The sophomore surgeon revisited.

In “The Sophomore Surgeon,” he attempted to explore the early years following completion of formal general surgical training. He never said why he chose the topic. I suspect that his motive was to speak to his recent and future surgical residents to give them some guidance beyond their 5 years of training. Of the many topics for this address that I have explored since you honored me with election to the presidency of the Pacific Coast Surgical Association, the possibility of adding another generation’s perspective to my father’s contribution was irresistible. When I first reread “The Sophomore Surgeon” after almost 40 years had passed, it was clear that the principles he set forth have remained true, but I was struck with how much almost everything else has changed. Even my father’s expansive mind never envisioned how much and how rapidly evolution would occur in our surgical milieu. I remember how excited he was when he discovered, in his beloved 13-volume Oxford English Dictionary, the derivation of the word “sophomore” from the Greek sophos, meaning wise, and moros, meaning foolish. Some might consider this an oxymoron, but the word aptly describes the recent surgical graduate: so knowledgeable about the care of surgical patients, but with so much difficult learning ahead. In fact, the most compelling reason for “revisiting” the topic is to explore the massive growth of the moros side of the equation. Another reason for reexploring this topic is my own deep interest in this matter after 31⁄2 decades of teaching surgical residents. I hope these observations and comments will be of help, not only to new graduates, but also to that large proportion of our association’s membership responsible for shaping the education of surgeons. Those of us charged with training surgeons have the most rewarding jobs I can imagine. Yet, as we participate in the amazing metamorphosis that occurs during this process, we must constantly consider what their futures will hold, and provide the knowledge, skills, integrity, and self-confidence they will need to face a rapidly evolving surgical practice. I have an additional interest in the subject. My son John has recently become a sophomore surgeon and my daughter-inlaw Evelyn has only a few months to go before she will become one. My wish is that they, and all recent and future surgical graduates, will not regret their career choice. Nearly every minute of my father’s surgical career was a joy to him, as it has been for me. His love of the profession was obvious in everything he did and said. For much of my own career, a surgeon could expect that the professional and financial rewards would be similar, or even better, than those that my father experienced. But, in the 39 years since he gave his presidential address, the surgical profession has faced an amazing metamorphosis. Some of these changes have been exciting and wonderful, like the explosion of new knowledge and technology that is available to help our patients. Other changes, largely economic, have been harmful to our patients and profession. My intention is to revisit the topic of the sophomore surgeon and to try to determine how all of this is affecting the recent surgical graduate. To assist in this analysis, I took the opportunity of sending a questionnaire to each of the 59 residents who were graduated from the USC general surgical residency between 1988 and 1997, seeking their opinions on the practice environment in which they presently find themselves. This period straddles the departmental chairmanships of Arthur J. From the Department of Surgery, Los Angeles County/University of Southern California Medical Center, Los Angeles. PRESIDENTIAL ADDRESS