• Oluwadamilola M Fayanju, Reena Aggarwal, Rebeccah B Baucom, Cristina R Ferrone, David Massaro, and Kyla P Terhune.
• *Duke University, Durham, NC †Barking, Havering and Redbridge University Hospital, Romford, Essex, UK ‡Vanderbilt University Medical Center, Nashville, TN §Massachussetts General Hospital, Boston, MA ¶VA MidSouth Health Care Network, Nashville, TN.
• Ann. Surg. 2017 Mar 1; 265 (3): 459-460.

ObjectiveHealth care reform and surgical education are often separated functionally. However, especially in surgery, where resident trainees often spend twice as much time in residency and fellowship than in undergraduate medical education, one must consider their contributions to health care.Summary Background DataIn this short commentary, we briefly review the status of health care in the United States as well as some of the recent and current changes in graduate medical education that pertain to surgical trainees.MethodsThis is a perspective piece that draws on the interests and varied background of the multiinstitutional and international group of authors.ResultsThe authors propose 3 main areas of focus for research and practice- (1) accurately quantifying the care provided currently by trainees, (2) determining impact to trainees and hospital systems of training parameters, focusing on long-term outcomes rather than short-term outcomes, and (3) determining practice models of education that work best for both health care delivery and trainees.ConclusionsThe authors propose that surgical education must align itself with rather than separate itself from overall health care reform measures and even individual hospital financial pressures. This should not be seen as additional burden of service, but rather practical education in training as to the pressures trainees will face as future employees. Rethinking the contributions and training of residents and fellows may also synergistically work to impress to hospital administrators that providing better, more focused and applicable education to residents and fellows may have long-term, strategic, positive impacts on institutions.

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