General internists have been applying principles of clinical epidemiology and decision theory in clinical investigations,1-4 and the resulting data are both stimulating and confusing to health professionals and patients alike. At the same time, fewer students are heading into internal medicine. This has prompted academe to reevaluate undergraduate and graduate medical education programs in internal medicine, with many suggesting that rapid changes on the hospital ward reinforce the physician's office as the focus for education. This not-so-quiet revolution is bringing clinical epidemiology, decision analysis, and medical ethics to the center of the stage, with particular focus on patient preferences (utilities) and shared patientphysician decision making.
In the most recent National Residency Matching Program, some of the most prestigious training programs in internal medicine found themselves with open positions. Why fewer students are choosing internal medicine is not altogether clear. In part, medical students may be choosing other specialties because