A surgical pioneer’s drug addiction and its influence on the modern North American residency

A surgical pioneer’s accidental addiction to cocaine and morphine played a key role in designing the modern North American surgical residency program.That’s the assertion made by two Calgary researchers in a paper published in the Canadian Journal of Surgery in 2020, which looked into how Dr. William Stewart Halsted developed the multi-tier residency program in the late 19th century.Dr. Halsted had been one of the “Big Four” founding professors of the Johns Hopkin School of Medicine, alongside Drs. William Welch, Howard A. Kelly and William Osler. He did not develop the first residency program (that honour goes to his Canadian colleague Dr. Osler). But Dr. Hasled’s residency program looked vastly different from the one that Dr. Osler had developed.Inspired by the German model of medical training, Dr. Halsted developed a residency system with multiple tiers, with the senior resident overseeing the training of junior residents. Residents would receive greater responsibilities upon advancement to the next year. However, advancement was not guaranteed, and the structure was shaped like a pyramid, with multiple entry- and mid-level positions but only one senior position.The researchers say this tiered structure of residency allowed Dr. Halsted to hide his drug addiction from his residents and maintain his secretive lifestyle, given that he could delegate much of the hands-on training to the senior resident. As a young surgeon in 1884, Dr. Halsted accidentally became addicted to cocaine after he had heard of a report that cocaine could be used as a local anesthesia and experimented on himself. He also became addicted to morphine after trying to use it to treat is cocaine addiction.Dr. Halsted’s model of having a distant relationship with his residents is a stark contrast to Dr. Osler’s, who had a tight-knit relationship with his residents. Dr. Osler frequently had his residents over at his house, and he even keys to his house to several of them so that they could have access to his books while he was away. “While all clinical disciplines had internships, none of these other three founding Hopkins professors appear to have developed a rigidly pyramidal residency model and, therefore, the training they offered was more personal and hands-on,” the authors wrote.Medical residency today still retains the graduated responsibility framework similar to Dr. Hasled’s original model. However, advancement is no longer pyramidical and instead “square shape,” given that failure to advance only occurs under rare circumstances. “At a time when surgical residencies are undergoing radical and dramatic changes, we should reflect on the history of surgical residency programs and the influencing factors that shaped these programs,” the authors wrote. “Our analysis identifies and highlights Halsted’s addiction as an important factor. While we are not condemning Halsted, we are suggesting that if one carefully analyzes and critiques the motivation for the structure of the Halsted surgical residency, his addiction was a major influencing factor.”

A surgical pioneer’s drug addiction and its influence on the modern North American residency

Register for free access or login.

Related Topics