The Evolution of Colorectal Surgery Training

From its origins in the late 1800s, colon and rectal surgery has evolved from itinerant practitioners to a highly specialized surgical discipline. We highlight the historical development and the current state of the colorectal surgery training programs. The American Proctologic Society (APS) was founded by Joseph M. Mathews in 1899 that catalyzed the formation of early training programs in University of Minnesota (1916) and Mayo Clinic (1919). The American Board of Colon and Rectal Surgery (ABCRS) was recognized as the eighteenth medical specialty board in 1949. Formal accreditation of the programs began in 1975, with the Accreditation Council of Graduate Medical Education (ACGME) gradually implementing standardized curricula and competency-based training milestones. The National Residency Match Program (NRMP) and Electronic Residency Application Service (ERAS) adopted in 1984 and 2003, respectively, further streamlined the application process. Training innovations like the laparoscopic education committees (1997) and robotic surgery programs (2010) bear testament to the dedication of the program directors to continually advance this field. With a structured curriculum, rigorous examinations, and a plethora of study resources, this specialty has evolved from informal apprenticeships to competency-based residency programs. Current challenges include grade inflation in evaluation, a 67% match rate (2024) despite program expansion, adapting to evolving trends in medical and surgical care, and mastering new surgical techniques in a limited amount of time. The collaboration between governing bodies ensures high-quality training standards for the colon and rectal surgeons of the future.