In Reply I sincerely thank Sue-Chue-Lam for his interest in the published article in JAMA Surgery, “Reflections of a Millennial Surgeon: The Changing Face of Medical Education.”1 His view on the importance of critical appraisal of teaching strategy within the constant flux of educational development between generations of learners is of paramount importance. A field cannot move forward without first looking back through the lens of process improvement. I soundly agree with the claim that human behavior is significantly influenced by material conditions, especially within the context of medical training. In reciprocal analysis of strategies in training Generation Y and Z learners, how are our contemporary processes in medical training structured to reflect the real “material conditions” of a life dedicated to the care of surgical patients? While shift work may improve the perceptions of work/life balance in the mindset of modern trainees, is this model truly preparing surgeon-physicians for the demands of patient care duty when they become independent practitioners? The incidence of burnout among practicing surgeons has not decreased with the addition of such restful cordons in training and has been associated directly with frank unpreparedness for patient care after training requirements have been completed.2-4 The group of boys who survived the Tonga shipwreck5 had no such escape mechanisms of comfort when their limits were tested, and their “material conditions” were not subjected to artificial mechanisms of wellness; yet, they succeeded in their endeavors.
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Clifton W. Change the Trainee, or Change the Training Environment?—Reply. JAMA Surg. Published online September 16, 2020. doi:10.1001/jamasurg.2020.3790
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