As internal medicine changes in response to changes in biomedical knowledge and the organization of medical care, and as a broader definition of clinical competence is established, the challenge to educators and evaluators is to determine methods of measuring the competence and excellence of practicing internists. As the definition of clinical competence in internal medicine practice broadens, tougher standards will be needed to ensure that the internist is competent to practice in a more complex and challenging discipline. New methods of reliably evaluating clinical competence will be needed. These challenges of devising new standards and new areas for evaluation offer opportunities for research in medical education.