Responsibilities of General Surgery: Training for the Future

The future responsibilities of general surgery are directly dependent on the training afforded future surgeons. Surgeons will be capable of doing only what they have been trained to do. In turn, surgical training is dependent on the training environment, practice pattern needs, the changing spectrum of surgical diseases, the competition, both within and outside general surgery, and the role forecast for surgeons in the future. TRAINING ENVIRONMENT The training environment varies widely across the country, affecting the kind of surgeon emerging from any given region. For example, city and county hospitals, which care predominantly for indigent populations, emphasize trauma and all the diseases of the underemployed. In these programs, there is usually emphasis on direct care of patients by the residents, who therefore develop independent care skills earlier. In contrast, a university-based program is often predominantly a tertiary care environment, accepting referrals through the reputation and skills of a subspecialty-oriented