Even after briefly parachuting into the world of graduate medical education to report on the monumental undertaking there that's in its early phases, it's clear that years of hard, unreimbursed and mostly unrecognized work await the ophthalmologist-educators whom we interviewed for our cover story.

Though it may seem an "academic" exercise to outsiders and even to practicing physicians, the impetus for change in medical education reaches beyond the walls of the nation's medical schools. Essentially, the government, the insurers paying for health care and the public are no longer satisfied with the assumption that the current system is producing competent doctors. They want proof.

That means scientifically validated, testable and reproducible systems that first quantify and eventually begin to improve on thier results. That means new  concepts, new systems and new terminology, like Systems-based Practice, among others. While the confined world of medical residency is a far easier laboratory in which to develop and test new ways of achieving the goals, it's short-sighted not think that, at some point, some version of these concepts and methods will be applied to practicing physicians.

When they encountered what at first glance appears to be a massive paper chase, most of the people interviewed for the story say they went through the same evolution: from cynicism to suspicion to acceptance and, in some cases, even enthusiasm (though they're not all there yet). Practicing physicians, no matter how any changes in recertification play out over the coming years, will react the same way.

That's why it's encouraging to hear Dr. Andrew Lee of the University of Iowa, one of the young educators shaping ophthalmology's response to these changes, talk about new concepts like Practice-based Medicine not in terms of statistics and forms, but real-world action.

Improved interaction with general practitioners (any interaction with GPs) and other specialties is a simplistic but generally accurate description of one of the goals of Practice-based Medicine. Why do only 30 percent of diabetics undergo the evidence-based recommendation of an annual eye exam? Many reasons. But one is that their GPs and ophthalmologists were never taught Practice-based Medicine. What would happen if they were? "If this system works," says Dr. Lee, "we save eyes."

Perhaps that kind of "eyes on the horizon" approach is what keeps Dr. Lee and his colleagues at work. There are massive changes ahead for medicine, and already afoot in the medical schools. You can learn about them in the feature story, and by visiting acgme.org/Outcome/.