Schwartz's Principles of Surgery 8 edition

Preface
For the past 35 years, the Principles of Surgery has been edited by Dr. Seymour Schwartz and a group of outstanding co-editors. It has been considered the leading large textbook for general surgery worldwide. I was surprised and deeply honored to have been asked to assume the role of editor-in-chief and was determined to ensure that the reputation of this legendary book would carry on its tradition of excellence. In this effort, the first assigned task was to select a new group of co-editors. After careful deliberation, five departmental chairmen who are leading scholars in a variety of specialties were selected from universities around the country. Our first meeting to discuss the development of the eighth edition of Schwartz's Principles of Surgery defined our first goal: to preserve the style and structure of the classic Principles of Surgery with its basic and clinical sections and to preserve the titles of 95% of the chapters. However, it soon became apparent after a thorough review of each chapter that new authors, those who were leaders in their respective fields, would be selected to compose this extensively updated and modernized text. Upon completion, 76% of the chapters are from new authors. These chapters contain the latest in surgical science, surgical techniques, and therapy for students, residents, and surgeons. Six new chapters have been added to round out this eighth edition: Cell, Genomics, and Molecular Surgery, Soft Tissue Sarcomas, Anesthesia of the Surgical Patient, the Surgical Management of Obesity, Patient Safety, Errors, and Complications in Surgery, and Surgical Considerations in the Elderly. Another important component of this work identified by the editorial team was the artwork. A new artist (Philip Ashley & Associates) was selected to direct the art program, which provides clear and consistent learning aids throughout the text and visually reflects the comprehensive and updated nature of this book.

The editorial team is deeply honored to carry forward the tradition of this great textbook into the 21st century. As a team we have worked diligently to create a state-of-the-art textbook to help students, residents, and surgeons study the craft of surgery and it is to students of surgery of all ages that we dedicate this book. It is your own devotion to learning the language of surgery that will translate into the best care of patients around the world. We hope the textbook will serve as the cornerstone of your own learning program as it has for the study of surgery for the past 35 years.

We wish to thank Katie Elsbury and Susie Lee for their exceptional skills in helping edit and coordinate all communication. We wish to thank Marc Strauss, Michelle Watt, and their team at McGraw-Hill for their willingness to work with us. We would also like to thank our families, whose love and support made this book possible.

F. Charles Brunicardi, M.D., F.A.C.S.
October 2004


Introduction

Medicine has undergone several important changes over the last decade. Technologic and molecular advances have fundamentally changed the way diseases are treated. Access to the internet has changed the way both physicians and patients learn about diseases. Political and economic pressures have changed the way society views and reimburses medical care. The end result is that access to medical care, access to information about medical care and the very nature of the doctor-patient relationship have changed. These changes in medicine have resulted in a need for new approaches to medical education as well. The Accreditation Council for Graduate Medical Education (AGME) developed the core competencies as a way to articulate, and measure, the specific goals of medical education in the United States.

The core competencies offer an effective conceptual framework to train surgeons and are designed to ensure that surgical residents will learn the skills necessary to competently and compassionately treat patients as they enter practice. The six core competencies, as designated by the ACGME are: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. These are principles that should make up the basis of competent surgical practice in the 21st century. Articulating these competencies, and mandating documentation that they have been learned, should ead to greater and more universal compliance with these principles. Even though the ACGME has mandated that all residency programs must train their residents in the six core competencies there is enormous flexibility in how this is to be accomplished. Training surgical residents in the modern health care system is an especially challenging endeavor. Not only must educators impart the medical knowledge of caring for patients and new advances in patient care but they must also impart the technical skills necessary to perform complex surgical procedures. Furthermore, with the burgeoning field of genomics and molecular biology, the surgical trainee must become adept at understanding and applying the latest in molecular medicine. The challenge of the surgical educator is to develop innovative and focused learning techniques to accomplish all six core competency mandates within an 80-h work week.

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