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The changes and modifications that occur in the practice of medicine are often recognized in retrospect, rather than being appreciated as they develop. As we review the past century of medical education, we can see clearly that medical education and medical practice have been improved dramatically by three "tidal waves" of change. The first of these major shifts occurred as specialties began to evolve more clearly out of the general practice of medicine; the second tidal wave occurred in parallel with the evolution of national mechanisms for accrediting training programs and certifying individuals; and the third tidal wave (the one we are experiencing now) is the dramatic proliferation of subspecialists and subspecialty training programs.
Bailey BJ. Fellowship Proliferation: Impact and Long-range Implications. Arch Otolaryngol Head Neck Surg. 1994;120(10):1065–1070. doi:10.1001/archotol.1994.01880340015004
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