history of surgery residency question

[sonic boom]

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I am student doing a project on the history of the surgical residency in the US and was wondering if anyone on here knew when the Halsteadian steep pyramid style training were finally phased out? I've read a lot of articles that describe the process and the "rectangle" training style devised at MGH that replaced the pyramid, but haven't been able to see actual dates that places like hopkins, duke, etc stopped with they pyramid style. Does anyone know or have any resources they could point me to with this info.

thanks

 

[Gozar]

http://www.scribd.com/doc/15169566/...urgery-as-an-Industry-Evolution-or-Revolution

The steep pyramid has not been totally phased out. Many programs in a variety of specialties have distinct preliminary and categorical positions. Categorical positions fall under the rectangle set up while prelim spots more closely resemble the triangle approach. Interns who perform well during a prelim year are more likely to be accepted for a categorical spot during the next application cycle.

 

[Winged Scapula]

http://www.scribd.com/doc/15169566/...urgery-as-an-Industry-Evolution-or-Revolution

The steep pyramid has not been totally phased out. Many programs in a variety of specialties have distinct preliminary and categorical positions. Categorical positions fall under the rectangle set up while prelim spots more closely resemble the triangle approach. Interns who perform well during a prelim year are more likely to be accepted for a categorical spot during the next application cycle.

But this wouldn't really be classified as pyramidal.

While Prelims may hope they are offered a contract to stay on, they are hired for 1-2 years only. This is not a pyramid.

A true pyramid is hiring 10 categorical interns and only graduating 5 Chief residents. That does not exist anymore although I hear rumor that it does/did in military residencies.

 

[s42brown]

I believe the only remnant of the pyramid system can be found within the U.S. Army. As a third year surgery resident at a military training facility I went through the quasi pyramid system myself. Each year the Army programs select 4+ "categorical" interns and only keeps three for PGY-2 year. However, there is a very good reason for this. Unlike our civilian counterparts, there is not an abundance of eager prelims out there to fill a spot vacated by someone who decided that surgery was just too tough. The army needs surgeons so this is a buffer to ensure each program graduates the appropriate number of chiefs each year😎