Five Uneasy Peaces: Perfect Storm Meets Professional Autonomy in Surgical Education

p t g l n July 2003, the Accreditation Council for Graduate edical Education (ACGME) required that all accredted graduate medical education programs implement a late of reforms, developed in response to tragic anecotes of supervisory failure and resident fatigue. To prempt threatened federal legislation, the reforms were imlemented with strong fiscal and licensure penalties for onenforcement. In the process, and absent evidence of heir direct applicability to surgery, the supervision, raining, and deployment standards from the airline inustry, the trucking industry, and the training of internal edicine residents were extrapolated to craft major reorm in a century-old paradigm of graduate surgery edcation. Changes were neither evidence-based in all ases nor supported with the investigational rigor reuired to change other practice paradigms. Nevertheess, their magnitude and concurrent philosophic and emographic changes in the nation’s medical schools ow invite an exploration of the discourse that produced hem; the questions arising from surgeons’ introspecion; and a review of the uneasy compromises made by merican surgery to achieve compliance. Although the ifficulty that surgeons have had coming to peaceful cceptance of the mandated restriction of the resident ork week to 80 hours has received the most publicity, here are at least five uneasy peaces associated with the eform.