American Surgical Association Presidential Forum A Lifetime of Surgical Education: Can We Do better?

Surgical education has traditionally focused on the surgical clerkship during medical school and general surgery residency. Over the past 20 years, however, there has been a tremendous evolution in this very important mission of academic surgery. The most dramatic of these changes affecting resident training began with the implementation of residency work-hour restrictions in 2003. Changes in assessment of competency of the surgical trainee, challenges in providing resident autonomy in the era of reporting surgical outcomes and RVU-based compensation, and the increased emphasis on fellowship training, including integrated training programs or early specialization, have dramatically affected the training of surgical residents. Undergraduate medical education in surgery has been affected as medical schools have shortened the time spent on surgical rotations, while students are being asked to make decisions regarding choice of specialty earlier to consider new integrated specialty tracks. On a positive note, after selection of surgical specialty, many schools have an increased emphasis on preparation for residency training with “surgical boot camps.” Maintenance of certification of trained specialists has added to the administrative burden of surgeons already at risk for burnout. Finally, questions as to how to introduce new technology, or to retrain or retool practicing surgeons, have yet to be answered. Thus, one can safely conclude that the changes in surgical education are now extending throughout the lifetime of a surgeon. Despite these extensive changes and challenges existing at all levels, surgical education has only been the focus of the American Surgical Association (ASA) Presidential Forum twice over the past 20 years. In 2004,1 with a report that preceded the presentation of the ASA “Blue Ribbon” panel,2 and in 2012, with a review of the issues in general surgery resident training.3 It is the purpose of this panel to provide an overview of surgical education from medical school until the late stages of a surgeon's practice. To lead the discussions, we have called on leading experts and innovators in surgical education from both the United States and the United Kingdom, and also members of the leadership of the American Board of Surgery (ABS)