If one out of six of our medical-school graduates were unable to pass his state board examination, there would be great alarm. The fact that almost this many young physicians, having completed acceptable training in internal medicine, are unable, even after several attempts, to pass the examination by the American Board of Internal Medicine should be cause for concern. This fact in itself may have several possible explanations, but I bring it up as only one of the reasons why we should take a fresh, new look at training in internal medicine. In the changing scene of medicine I believe that it is high time we review our methods and goals.
With the decline in general practice in the classic and broad sense, there has been a reciprocal rise in specialism in the United States (Fig 1). To me the most impressive fact is the rapid increase in the number