Surgical Education and Training: Historical Perspectives

Abstract

Surgeons trace their origins to the barber-surgeons, from whom they separated in the mid-eighteenth century to develop the art and science of surgery. It would take them another 100 years to transform themselves from the manual workers of medicine into a professional medical elite. The defining learning experience for aspiring surgeons was the apprenticeship. Originating in community settings, apprentices supplemented their education at the new hospitals and their adjoining learning facilities and private amenities and ultimately at the expanding Universities. The newly formed surgical colleges and corporations remained predominantly as examination bodies for a further century.

The first formal surgical training program originated in Germany. Introduced into North America in the late nineteenth century with initial acclaim, it was later considered too autocratic, pyramidal, and wasteful, and replaced in many centers by a more efficient system. Surgical apprenticeship in the United Kingdom remained unchanged until the latter half of the twentieth century when it was acknowledged as excessively long, wasteful, and ruinous for the many trainees unsuccessful in obtaining consultant hospitals posts.

It was the developments at the end of the twentieth century that led to a tipping point in surgical training and a search for a new educational model. Advances in educational theory, operating room efficiency, sicker hospital patients, emphasis on reducing medical errors, shorter residents’ working hours, and new surgical techniques such as minimally invasive surgery, changed the learning environment forever. In response, surgical skills laboratories were developed where the teaching, learning, and practice of technical and other skills could take place with immediate feedback prior to the resident performing surgery on patients. Efforts continue to ensure that a patient-centered and resident-orientated surgical education is available worldwide.