The WAMI Program: 25 years later.

The Washington, Alaska, Montana and Idaho (WAMI) Program is a four-state decentralized medical education program initiated at the University of Washington School of Medicine (UWSM) in 1972 with the goals of: (1) admitting more students to medical school from all states, (2) training more primary care physicians, (3) bringing the UWSM's resources to needy communities, (4) redressing the maldistribution of physicians by placing more MDs in predominantly rural states and (5) avoiding new construction costs. The program consists of a University Phase and a Community Phase, the latter extending to residency/postgraduate medical training. Thirty-three years on, and now renamed WWAMI (with the inclusion of the State of Wyoming), nearly 1200 students have been admitted to the program, with 5947 clerkship experiences and 2282 resident rotations, and the original goals of this experiment in decentralized medical education have been largely met. Almost half of all residents supported by the program return home to practice, and of graduates who underwent a part of their training in Alaska, Montana and Idaho, 64.7% returned home to practice. This paper reports on some lessons learned and speculates whether the WAMI program can keep pace with the rapid changes in medical education.