Changing surgical education strategies in an environment of changing health care delivery systems.

Emerging changes in health care delivery will have a significant impact on the structure of surgical education in academic departments of surgery. Based on some assumptions as to the probable nature of the final product of this reform, this article encourages a proactive stance by surgical educators to anticipate changes and move toward restructuring in areas of curricular content, the teaching process, performance evaluation strategies, and faculty infrastructure of the academic department. Curriculum changes must bridge the gap between public health and medicine and continue the aggressive trend toward teaching in the outpatient setting. Surgical educators must adapt to evolving computer and instructional technology that will make multimedia presentations, distance education, teleconferencing, hypermedia, and virtual reality commonplace in the teaching setting. Increased emphasis on accountability and accreditation will require stringent criteria in performance and program evaluation methodology. The academic infrastructure will need to adapt to the changing goal of training more general surgeons and fewer specialists and yet maintain the fundamental responsibility of an academic surgeon for mentoring the medical student and surgical resident.