U.S. health care reform: will it change postgraduate surgical education?

The principal goals of the pending health care reform initiatives in the United States are improving access to health care and controlling its costs. There are multiple proposals designed to reach these goals. Regardless of the final result, health care reform is likely to have significant implications for postgraduate surgical education. The teaching environment is already rapidly changing. Present environmental influences include the explosion of surgical knowledge, demographic changes, expansion of regulatory requirements from within the health care delivery system and within surgery as a discipline, societal and cultural changes, and economic pressures. Current and pending concerns prompt several questions: What should we teach? Where do we teach? How long should it take? Who are our learners? How do we evaluate our educational programs? Who should pay? A number of predictable changes affecting surgical education are proposed. New, more complex technologies will result in increased surgical specialization. Demands on surgical education will require that it be shorter, more relevant, more efficient, more effective, and more accountable. Surgical manpower requirements must be more clearly defined. Better and more relevant measures of clinical outcomes will be developed. Use of improved informational technology to manage clinical activity will expand. Solutions to the problem of foreign medical graduates will be clarified. The issue of who pays for surgical education will require resolution with some new and creative results. A proposal for shorter and more effective surgical residency is advocated.