Graduate medical education in the United States.

This paper discusses graduate medical education in the United States under the headings of History, Goals and Incentives, Curricula, Influences, and Essentials. The factors that influence graduate medical education are: evolving knowledge and technology; local, state, and national organizations; class size and composition; changing student specialty preferences; methods of health care delivery; economic constraints; and governmental regulation. Given the desirability for change, those aspects of the graduate medical education experience that must be preserved include control of the educational process by educators, the primacy of education over service, adequate supervision, continuity of care, stable funding, educational breadth, and high standards.