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Affiliation of hospitals for surgical residency training has in the last 25 years undergone unprecedented expansion. Its impact on the quality of the training experience varies depending on whether the concerned program is of the university or clinical type.
The university resident's American origins are in the Halsted-Hopkins model which spread from Baltimore during the period 1890-1930 through Halsted's disciples. Since then he has been widely copied, but rarely in purified form. Halsted's inspiration came from the golden age of German academic medicine, 1850 to 1914. Although not strictly comparable with its American offshoot, in that it focussed primarily on the undergraduate, the German system for the first time identified teaching of surgery with academic rank and productivity.
In the university residency the learning experience springs from a thorough grounding in the principles of surgical biology more than from precept. A strong full-time chief in the background, but very much
Graduate Surgical Training and Affiliated Hospitals. Arch Surg. 1971;103(2):350-351. doi:10.1001/archsurg.1971.01350080266043