their strong arguments defending these views also raise several fundamental issues concerning the institutions responsible for training practitioners of internal medicine. Without question, the economic forces that Shroeder and colleagues recognize as having significant impact on the practice of medicine exist and are increasing. The current emphasis on cost containment has clearl