Graduate medical education in an HMO: an internal medicine residency program

Graduate medical education in the setting of a large health maintenance organization (HMO) is a challenging enterprise with surmountable problems and tangible rewards. Ten years ago an independent residency program in internal medicine was begun at one of the largest medical centers in the Kaiser-Permanente Medical Care Program in Northern California. The residency program, at the Kaiser-Permanente Medical Center in Santa Clara, is described and compared with other graduate medical programs. Included are discussions of curriculum development, faculty, funding, medical school affiliation, and the role of HMOs in graduate training.