The dynamics of medicine force us to continually update the content of residency curricula. Before selecting the material to be added or withdrawn from the curricula, goals for the desired product must be established. Further, the potential effects of emerging disciplines on the structure and composition of departments and residencies must be carefully considered. The Residency Review Committee for Internal Medicine (RRC-IM) is the principal instrument for forcing the integration of emerging disciplines into clinical education. Several questions must be considered when deciding how best to integrate these new disciplines. Should selected internists be designated to teach them? What are the most appropriate training sites? Which disciplines should be linked for pedagogic efficiency and relevance? How do we separate the educational pathways for generalists and subspecialists? The strategy of requiring additional training for a second certificate from the American Board of Internal Medicine (ABIM) has served internal medicine well for 50 years. Innovations in science and technology, however, are occurring at an accelerated pace. One solution may be to separate standardized residency training into multiple 4-year tracks that produce variously skilled graduates.
