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June 1987

Specialization: Competence vs Expertise

Author Affiliations

San Francisco

Arch Surg. 1987;122(6):637. doi:10.1001/archsurg.1987.01400180019001

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Surgical leaders have expressed concern that excessive "fragmentation" of our profession into specialties and subspecialties threatens to destroy surgical unity and important traditional values.

From the days of Halsted surgical training has encompassed all aspects of the human anatomy. In keeping with that tradition it has characteristically been a group of general surgeons who provided the energy and imagination to pioneer the development of each new specialty segment of surgery. Not surprisingly these accomplished general surgeons usually chose not to abandon the rest of their practice and resisted measures to identify the new specialty separately from the parent discipline.

That posture, I believe, is detrimental to progress and quality. The explosion of technical and informational knowledge in the realm of general surgery and its closely allied subspecialties now exceeds the capability of any individual to absorb and apply all of it expertly. It behooves us to examine whether the format

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