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More than 100 years ago William Stewart Halsted established a graduate training program for surgeons, based on the German system, at the Johns Hopkins Hospital. When the American Board of Surgery was organized in 1937, the Halsted triad of educational principles, namely knowledge of the basic sciences, research, and graduated patient responsibility for the resident, were the goals of the founders. The pyramidal structure of the Halsted system—that is, indefinite length, vigorous competition for advancement leaving only one resident at the pinnacle, and one chief of service—was never widely used. Almost all programs in the years after World War II adopted the rectangular structure established by Churchill at the Massachusetts General Hospital. Halsted's principles of education have been retained and are still the essential requirements of residency training programs. Unfortunately, the most important element of the triad, graduated responsibility for patient care leading to the role of the resident as the surgeon, can no longer be offered to residents due to social and economic changes in medical care. Thus, the heart and soul of the Halsted system of graduate surgical education has been lost. A drastic change is needed. Halsted is dead. |
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