**2. Surgical requirements and education during the 21st century**

Prior models of surgical education emphasized an acquisition of technical and practical knowledge as paramount, even at potential personal cost to the trainee. Surgical education has taken on a more holistic approach with a focus on developing a well-rounded physician both inside and outside the operating room. The American Board of Surgery (ABS) reports that the purpose of graduate surgical education is, "to acquire a broad understanding of human biology as it relates to surgical disorders, and the technical knowledge and skills appropriate to be applied by a surgical specialist" [9]. In some regards surgical education is still influenced by the previous Halsteadian model in which the resident gradually assumes increased levels of responsibility until the final stage of training when he or she handles complete patient management [3]. However, education today is equally focused on resident well-being and education. In the United States, now work a maximum of 80 hours per week, with allotted time set aside for protected, uninterrupted education time. Didactics, journal clubs, and weekly conferences are also incorporated into current residency training programs.

Previous eras were not guided by standards in terms of length of training or what information/skills needed to be taught [1]. The ABS has since developed a set of standards and minimum requirements for individual trainees and their residency programs. As of 2021, in the United States, training requirements include:


In addition to training, minimum requirements for the operative experience have been set forth by the ABS. This includes a minimum of 850 operative procedures over 5 years with at least 200 occurring during the chief resident year. Residents are also required to perform 25 teaching assistant cases in which a senior resident guide another through an operative procedure. Lastly, 40 surgical critical care cases are required prior to graduation [9].

Didactics and lectures make up an important component of surgical training. In the early 2000's there was push among resident education leaders to develop a standardized national curriculum. In response the Surgical Counsel on Resident Education (SCORE) was developed in 2004 with the mission to improve resident education in general surgery. SCORE developed a curriculum which lists the topics that should be covered in a five-year general surgery residency training program. The curriculum was developed in agreement with the six core competencies defined by the ACGME. The competencies expected from a graduating resident include: patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning, and systems-based practice [10, 11].

In addition to the curriculum, SCORE developed an online "Portal" to provide residents and residency training programs with educational materials and a structured learning schedule. Today, most surgical programs in the United States utilize this resource for resident education. The Portal provides over 800 topics, a topic of the week program, over 13 surgical textbooks, 2,000+ multiple choice questions, and 200+ narrated operative videos. The portal provides a weekly structured program which repeats over two-year cycle. This program specifically dives into the SCORE curriculum, providing a methodical way for residents and programs to learn material expected of a practicing general surgeon [11].
