INTRODUCTION The decade of the 1980s continues to be marked by significant societal changes that have an impact on American medical education. Foremost among the trends has been the declining number of applicants to US medical schools. Undergraduate medical education faces enormous challenges as the pressures for accountability by the profession mount. Not only must medical educators respond to the rapidly expanding knowledge base in the biomedical sciences, but they must balance that with the charge of training physicians who will spend more time with their patients and demonstrate compassion and caring. New methods of health care delivery, shorter hospital stays, and the ascendancy of the ambulatory care setting have all created a need for reexamination of the methodology and the settings that can best be employed for teaching medical students. Challenges such as the acquired immunodeficiency syndrome epidemic, the continued pressures of professional liability, and demands for better supervision