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Kenneth M. Ludmerer, MD; Michael M. E. Johns, MD

JAMA. 2005;294:1083-1087.

Because of the traditional subordination of education to service, graduate medical education (GME) in the United States has never realized its full educational potential. This article suggests 4 strategies for reasserting the primacy of education in GME: limit the number of patients house officers manage at one time, relieve the resident staff of noneducational chores, improve educational content, and ease emotional stresses. Achieving these goals will require regulatory reform, adequate funding, and institutional competency in the use of educational resources. Modern medicine grows ever more complex. The need to address the deficiencies of GME is urgent.

Author Affiliations: Departments of Medicine and History, Washington University, St Louis, Mo (Dr Ludmerer); The Robert W. Woodruff Health Sciences Center, Emory University, Atlanta, Ga (Dr Johns).

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