In his allegorical series of paintings, The Voyage of Life, Thomas Cole portrayed the challenges people encounter during 4 stages of life. The painting Youth on the cover of this issue of JAMA launches the 2005 Medical Education issue, which contains articles bearing on challenges facing physicians through the stages of their profession, from the comparatively youthful medical student years, through residency, and into the time of establishing their careers and maintaining excellence.

Youth depicts a young man focused on moving toward his ideals, which seem to be directly ahead of him. Unfortunately, out of his view but visible to us, the river will take an unexpected turn leading to rapids and a ravine. Similarly, many unexpected (and sometimes unperceived) challenges to ideals are faced by . . . [Full Text of this Article]