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The quality of health care in this country depends, in part, on the quality of physician training. Educators in graduate medical education (GME) increasingly are concerned that residency training is not keeping pace with the changing demands of medical practice. This widening training–practice gap creates challenges for physicians entering practice, burdens physician employers with educational responsibilities, and has the potential to negatively affect the quality of health care. This article reviews the data supporting these concerns, considers how GME arrived at this state, and suggests a number of steps that need to be taken to begin to narrow the training–practice gap.