Changes in medical practice and in the financing of hospital care have resulted in a narrowing spectrum of adult medical illness among hospitalized patients. Residency training based primarily in the hospital underemphasizes many diseases and disorders that are treated exclusively at ambulatory sites. Curriculum modifications should allow for increased training time for residents in the ambulatory care setting. Reducing clinical inpatient service demands on residents and alleviating the attendant stress will allow more time for such educational experiences. The Medical College of Virginia has had recent experience with three modifications to the curriculum, which are intended to accomplish these ends: a specialized unit for inpatient services, which is not staffed by interns; a reorganization of the daily inpatient care schedule; and a modified "night float" team.
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