I chose this topic because many of us are frustrated by events affecting medical education that seem to be out of our control and have the risk of leaving us apathetic and our progeny aimless. I will focus specifically on graduate medical education (GME) because it is closest to home for most of us and the concepts readily translate to other realms. I hope to identify some of the potentially opposing internal and external forces that have imposed strain on the educational experience. These forces, which have developed naturally or with our assistance and good intent, are pervasive and insidious and often threaten the education they may be intended to protect or promote. I offer my analysis of how we arrived at this point and some thoughts for ways to regain our enthusiasm and bearings.

The culture of medicine is changing dramatically in front of us, and it is not so easy to stop the world for us to get off. We remain bewildered by how far ahead we are in understanding fundamental features of biology; how far behind we are in delivering the knowledge to the bedside in a manner that improves care and satisfaction; and how much time we spend in medicine doing less of what we thought we were educated to do. It is no mystery that there will be further reduction in the amount of time that residents spend in direct patient care during their formative years of medical training with the decrease in work hours and increase in layers of regulations and red tape. If Malcolm Gladwell (1) is correct, one predictable consequence is that it will take longer to reach 10,000 h, which he cites as the practice time “required to achieve the level of mastery associated with being a world-class expert—in anything.” We can bemoan the loss of the milieu and experiences that made our own training exciting (perhaps glorified by our filtered memory) or we can find the means to reinfuse vigor and creativity into our progeny through their education. Accordingly, I hope to stimulate you to consider: how we can keep our students engaged, challenged, and excited; keep ourselves equally engaged, challenged, and excited; and keep the educational process vibrant and stimulating. Frankly, if we cannot address this problem, who can? We do not have the luxury to reassign the responsibility to those without the authority.

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