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There is little doubt that the medical profession stands at a major crossroads with regards to the fundamental structure of surgical education. Although the apprenticeship model has been used for centuries, we are rapidly moving toward a new era of proficiencybased education. This transition is motivated by several important factors, including greater emphasis upon patient safety, increased focus on educational efficacy, and a shift toward objectively measured performance outcomes (i.e., demonstration of clinical proficiency). At the same time, the paradigm shift is challenged by limitations imposed by trainee work hour restrictions and by the initial investments and ongoing expenses associated with implementation of new training paradigms.
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