Creating the educated surgeon in the 21st century

In this J. Roland Folse Invited Lecture in Surgical Education, given before the Association for Surgical Education, a resident considers two challenges for surgery and surgical training: the increasing importance of less invasive technologies, and the growing awareness of the importance of "systems" in care. As less invasive technologies evolve, the role of surgeons is being fundamentally challenged. Two alternative models of adaptation to technological change exist: the breast surgery model, in which surgeons restrict their role to providing open operative interventions, versus the neurosurgery model, in which surgeons adopt even noninvasive technologies in order to continue to manage diseases that might need open intervention. The neurosurgery model appears preferable but poses difficulties for the existing structure of surgical training. Evidence that surgical outcomes are critically dependent on entire teams of personnel, and not merely individual surgeons, may require changes in surgical training, as well.