Among those responsible for graduate training in internal medicine, the focus of attention recently has been the designing of programs that emphasize the concept of general internal medicine and that will "produce" general or primary care internists. 1 Innovations in program design have included arrangements for residents and staff to have responsibilities for both inpatient and outpatient phases of care by organizing "firms" 2 and have included greatly increased expansion (up to 50%) of the time in the training program in ambulatory care. 3 Innovations in design of those portions of training programs where residents are confronted by the challenges of critical care medicine, namely, on hospital wards, have not been discussed. Nevertheless, improvements are needed here as well. Persistent complaints by residents are that while performing inpatient services that use the traditional general medicine ward attending system, they spend inordinate amounts of time presenting specialty problems to general medical attending