The Progression of Surgical Training Model Over Time

In the mid-16th century, medical apprentice training began at around 13 years of age under a single mentor.

This process involved direct observation and imitation of skills in a clinical environment for 5 to 7 years, which was followed by independent practice. There was no regulation on the requisite skills, structure of training, or oversight after independent practice.

Over time, the development of the Halstedian pyramidal graduated autonomy residency model, and the formation of medical boards provided a necessary structure for surgical training.

The evolution of standardization across hospitals and residency review committees and a shift to competency-based education have propelled us into the modern era.

The future of surgical education depends on surgeon leaders recognizing the challenges inherent in acquiring a massive amount of requisite knowledge and skills in an expedited amount of training time.

Rather than a linear “see one, do one, teach one” model, trainees are expected to evolve in multiple domains simultaneously to become well-rounded physician surgeons.

Surgical educators will need to plan beyond the acquisition of technical skills and medical knowledge to emphasize the value of ongoing self-reflection and feedback, increase specialized certification, and encourage the development of nontechnical skills.

The next major shift in the training model is toward a full holistic review of how the trainee performs at all core competencies in the setting of the larger healthcare system.