Over the past 3 decades, there have been many changes in surgical care, but relatively few modifications to general surgery training. The training of future surgeons must adapt to account for the current climate of duty hours, supervision, and technological changes. In some ways, change has begun, but it will accelerate. This Viewpoint addresses the current changes in care and training and details future directions for residency training in general surgery.
There have been myriad changes in technology over the past 3 decades.1 Advances in image-based technologies have allowed for nonoperative management of traumatically injured patients through improved diagnosis and treatment using noninvasive means; in prior decades, these injuries required exploratory laparotomy. While the advances have improved patient care, they have also resulted in fewer operative trauma cases than experienced by prior generations of resident trainees. The advances in minimally invasive surgery have similarly represented improvement for patients, but have resulted in residency graduates with very different case distributions than in the past.2 Similarly, less biliary tract and portal vein surgery is done today. Gastric surgery is also less common (except for bariatric) because of increased understanding of ulcer pathogenesis and treatment of Helicobacter pylori. Interventions for vascular disease are now commonly done by percutaneous means. In total, these changes have presented new challenges in preparing modern graduates to be proficient in open surgical techniques, as the surgeon in practice is often faced with urgent conditions that require such proficiency, even in this era of increased technology.