Early specialization in surgical training: an old concept whose time has come?

The complexity of surgical science and surgical patient care is increasing at an accelerating pace. As a consequence, many areas of surgical practice once within the scope of general surgery have evolved into distinct specialties with unique advanced training requirements. Given this evolution in surgical specialization, many have considered that our current model of surgical training--a 5-year residency in general surgery, followed by any of a wide variety of fellowships to acquire refined, advanced training--is due for major restructuring. The current debate focuses on the benefits and potential disadvantages of earlier differentiation of surgeons into specialty training pathways. The structure of surgical training, including the definition of core surgical training and the optimal structure to introduce advanced specialty training tracks, is the central issue in this debate. This article reviews the question and current deliberations of the stakeholders in graduate surgical education and training.