From Apprenticeship to Accreditation: The History of Colorectal Training Programs in the United States

The evolution of colorectal training programs in the United States has seen significant change in the last century. In the early 1900s, apprentice and pyramidal models predominated, along the lines of Halsted, and allowed surgeons to gain advanced training not only in surgery but also in proctology and subsequently in Colon and Rectal Surgery (CRS). Both World Wars contributed to the evolution of training paradigms which led to the introduction of internships, residencies, and subsequently specialty training. With the incorporation of the American Board of Proctology in 1935, the Board began the process of driving and determining educational pathways to achieve specialization in our field. Despite the establishment of an independent colorectal board, CRS training has strong roots in General Surgery and with the American Board of Surgery (ABS). With the growing numbers of programs, it became evident that standardization and accreditation of training programs was necessary to ensure appropriate and adequate training in the breadth of colon and rectal surgery. In this chapter, we explore the path from apprenticeship to accreditation and how training has evolved in the United States for a colon and rectal surgeon.