The professional standards review organization (PRSO) program offers both a challenge and an opportunity to the academic medical center. Application by the local PSRO of objective measures of the quality and medical necessity of services challenges the medical center to demonstrate that its self-image of excellence is correct. Educating and training medical students and house staff in methods of self-evaluation and peer review could have a major impact on both the success of the PSRO program and the quality of medical care. Evaluation of the educational programs of the medical center through review of actual practice behavior presents an unparalleled means for improvement in undergraduate, graduate, and continuing medical education.