Evolution of surgical education through the 20th Century into the 21st Century.

An abridged overview of the development of surgery and early surgical education, training and practice is presented, beginning in colonial America in the 18th century, extending throughout the 19th century, evolving rapidly during the 20th century, and progressing into the first decade of the 21st century. The metamorphosis and transformation of surgery training programs in the United States are described and discussed, together with some of the most relevant rationale and justifications for the many changes introduced, established, mandated and in progress. The current accreditation requirements, oversight, and governance of general surgery training programs; the incorporation of multiple technical and technological advances into general surgical practice; the addition of required training modules and systems to the programs; and their secondary implications, consequences, and impact upon the programs, are presented. These include financial and other resource impediments, the 80-h work week implications and constraints, the technological explosion, the demands of the required expanded general surgical curriculum and operative case experience, the continued erosion of general surgery by surgical and medical specialists, the increasing workload coupled with decreasing reimbursement for surgeons and their services; and the challenges and difficulties of amalgamating all of these confounding or conflicting factors into an effective and viable general surgery program. Finally, some of the personal insights, opinions, experiences, and philosophy of the author are incorporated into the narrative.