Excerpt: Sir William Halsted introduced a German-style residency training system with an emphasis on graded responsibility at Johns Hopkins Hospital in 1889. This system remains the cornerstone of surgical training in North America more than a century later. However, advances in educational theory, as well as mounting pressures in the clinical environment, have led to questions about the reliance on this approach to teaching technical skills.
Those pressures include a move toward a shorter workweek for residents and an emphasis on operating room efficiency, both of which diminish teaching time. Yet the patients in our teaching hospitals are generally much sicker and have more complex problems than in times past. The increasing complexity of cases and a greater emphasis on mitigating medical error limit a faculty’s latitude in assisting residents with technical procedures.
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