Priorities in general surgical training

We wished to determine which area of surgical resident training receives the highest priority--surgical technique, surgical judgment, or "book knowledge." We were also interested in how the programs addressed each area, particularly the teaching of surgical technique.

A questionnaire was distributed to the program directors and chief residents of all 289 general surgery residency programs in the United States.

Answers were received from 144 chief residents (50%) and 152 program directors (53%). Programs to teach surgical judgment and technique were offered by 55 (36%) and 68 (45%) of general surgical residencies. Most program directors (83%) and chief residents (72%) considered surgical judgment the most important aspect of surgical training. Sixty-four percent of chief residents felt they were receiving adequate training in the technical aspects of surgery. Approximately half of the program directors felt that residents needed better training in the technical aspects of surgery. One hundred thirty programs (86%) had specific curricula for teaching "book knowledge."

With the advent of minimal access surgery and the constant introduction of new instruments and procedures, new demands are constantly being placed on practicing surgeons. In order to prevent the further fragmentation of general surgery, a more structured approach to the early teaching of surgical skills should be considered.