The next generation of surgical residencies. What are the challenges and the opportunities?

I suggest restructuring general surgical residencies to facilitate training of surgical specialists and subspecialists. Basic surgical education for 1 or 2 years should provide a foundation of fundamental cognitive, technical, and patient management skills useful for all surgery residents, regardless of discipline. Intermediate surgical education for an additional 2 or 3 years should amplify cognitive, technical, and clinical skills and senior responsibility in general surgery for individuals entering a general surgical subspecialty or for advanced general surgery training. Residents seeking a career in advanced general surgery would take 2 additional years of training in advanced surgery. Such individuals could pursue additional subspecialty training and research experience to qualify as academic surgical scientists. Implementation of such innovations in general surgical education awaits the cooperative joint efforts of appropriate accrediting and certifying organizations, specialty societies, and surgical program directors.