General surgery in an era of superspecialisation--what is the future?

Abstract

The present century has seen extraordinary scientific advances and enormous social changes unparalleled in all medical history. Of these, specialisation and superspecialisation are significant developments that have made major impact on the practice of surgery. While specialisation is intended to improve the quality of care, excessive specialisation resulting in separation into narrow areas can have a deleterious effect on the total care of the patient, teaching, training and surgical research. General Surgery which is the foundation of surgical practice has been affected more than any other in this process and the problem has received world wide attention. General Surgery is a broad speciality responsible for the care of the surgical patient as a whole including diagnosis, preoperative, operative and postoperative management of all common surgical conditions. In addition, it requires the special expertise to manage the surgical problems of the alimentary tract, abdomen, endocrines, vascular and head and neck and comprehensive care of trauma and critical care. The general surgeon will continue to play a major role in future to suit the changing trends in surgical practice especially with the recent advances in endoscopic and laparoscopic surgery. The general surgeon of the future should continue to have a broad based training, be knowledgeable in basic sciences and responsible for total care of the patient and at the same time, have a special interest and expertise in subspecialty. General Surgery should continue to provide the basic training for all specialties, foster basic and clinical research and provide a solid foundation for all surgical trainees and above all continue the leadership role in the teaching of undergraduate students.