Three-Phase Model for Surgical Training: A Proposal for Improved Resident Training, Assessment, and Satisfaction

Abstract

The currently prevalent Halstedian structure of resident training for surgery, effective in producing outstanding surgeons for generations, has been criticized for the failure to adapt to trainees’ needs in modernity. Critics contend that our time-based system does not individualize training, and that it assumes that residents, by being in the hospital long enough, will be prepared for practice. Moreover, some have raised concerns that residents are evaluated suboptimally during training, and sometimes advance into their senior years before clear deficiencies are formally recognized and ameliorated. Finally, there is increasing concern among educators that candidates presenting for the certification examination have insufficient knowledge and experience in critical areas of surgery. In an era of an ever-increasing scope of training and regulatory requirements, and decreasing resident work hours and autonomy, nearly all residents seek additional training before entering practice. Their sense of lack of preparation for independent practice s thought to be a primary cause for this trend. Residents and educators in a variety of specialties believe that the limitations of work hours interfere with their educational goals. Our current pedagogy is disadvantaged by conflicting demands on the faculty, who are forced continually to increase their clinical throughput while being insufficiently incentivized to teach. Additionally, as a direct result of work-hours restrictions, faculty receive less dependable and consistent resident coverage. Residents, themselves, are also conflicted: Despite their escalating educational loans and social pressures which might drive them to begin gainful work, more than 80% pursue fellowships. Moreover, the American oard of Surgery qualifying and certifying examination passage ate has trended downward since the introduction of the work-