Alternative training models for surgical residency

Alternative # 1: spending more time in residency on the things general surgeons actually do

As chair of the American Board of Surgery Committee on Education and Training, I was asked about a year ago to lead a group that would reconsider the structure of general surgical training. In trying to understand what should be taught in a general surgery residency, it seemed sensible to look at what practicing general surgeons do. As part of recertification in surgery every 10 years, practicing surgeons are required to submit to the American Board of Surgery a list of their cases spanning the

Alternative # 2: changing the training system from hospital-based teams to other models

All residency program directors faced a stark new reality in June 2002, when the ACGME announced new work hour regulations for residents, limiting the week to 80 total hours of duty and imposing other strictures to ensure that residents were not overly fatigued when caring for patients. Surgical faculty members went through denial and anger and other phases of the grieving process as they realized that things would never be the same again.

My attitude toward this change was supportive. As I look

Real-life experience with alternative training models

We have now had about 8 months of experience with a completely re-engineered surgery residency at Northwestern, in which a night float system was introduced, a number of mentored rotations were developed, and a small amount of elective time was introduced. The most unusual aspect of our current training program is the significant percentage of the training that is provided in the mentored rotations. Fig. 1 shows the current layout of the 5 years of general surgery residency, indicating the

The curriculum of the future

For the curriculum of the future, it would be desirable to move to a more robust system for demonstrating the competency of the trainees [7], [8]. I suspect that most of us could easily identify the attributes we would like to see our residents display. In fact, the ACGME has helped us identify the attributes of a good surgeon by specifically enumerating the six competencies that they want all residents to display [9]. These include robust medical knowledge and skillful patient care, but go

Acknowledgements

The author would like to recognize Debra DaRosa, PhD, for her intellectual contributions in residency redesign and to surgical education, and Elizabeth Ryan, MEd, for the evaluation data from the new residency models.