The making of a surgeon: 10,000 hours?

There have been many changes in the "making of a surgeon". Some of the key aspects that have altered residency/fellow training include work hour restrictions; a decrease in autonomy; and the explosion in knowledge, the change in technology, and the movement of complex cases away from General Surgery. There are a number of opportunities for enhancing current surgical training which include the following: 1) returning to reasonable work hour limits; 2) improving the efficiency of resident/fellow training by promoting early development of operative skills and starting down the path toward competency-based education; 3) increasing autonomy in the General and Pediatric Surgery residencies by developing and implementing structured processes for graded autonomy, further promoting the teaching assistant role, and even incorporating time as an attending into the period of training; and 4) developing a paradigm of uniform core surgery training followed by additional qualifications and training in both General Surgery and the surgical specialties.