The talk traces briefly the development and changes of surgical training in the English-speaking world in the early days and the trials and tribulations of surgical training in Singapore a few decades ago. The factors that brought about the surge of American surgery from late 19th century to the first half of the 20th century are discussed. Structured surgical training leading to the exit point was introduced by William Halsted of Johns Hopkins Hospital around 1892, a system that was later adopted by all other medical disciplines and by all other hospitals in the US. It is considered to be the prime mover of the rapid progress of American medicine. Training surgeons to only the entry point while leaving the competence of trainees to chance, used to be common in the British surgical world. The trend now favours surgical training to the exit point. It is also the system being adopted in Singapore. Increasing demands of high standard of patient care and public accountability no longer allow us to be casual and permissive mentors of future generations of surgeons. Proper surgical upbringing requires a good structured programme that itself needs to be accredited and periodically reviewed. It also requires that discipline be observed on the part of trainees. Knowledge and skills are within the capability of our mentors to impart, but inculcation of good attitude and ethics in trainees is a harder goal to achieve.
I am greatly honoured to be given the privilege of delivering the 3rd College of Surgeons Lecture, especially when I have retired from surgery for 3 years. I am not in a position to contribute anything significant to your knowledge. There is an old Chinese saying that learning is like sailing upstream; if you do not advance, you go backward. I am now miles and miles downstream.
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