You Can't blame the wreck on the train

Abstract General surgical residency education is faced with a number of challenges today. Among those are resident duty hour limitations, the fact that residency is hospital-based despite the practice of general surgery being largely outpatient, changing diseases and conditions treated by the general surgeon and changing methods of treatment, development and maintenance of a user friendly curriculum and the support and provision for faculty development. The greatest single barrier, though, to education of the surgical resident is the lack of appropriate supervision. In this article, the author describes some of the factors that have conspired to remove appropriate supervision from general surgery residency programs as well as describing a number of steps which, if accomplished, would allow the return appropriate supervision to those programs.