My vision for the future of the specialty of general surgery is founded in the education process of physicians. For the past 200 years, linear education has been the approach used during the schooling, training and residency of physicians. This linear method classically includes one speaker who stands at the front of a group of students. The speaker gives a lecture, assigns out of class reading, and tests content knowledge by using a scale of comprehension in written form. In an exaggerated example, a military setting or athletic program exhibits the linear style using negative reinforcements, abusive conditioning, and a strict adherence to rules.

Little to no feedback is allowed, promoting conflict between the expert/lecturer and the student/learner. The linear model relies on:

• order being predominant over change, doing it the same.
  
  
• rules holding priority over a dynamic questioning of old ways.
  
  
• conformist thinking rather than independent thought which allows feedback.
  
  
• merit systems, which promote competition and self preservation.
  
  
• performance based incentives, which disregard a team approach.

Physicians have been bullied into rigid ways of providing medical practice, because 'that's the way it has always been done'. Little value has been placed on continuing education for the surgeons who were post-graduate-perhaps because so little was changing. When change was discussed, the innovator was met with criticism, snobbery and peer humiliation.

Cyclical Education on the other hand is a style of teaching that will provide pre and post surgical training with a new face. W.E. Deming, an educator of economics, said, "All qualities that have been traditionally and erroneously applied to competition actually apply better to cooperation. Cooperation builds character. [It] is basic to human nature, and makes learning more enjoyable and productive."

The future of surgical medicine depends on the cyclical education model. Cyclical education turns the student into a thinker, an active participant in his/her educational program. There is room, even encouragement, for questioning and expressing ideas. Rules are examined, but not held as universal, infinite truths.

With the surgical disciplines changing rapidly alongside technology, and consumers who are hungry for information, surgeons will be challenged to think in new ways, to research new avenues, and to operate in technically challenging arenas. We have already experienced a global community of surgery, which has brought together the elders, the pioneers, and the novices. We have experienced the teachers of academia being questioned, and actually taught, by the private practice surgeons-as evidenced in arthroscopy, laparoscopic surgery, and most recently, minimally invasive surgery.

My vision for the specialty of general surgery is that the minimally invasive movement started in the late 1980's will never stall due to a reliance on old methods, old technology, old beliefs, or old practices. My goal is to develop new leaders in surgery, erasing the division and chasm between academic and private practice. Thus, increasing the number of creative leaders who will strive to increase their knowledge because the path will no longer hold competition, but cooperation. The end result of this will be to the benefit of the public. For when information is available and true, then the public at large can trust that all surgeons are being held to a new and consistent standard.

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