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Thank you very much for inviting me to start off the discussions today on postgraduate medical education. Historically, postgraduate education has always been grounded in the perception of the specific health care needs of patients. Therefore, I'm first going to address some of the more important health care needs of children, emphasizing the unmet needs which future pediatricians must be prepared to meet. Then I'd like to move on from these discrete problems to several very difficult fundamental challenges that cut across rotations and the residency years. There is a saying attributed to Mark Twain that might well have been directed to us as educators. "It is noble to teach oneself; it is still nobler to teach othersand a lot more trouble."¹ These cross-cutting challenges are a lot of trouble to address.

But to begin, let's consider the health needs of children. Many groups of children deserve attention; however, 6 subsets, in particular, stand out. I'm going to comment briefly on each of these from the perspective of residency training.

First, there are those children and youth requiring hospitalization for high levels of care. The numbers of children and youth receiving tertiary and quartinary care have been relatively stable for several years.² It is unlikely that the number of acute hospital days of care for these children will increase. The trend to diagnose and treat more and more of these children in ambulatory settings is likely to offset the introduction of new hospital-based diagnostic and treatment modalities.

These patients are usually the recipients of the mainstream of direct services and research provided by the faculties of academic pediatric departments and, not surprisingly, academic departments across the country care for a large proportion of this total group. Participation in the care of these children also constitutes a major part of the . . . [Full Text of this Article]