We agree with Dr. Mansi that the model of internists serving as "traffic directors" not only is unattractive to physicians but also delivers suboptimal care to patients. Appropriate procedural training is an important component of residency. Difficulty in assuring that each resident receives sufficient experience to achieve competency and the widely differing needs of residents have contributed to a lack of agreement about what procedures should be required (1, 2). We favor a model in which procedures fall into 3 categories: 1) those that are required of all residents, 2) those that should be available and are encouraged but are not required during training, and 3) specialized procedures that require additional training and experience that can be obtained during the customized component of residency training by residents who wish to gain competence in performing these procedures. Such a model for procedural training is currently being developed by the AAIM Education Redesign Task Force.

Dr. Horning and Dr. Dalekos and colleagues correctly point out that redesigning training is only one component of the changes that must be made in the best interests of internists and their patients. Additional objectives, such as redesigning the dysfunctional payment system and improving physician satisfaction (through decreasing physician hassles and implementing better practice models), are high priorities of the ACP, which is working actively to address these issues. Society must recognize that broadly trained specialists in internal medicine represent the cornerstone of the U.S. health care system through their application of scientific and pathophysiologic knowledge to diagnosis and treatment and through their longitudinal care of patients with complex and chronic illness.

Drs. Fitzgibbons and Meyers have outlined the activities of the AAIM Education Redesign Task Force in contributing to the redesign of residency training. The Task Force has been extremely valuable in convening a variety of stakeholders in internal medicine training to implement many changes proposed in our paper, as well as in the APDIM position paper by Fitzgibbons and colleagues (3). In response to the challenge posed by Drs. Schroeder and Sox (4) to "putt or get off the green," the Task Force will be an important vehicle for effecting changes in training. The ACP is pleased to be participating in the Task Force, and we look forward to substantial progress in achieving the goals of redesigning residency training.