The Culture of Surgical Training

Abstract

The culture of modern surgical training is difficult to quantify in absolute terms. We aim to provide context by examining the origin of surgical residency in the early twentieth century and how it evolved over time. In order to understand the culture underlying surgical training, three main stakeholders are identified including patients, surgeons, and residents. The relationships between these parties are explored, and common value systems are discussed. We examine modern barriers that residents face in the work environment and highlight the ways in which they contribute to burnout and attrition among surgical trainees. Positive and negative aspects of the hierarchical training structure and work dynamics inherent in surgical residency are analyzed. Mentorship is identified as a key component of the modern surgical education framework, though limitations exist in the scope of mentorship offered to trainees by attending surgeons. We discuss important realities of worldwide heterogeneity in surgical training culture and specifically utilize case examples highlighting differing surgical educational experiences in regions with limited resources. Limitations are highlighted acknowledging significant contributions from North American, European, and Australian groups to the body of literature cited in this chapter. Herein, we provide a snapshot of modern surgical culture. This chapter spans the inception of surgical residency programs, followed by key stakeholders and interprofessional relationships that are central to surgical training, and finally discusses surgical resident working conditions, power dynamics, and mentorship.