Presidential address: Medical education: Thoughts on the training of physicians and surgeons

Abstract

I would like to thank the Midwestern Vascular Surgical Society for the privilege of serving as the 25th President of the society. I am grateful for the collegiality, support, hard work, and wise counsel of the executive committee and very grateful for the friendships and camaraderie we enjoy at these meetings. Much has transpired since the Chicago meeting 1 year ago. The changes within our country and society as a whole have been swift and emphatic. There are also substantial challenges to the discipline of vascular surgery, the entire field of surgery, and indeed medicine as a whole. When provided an opportunity such as this, one becomes acutely introspective. Basic science and clinical research are the essential foundation underlying clinical surgery, but there are many much more qualified than I to make that point. I am an experienced and capable, but not extraordinarily gifted, technical surgeon. My choice of topics was therefore quite easy and reflects a lifelong interest in medical education. Three critical descriptors of US medicine in the early 21st century are that there has been an explosive increase in basic knowledge underlying clinical practice, that recent technologic advances are so fundamentally complex as to require radical change in educational paradigms, and that there really is a crisis in the delivery of healthcare. Much of the latter is financial, administrative, and regulatory but has enormous impact both on our practices and on our educational programs. Today, in an admittedly highly selective and personal way, I would like to share some thoughts on medical education. My comments will be primarily focused on general medical education issues, but clearly from a surgical perspective. I would like to take a few moments to briefly celebrate the past, identify issues critical to our medical education responsibilities (Table I), and, given the privilege of the moment, suggest certain courses of action.