What combination of clinical, evaluative, and didactic residency experiences makes the best internist? Despite 100 years of published standards for residency sponsorship, and 30 years after the formation of the Accreditation Council on Graduate Medical Education (ACGME), we know little about how many patients residents should see, how many hours of conference they should attend, what they should read, or how long they should train. We have few validated measures of an individual resident's competence (nor of a residency program's). There are many reasons'for our lack of evidence-based residency training: inpatient sendee needs of sponsoring institutions, the cost of experimentation and Innovation, and the burdensome, cookie cutter-Hke, process-based requirements imposed by the ACGME, just to name a few.
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