FELLOWSHIP PROLIFERATION - IMPACT AND LONG-RANGE IMPLICATIONS

The changes and modifications that occur in the practice of medicine a re often recognized in retrospect, rather than being appreciated as th ey develop. As we review that past century of medical education, we ca n see clearly that medical education and medical practice have been im proved dramatically by three ''tidal waves'' of change. The first of t hese major shifts occurred as specialties began to evolve more clearly out of the general practice of medicine; the second tidal wave occurr ed in parallel with the evolution of national mechanism for accreditin g training programs and certifying individuals; and the third tidal wa ve (the one we are experiencing now) is the dramatic proliferation of subspecialist and subspecialty training programs.