Must it always be only in rueful valedictory repentance- that the gatekeepers of medical education come to see what they have been doing? -Henry Dicks, 1965. To the Editor: Whitcomb's article on the looming crisis facing graduate medical education (GME) echoes many of the comments that Dicks has made about GME. Dicks, however, was writing not in 2011 or even 2000 but, rather, 1965. Clearly, the problem of developing a GME system to meet the health needs of the population has confounded policy makers for generations. Why is it so difficult, and can we do any better in the future? The simple answer is that it is not a simple problem and that many conflicting forces can have unforeseen and sometimes perverse effects on the system; some of these can take years to take effect.
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