RT Journal A1 Zeller JL, Fontanarosa PB T1 SHared accountability, appropriateness, and quality of surgical care JF JAMA JO JAMA YR 2009 FD October 14 VO 302 IS 14 SP 1590 OP 1591 DO 10.1001/jama.2009.1495 UL http://dx.doi.org/10.1001/jama.2009.1495 AB For a quarter century, an ongoing dialogue has focused on the integrity of the surgical residency training curriculum. The complexities of resident training, the acquisition of cognitive knowledge and technical skills, the quantification of experience, and intricacies of the certification process have been scrutinized and discussed. As a vital constituent in the health care systems of the rural and urban United States, surgeons have benefited from this dialogue, which has contributed to the standards of the profession. In addition, the varied implications of the economic, technological, and workforce challenges that have confronted every academic and community-based surgeon have likewise resulted in reforms and substantial changes in the evolution of surgical education.1 Despite such a deliberate focus on the training and accreditation of surgeons, there now emerge novel challenges related to national health care reform that undoubtedly will affect the current practice of surgery.