The practice of general surgery has evolved in recent decades toward subdivisions—subspecialties—which reflect concentrated expertise and experience, refinements of the knowledge base in those areas, technological advances and inventions, and public demand. Surgical education and training programs have responded by incorporating the new elements, wherever possible, into the general surgical residency. Often this has been possible, as in the example of laparoscopic cholecystectomy. However, the challenge has been more difficult—some would argue unattainable—when the procedure is particularly complex and/or in short supply for the number of potential trainees (as in laparoscopic adrenalectomy, major pancreatectomy, or resection of a retroperitoneal or pelvic sarcoma), when multidisciplinary approaches or clinical trials are central to treatment plans (as in surgical oncology), or when the patients are looking for “a (sub)specialist” (ie, a breast surgeon). Some groups now argue that the 5-year program of general surgery, capped by 1 to 3 years of subspecialty advanced training, is at once too long and inadequate for the exploding needs of the subspecialty knowledge base.
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© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.