The sections that follow describe the existing and planned curricular innovations for the training of the general internist at their institutions, present the philosophies underlying these educational changes, and conclude with some caveats for future training. AT WASHINGTON UNIVERSITY The Medical Care Group of Washington University School of Medicine, St Louis, is an experimental prepaid group practice. This program was designed as a research project in the use of medical care services. Since completion of the initial research effort, it has provided the major site for a training program for general internal medicine and pediatrics. This prepaid group practice is staffed by internists, pediatricians, and obstetricians providing primary ambulatory, hospital, emergency, and home services. Specialists on the full-time faculty of Washington University provide consultations, surgery, x-ray, and other services. Medical Care Group services were financed by a health insurance option added to the patient's existing hospital plan. Enrollees were randomized