US HEALTH-CARE REFORM - WILL IT CHANGE POSTGRADUATE SURGICAL EDUCATION

The principal goals of the pending health care reform initiatives in t he United States are improving access to health care and controlling i ts costs. There are multiple proposals designed to reach these goals. Regardless of the final result, health care reform is likely to have s ignificant implications for postgraduate surgical education. The teach ing environment is already rapidly changing. Present environmental inf luences include the explosion of surgical knowledge, demographic chang es, expansion of regulatory requirements from within the health care d elivery system and within surgery as a discipline, societal and cultur al changes, and economic pressures. Current and pending concerns promp t several questions: What should we teach? Where do we teach? How long should it take? Who are our learners? How do me evaluate our educatio nal programs? Who should pay? A number of predictable changes affectin g surgical education are proposed. New, more complex technologies will result in increased surgical specialization. Demands on surgical educ ation will require that it be shorter, more relevant, more efficient, more effective, and more accountable. Surgical manpower requirements m ust be more clearly defined. Better and more relevant measures of clin ical outcomes will be developed. Use of improved informational technol ogy 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 creat ive results. A proposal for shorter and more effective surgical reside ncy is advocated.