The Rise of Graduate Medical Education
In the years following World War I, medical knowledge, techniques, and practices were growing and changing too rapidly. Even a superior experience in medical school could no longer prepare a person for private practice. Accordingly, a period of hospital education following graduation—the “internship”—became standard for every physician. In addition, further training was necessary for those who wished to enter specialty practice or pursue academic careers. For these purposes the “residency”—a several-year hospital experience following internship—became the accepted vehicle. In the creation of a system of graduate medical education, the Johns Hopkins Medical School played a seminal role. Nevertheless, the university-based, academic model introduced by Johns Hopkins was never to succeed so completely in graduate medical education as it did in undergraduate medical education. Always, the tension between education and service, between university ideals and apprenticeship traditions, wracked even the best intern and residency programs. Moreover, unlike undergraduate medical education, which remained university-based and regulated, graduate medical education became hospital-based and professionally regulated.
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