The evolution of the neurosurgery residency system in North America. Part I. From the origins to the 1970s

Abstract

This article analyzes the evolution of the residency system in the United States of America, from its inception at Johns Hopkins Hospital and Medical School to the 1970s, and is followed by a second paper (Part II) completing the analysis up to the present day. The establishment of a formal residency system began with the altruistic commitment of an academic staff dedicated full-time to clinical care, teaching, and research, along with the equally unconditional dedication of the first residents, who, in exchange for their exhausting work, received only the knowledge they acquired. This initial scenario contrasts sharply with the current situation, in which – despite having excellent technical resources and stable working conditions – the academic hospital staff and residents experience a decline in the quality of teaching and research. A decline caused, among other factors, by funding cuts and the reduction of residents’ working hours, which have forced them to “compress” their workload to the detriment of both patient care and their own learning. A better understanding of the advances and setbacks experienced by the residency system throughout the 20th century and the first two decades of the 21st may help address some of the dysfunctions that currently affect it.