Fellowship Proliferation: Impact and Long-range Implications

The changes and modifications that occur in the practice of medicine are often recognized in retrospect, rather than being appreciated as they develop. As we review the past century of medical education, we can see clearly that medical education and medical practice have been improved dramatically by three "tidal waves" of change. The first of these major shifts occurred asspecialtiesbegan to evolve more clearly out of the general practice of medicine; the second tidal wave occurred in parallel with the evolution of national mechanisms foraccreditingtraining programs andcertifyingindividuals; and the third tidal wave (the one we are experiencing now) is the dramatic proliferation ofsubspecialistsandsubspecialty trainingprograms.