Postgraduate Residency Training in Surgery in the United States

Abstract

It is indeed an honor for me to represent the United States in this symposium on surgical education that has been organized to pay tribute to Professor RUDOLF ZENKER on the oc~asion of his 75th birthday. I know Professor ZENKER best through his many distinguished students who currently occupy chairs of surgery in universities throughout Europe, and it is fitting that this great teacher be honored by a meeting in Munich devoted to education. Moreover, it is not only gracious but also entirely appropriate that Professor HEBERER has seen fit to include a discussion of surgical residency training in the United States in this sympo­ sium honoring a great German educator, since the American surgi­ cal residency system had its origins in the university clinics of Germany. More specifically, postgraduate surgical training in the United States was a direct outgrowth of the LANGENBECK-BILL­ ROTH surgical school of Germany. The father of the American surgical residency system was WILLIAM STEWART HALSTED. In 1878, HALSTED visited Germany and was pro­ foundly impressed by the German master surgeons and their struc­ tured program of surgical training, which contrasted strikingly with the rather haphazard surgical apprentice system in the United States. He met BILLROTH and established a close and life­ long friendship with BILLROTHs first assistant, WDLFLER. When HALSTED became Chief Surgeon at The Johns Hopkins Hospital in 1889, he immediately adopted a modification of the German method of postgraduate training in surgery [1,2]. It was this adapta­ tion that subsequently became the model of surgical residency training in the United States and profoundly influenced the course of American surgery. During his 33 years as the Chief Surgeon at The Johns Hopkins Hospital, HALSTED produced 22 pro­ fessors of surgery and 16 associate professors and assistant professors [3]; this legion of disciples propagated his system of surgical education throughout our land. Surgical Manpower in the united States The main objective for all postgraduate education is the produc­ tion of the appropriate number of skillful specialists to meet the health care needs of the citizens. In the United States there are 380,000 physicians serving a population of 205 million. Of these, 52,000 or 16.8% are board certified surgeons practicing general surgery and the various surgical specialties [4]. An ad­ ditional 30,000 physicians perform some surgery, often of a minor nature and often only occasionally, although they are not board certified specialists. The number of nonboard certified surgical practitioners has been declining rapidly during the past two de