European Annals of Otorhinolaryngology, Head and Neck diseases 138 (2021) 291–298

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History

Throat cancer surgery training in France

A.-S. Touzé a,∗ , A. Mudry b , S. Morinière a,c
a
Service ORL et chirurgie cervio-faciale, centre hospitalo-universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France
b
Department of otolaryngology, head and neck surgery, School of medicine, Stanford university, 801, Welch road, 94305-5739 Stanford, CA, USA
c
Université François-Rabelais, 10, boulevard Tonnellé, 37000 Tours, France

a r t i c l e i n f o a b s t r a c t

Keywords: This article reviews the development of practical and theoretical teaching of surgical management of
History of otorhinolaryngology throat cancer, from the dialectic of the Middle Ages to computer simulation of the 21st century. This work
Surgical training is essentially based on original historical publications, analysed from secondary references relevant to the
Throat cancer
interpretation of the original texts. The literature search was essentially conducted in the “bibliothèque
universitaire de médecine de Tours”, the “bibliothèque inter-universitaire de médecine de Paris”, the
“Assistance publique–Hôpitaux de Paris archives” and the “bibliothèque nationale de France”. PubMed
was used for the most recent references. The search terms focused on surgical training, the history of
otorhinolaryngology and throat cancer. Up until the 19th century, throat cancer surgery training was
provided by general surgeons. The otorhinolaryngology specialty was created at the turn of the 20th
century: throat cancer surgery became a subspecialty, but certain university obstacles prevented the
creation of formal throat cancer surgery training. In the 20th and 21st century, throat cancer surgery
training was enhanced by technical innovations as well as ethical imperatives. The principle of mentoring,
essential in surgical training, has remained a constant feature throughout the ages, regardless of the
scientific progress described in this historical review.
© 2020 Published by Elsevier Masson SAS.

1. Introduction It is based on original historical publications from the period

Transmission of surgical know-how has evolved over the
centuries, from an ancestral empirical approach to mandatory
specialist training. Although surgical training has varied over
time and according to the particular field of surgery, the prin-
ciple of mentoring has remained the common basis for this
training.
Throat cancer surgery has a special history and a particular role,
as it has been successively part of general surgery and then part of
one of the new specialties that were created in the 19th century:
otorhinolaryngology. This specific disease has largely contributed
to adding an additional facet to otorhinolaryngology: head and neck
surgery (HNS).
The purpose of this article is to review the development of
practical and theoretical teaching of surgical treatments for throat
cancer, from the dialectic of the Middle Ages to computer simula-
tion of the 21st century.
under consideration, analysed from secondary references relevant
to the interpretation of the original texts. The literature search
was essentially conducted in the “bibliothèque universitaire (BU)
de médecine de Tours”, the “bibliothèque inter-universitaire de
médecine (BIUM) de Paris”, the “Assistance publique–Hôpitaux de
Paris (AP–HP) archives” and the “bibliothèque nationale de France
(BNF)”. PubMed was used for the most recent references. The search
terms focused on surgical training, the history of otorhinolaryn-
gology and throat cancer. A chronological approach was adopted,
starting with the Middle Ages, corresponding to the period of cre-
ation of the first French medical schools.
The first part is devoted to surgical training from the Middle
Ages to the 18th century. The second part examines the legisla-
tive framework for otorhinolaryngology and throat cancer surgical
training in the 19th century. The third part focuses on the con-
solidation of throat cancer surgical training in the 20th and 21st
centuries.

∗ Corresponding author.
E-mail address: As.touze@outlook.fr (A.-S. Touzé).

https://doi.org/10.1016/j.anorl.2020.09.008
1879-7296/© 2020 Published by Elsevier Masson SAS.
A.-S. Touzé et al.
2. Discussion
2.1. Development of surgical training from the Middle Ages to the
17th century
2.1.1. Creation of the first French universities and surgical
training
In the Middle Ages, medical training was first organized at Mont-
pellier University, the first French medical school established in
1220 [1] in the footsteps of the famous Italian school of medicine
in Salerno founded in 846 [2]. Medical schools were subsequently
established in Toulouse in 1229 and in Paris in 1274. Up until
the end of the 18th century, Latin was the reference language of
medicine and all teaching was based on the writings of the Ancient
Greeks and Romans (Hippocrates, Galen, Paul of Aegina) and Arabic
physicians (Avicenna, Rhazes, Albucasis).
As the Paris School of Medicine was placed under the authority
of the Catholic church, medical students had an ecclesiastical status
[3] and the practice of surgery was forbidden following the Council
of Tours in 1163: “Ecclesia abhorret a sanguine”.
Nevertheless, surgical training was innovative and tended to
evolve more rapidly than the medicine of the time, which remained
trapped in dialectics. The Paris College of Surgery was founded in
1295: practical training occupied an important place in the wards
of Hôtel-Dieu and La Charité hospitals [4].
The discovery of the printing press by Johannes Gutenberg in
1450 marked a turning point in the spread of university education:
the first medical treatises spread across Europe at the beginning of
the 16th century [5]. However, practical training remained primor-
dial. According to Ambroise Paré, “Surgery is learned by the eye and
the hands” [6], and “it is a very difficult thing to put manual surgery
clearly and entirely in writing, for it is rather to be learned by imagi-
nation and by seeing good and experienced masters perform, if you
have the means or, indeed, to try it on dead bodies, as I have done
many times” [7].
Pierre Dionis published his Cours d’opérations de chirurgie in
Paris in 1673, primarily intended for provincial students. Dionis
said of surgical training: “Paris offers better means of instruction
than in any other city of Europe: public demonstrations are made
there in three different localities, in the Royal Garden, at the École
de médecine, and at Saint-Côme, all by sworn masters of surgery
in Paris, providing equally accurate demonstrations” [8]. The first
stages of surgical training essentially consisted of mentoring, like
many other manuals trades. However, surgeons were not part of the
university, as manual labour, a mark of serfdom, was the subject of
a certain contempt. Until the end of the 18th century, a centuries-
old feud between surgeons and physicians, essentially concerning
the recognition of their status.
2.2. Anatomy teaching
Ancient anatomy found a new lease of life during the second
part of the Middle Ages, when dissection of human corpses was
allowed. In Montpellier, from the 14th century onwards, one to two
tortured bodies were delivered to the medical school each year. Guy
de Chauliac established the importance of anatomy as the basis of
surgery [9]. Surgical students sometimes even obtained corpses to
dissect directly from cemeteries: “Young surgeons need corpses;
but as a corpse costs a Golden Louis, they steal them: they set out
as a team of four, take a cab, climb over a cemetery wall. One fights
the dog, who guards the dead; the other descends into the ditch
with a ladder; the third straddles the wall, throws the corpse over
the wall, and the fourth picks it up, and puts it in the cab” [10].
In the 15th century, the medieval obscurantist mentality was
called into question. The 16th century planted the seeds of scien-
tific medicine, in parallel with the decline in rigid scholastic dogma.
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European Annals of Otorhinolaryngology, Head and Neck diseases 138 (2021) 291–298
Anatomy started to flourish in Italy. In 1543, Andreas Vesalius pub-
lished his anatomical discoveries and revealed the errors of the
great Galen’s fundamental treatise De humanis corporis fabrica [11].
This book, richly illustrated by multiple engravings, became the first
reference book of modern anatomy (Fig. 1).
Very rapidly, the main anatomical details of the pharynx and lar-
ynx were described, particularly by Giulio Casserio in 1600 [12]. In
1629, Jean Riolan the Younger published a textbook of anatomy that
became a reference work of the time [13]. Almost all of modern ter-
minology had been established, although the glottis was described
as the fifth cartilage of the larynx “locked away in the arytenoid
cartilage, at the bottom of which it encircles the cricoid. It is a small
round cartilage, split by the middle, and is an essential instrument
to create the sounds of the voice” [14]. The anatomy of the pharynx
and larynx was further elucidated in the 18th century, providing
surgeons with access to this region.
2.3. Clinical-anatomical medicine
The 18th century is considered to be the golden age of surgery
as a result of scientific progress and the development of surgical
teaching. However, after the 1789 Revolution, the Academies of
Medicine and Surgery were dissolved, and official medical training
disappeared in France in 1793. At the time, the College of Surgery
had ten chairs versus only six chairs at the College of Medicine [15].
In 1794, three Schools of Health were founded in Paris, Montpel-
lier and Strasbourg. For the first time, medicine and surgery were
brought together and hospitals become the sites of medical train-
ing. Napoleon Bonaparte restored a form of medical education and
created medical and surgical internships in the Hospitals of Paris
in 1802.
The model of clinical medicine [16] that was established at the
end of the 18th century was based on two essential foundations:
bedside observation and the practice of dissection. Observation,
experimentation, and verification are the key words of this clinical-
anatomical method, largely promoted by public hospitals. Since
1794, the public hospital has been the site of practical training for
medical students and, over the centuries, it has remained a presti-
gious health care facility, in which training is dispensed by the most
renowned physicians: “From the day on which a young man wishes
to be a physician, he ought to attend the hospitals. It is essential to
see – to be always seeing – sick persons. [. . .] For these reasons,
then, I ask the young student to attend every day an hospital visit”
[17].
3. Legislative framework for otorhinolaryngology and head
and neck surgical training in the 19th century
3.1. Unregulated practical training
The lack of formal education until the end of the 19th century
led the French pioneers of otorhinolaryngology to seek training
abroad: Berlin, Prague, Vienna were the leading places of European
otorhinolaryngology, attended, in particular, by Achille Gouguen-
heim and Marcel Lermoyez [18,19]. They subsequently shared their
experience in France: informal training flourished in private clinics
[20]. However, this training, reserved for a select few, was some-
times criticized for favouritism and its deliberate co-optation. In
the preface of his Manuel opératoire, Louis-Hubert Faraboeuf wrote:
“From the beginning of my organization of the Practical School,
when no official demonstrative teaching was available for oto-
laryngology, ophthalmology, urology, or gynaecology, I drafted my
training myself and provided my best students with courses by
volunteer specialists” [21].
A.-S. Touzé et al.
Fig. 1. Muscles of the larynx.
Vesalius A. De Humani Corporis Fabrica. Basel: Joannes Oporinus. 1543;2:256.
Charles Fauvel opened his clinic in Paris, a veritable sanc-
tuary of laryngology where Achille Gouguenheim, Émile-Jean
Moure, Émile Isambert were trained [22]. Isambert founded the
first laryngology clinic at Lariboisière Hospital in 1874, with an
unofficial but tolerated outpatient clinic (https://www.biusante.
parisdescartes.fr/histoire/medica/presentations/orl/c.php). He
devoted a lecture to laryngeal cancer in his “Conférences cliniques
sur les maladies du larynx et des premières voies”, but only
proposed purely palliative treatment [23]. The growth of hospital
otorhinolaryngology was halted for several years by the early death
of Émile Isambert. It was not until 1887 that Achille Gouguenheim,
the true founder of university hospital otorhinolaryngology, was
appointed head of the department, making Lariboisière Hospital
one of the first French otorhinolaryngology centres. Surrounded by
otologists and rhinologists, he gradually transformed the laryngol-
ogy clinic into a complete otorhinolaryngology department, where
a number of future Parisian specialists, such as Marcel Lermoyez
and Henri Bourgeois, came to train. All of these surgeons left a rich
legacy to French laryngology, although their eponyms that used
to be in common usage have gradually disappeared from modern
laryngology teaching [24].
However, head and neck cancer surgery, still poorly defined, was
readily entrusted to general surgeons such as Charles Périer [18].
“Gouguenheim was nothing less than a surgeon. When the con-
dition of one of his patients required an operative procedure, this
patient was referred to a surgical ward. Gouguenheim only per-
formed and only allowed his interns to perform tracheotomy” [25].
Acquisition of the various clinical examination techniques
requires well-supervised teaching and further consolidates the
three poles of otorhinolaryngology. “The various methods of exam-
ination used for exploration of the various organs in which we are
particularly interested share a considerable analogy” [26], declared
Jean Baratoux in one of the first books devoted to this specialty.
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European Annals of Otorhinolaryngology, Head and Neck diseases 138 (2021) 291–298
However, surgical lectures were still delivered in hospital sur-
gical clinics [20] by general surgeons such as Simon Duplay [27] or
Félix Terrier [28,29]. Throat cancer training was essentially based
on clinical cases and shared experience [30,31], while theoreti-
cal considerations were still non-existent. The principle of modern
mentoring, established by William Halsted in 1889, prevailed [32].
This practice was based on the educational theories of the Viennese
surgeon Theodor Billroth [33], who was also the first to perform
total laryngectomy in a patient with cancer in 1873.
3.2. Theoretical teaching and university hospital obstacles
At the end of the 19th century, it was essential to develop
specialty training, but certain academics opposed such a develop-
ment, suggesting that such specialization would lead to neglect
of the holistic management of the patient, with the risk that
specialist clinical chairs would replace the then highly presti-
gious general clinical chairs [34]. Otorhinolaryngology was born
following the spread of laryngoscopy in the second half of the
19th century, and one of the first steps of its development
was the establishment of specialist training by the creation
of academic chairs, specialized journals and learned societies.
However, the lack of formal training until the beginning of
the 20th century was the main obstacle to the development
of otorhinolaryngology in France. This difficulty was essen-
tially due to the conservative attitude of the university hospital
administration and obstruction by a few already appointed pro-
fessors (https://www.biusante.parisdescartes.fr/histoire/medica/
presentations/orl/c.php).
This absence of an administrative framework led to the devel-
opment of informal training in private clinics, and the creation of
journals and learned societies. In 1875, the first French journal of
otology and laryngology was founded in Paris by the laryngologists
A.-S. Touzé et al. European Annals of Otorhinolaryngology, Head and Neck diseases 138 (2021) 291–298

Fig. 2. Ladreit de la Charrière J, Isambert E, Krishaber M.

Annales des maladies de l’oreille et du larynx (otoscopie, laryngoscopie, rhinoscopie). Paris : G. Masson. 1875;1.

Emile Isambert, Maurice Krishaber and the otologist Jules Ladreit
de la Charrière: the Annales des Maladies de l’Oreille et du Larynx
(Otoscopie, Laryngoscopie, Rhinoscopie) [35] (Fig. 2), the ancestor of
Annales Françaises d’Oto-rhino-laryngologie et de Pathologie Cervico-
faciale.
The first official French otorhinolaryngology-training course
was proposed in Bordeaux, at the initiative of Emile-Jean Moure,
who, in 1891, created a school that remained unique for several
years. Moure devoted one of his lectures at the Faculty of Bordeaux
to laryngeal cancer, recommending total resection as the treatment
[37]. In Paris, a complementary course in laryngology, rhinology
and otology was instituted in 1896 [38,39] by André Castex.
The creation of this teaching constituted the first step towards
recognition of the specialty by Parisian universities. The first
otorhinolaryngology department in Paris was officially founded in
Lariboisière hospital by Achille Gouguenheim [25] in November

294
A.-S. Touzé et al.
Fig. 3. Emile-Jean Moure.
Photograph by J. Serini. Credit: Wellcome Coll. CC BY.
1897, resulting in the co-existence of university, hospital and
private clinic otorhinolaryngology training [40]. The second
otorhinolaryngology department in Paris was created at Saint-
Antoine Hospital at the initiative of Marcel Lermoyez, and was
officially established in March 1898 [41].
In 1899, the Paris hospital administration decided to appoint
two hospital otorhinolaryngologists: internist, Marcel Lermoyez,
and the general surgeon, Pierre Sebileau. This progressive imple-
mentation of otorhinolaryngology training also illustrates the
various access pathways to otorhinolaryngology. “Some practition-
ers enter the field of otorhinolaryngology directly, as is the case for
most of our young colleagues who now encounter, in the course
of their studies, the means and the opportunity to learn about this
specialty; others enter via the back door, from medicine, such as
Lannois and Garel in Lyon, or Escat in Toulouse; others from surgery,
such as Gautier, in Lille; and others from anatomy, such as Jacques
in Nancy, or Mouret in Montpellier, who are clearly not the least
renowned” [42].
4. Consolidation of throat cancer surgical training in the
20th and 21st centuries
4.1. Management of throat cancer and surgical training by
otorhinolaryngologists
Three leading names in the field helped to establish the
academic recognition of throat cancer surgery in the early 20th
century. Emile-Jean Moure (Fig. 3), leader of the Bordeaux school
and a real promoter of surgery, transformed laryngology from
a medical specialty to a surgical specialty [36]. He stressed the
importance of pharyngeal suture after total laryngectomy to avoid
the risk of infection [43]. As early as 1907, Emile-Jean Moure
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European Annals of Otorhinolaryngology, Head and Neck diseases 138 (2021) 291–298
Fig. 4. Pierre Sebileau.
Hérain F. (de). Engraving 70 × 45 mm. Coll. BIU santé médecine. 1926. Image reference:
meda0032.
considered total laryngectomy to be a routine procedure: “this
operation is no more serious than another” [44].
Pierre Sébileau (Fig. 4), head of the otorhinolaryngology depart-
ment at Lariboisière hospital since 1901, used his experience as
a general surgeon to promote the development of throat surgery
[45]. He ensured rapid growth of the activity of his department,
personally ensuring the surgical management of throat cancer [46].
In 1908, he became lecturer in otorhinolaryngology and head
of the Paris university clinical teaching [47]. He was appointed the
first professor of otorhinolaryngology in Paris in 1919.
Etienne Lombard (Fig. 5), trained by Achille Gouguenheim and
Pierre Sebileau, was the first to obtain the title of “Otorhinolaryn-
gologist of the Hospitals of Paris” in 1902, following the creation of
this specialist entrance examination [48]. He was appointed head of
the Laënnec hospital otorhinolaryngology department in 1911, the
third otorhinolaryngology department to be opened in Paris. He
was particularly interested in laryngeal cancer and wrote a com-
prehensive report on the subject in 1914 and established a new
classification of this disease [49].
From an institutional point of view, the various French chairs
of otorhinolaryngology were created over a number of years. In
1907, twenty-five years after its creation, the “Société française
d’otologie, de laryngologie et de rhinologie” modernized its name
to “Société française d’oto-rhino-laryngologie”. The term “Patholo-
gie cervico-faciale” (head and neck disease) was only added in 1965
A.-S. Touzé et al.
Fig. 5. Etienne Lombard.
Berger P. Photograph. Presse Med. 1920;(56) [Appendix volumes, p. 1036–1037].
[50], which was subsequently changed to “Chirurgie de la face et
du cou” (head and neck surgery) in 1998.
4.2. Changing practices during the 20th century
The beginning of the 20th century was marked by a diversi-
fication of the methods of surgical training: lecturers started to
propose, as part of their courses, cinematographic broadcasts [51]
and animal dissections instead of only cadavre dissections [52].
The official courses, dispensed by the Faculty, generally poorly
attended, were improved in order to increase their audience. Sur-
gical technique training courses were set up by prosectors of the
Paris faculty of medicine. Head and neck surgery teaching, including
throat cancer surgery, was still dispensed by the general surgeon,
Charles Lenormant. He stressed the importance of practical train-
ing: “To operate safely, one must have a correct technique that can
only be acquired by attending operative medicine amphitheatres:
an operation can only be truly successful when one has been able
to study and repeat the successive steps of the procedure” [53].
Training courses were held in the afternoon and evening in the
form of sessions lasting 2 or 3 months. Mornings were reserved
for hospital ward rounds that medical students attended on a daily
basis; continuity of medical care in the afternoons and at night was
ensured by interns [54]. Internship, reserved for an elite, consti-
tuted a true calling for trainee surgeons: “Internship also continues
to be the best school for practical training. Constantly living in the
hospital allows the intern to observe patients at all hours of the day
and night, when it is necessary or useful” [55].
Course content followed progress in surgical techniques and the
surgical indications in head and neck surgery, and it was not until
1922 that Fernand Lemaître created weekly lectures concerning the
treatment of cancer of the larynx [56].
Theoretical and practical courses in broncho-oesophagoscopy,
dispensed by hospital otorhinolaryngologists, were first mentioned
in the first decade of the 20th century, with a detailed description
of direct laryngoscopy, bronchoscopy, oesophagoscopy and gas-
troscopy techniques [57,58]. Neck dissection was first described
in the 1930s in surgical practical training programmes delivered
by university otorhinolaryngologists [59].
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European Annals of Otorhinolaryngology, Head and Neck diseases 138 (2021) 291–298
Otorhinolaryngology requires a very specific form of training,
derived directly from the methods of exploration of the 20th cen-
tury: “Examination of the nasal cavities, larynx, eardrum, require a
certain experience. These examination techniques cannot be taught
in the same way as the methods of examination of an enlarged
liver or abnormal neurological reflexes, in which the young stu-
dent watches his teacher examine the patient, while listening to
his explanations” [60].
4.3. Formalization of throat cancer surgery training
The reform initiated by Robert Debré in 1958 revolutionized
medical training by creating university hospital centres (CHU) by
changing the status of the medical profession, which then had three
responsibilities: clinical practice, teaching, research [61]. The hos-
pital became the essential university support for theoretical and
practical training for medical students.
This new framework formalized the principle of mentoring in
throat cancer surgical training, allowing the intern to perform all or
part of the operation under the surgeon’s direct and effective super-
vision [62]. This method of transmission of surgical skills, which
had been popular for years, gradually allowed the intern to per-
form the operation unassisted. As standardization of such a process
would be illusory, evaluation tools were set up [63]. This practical
training was complemented by the organization of courses in the
anatomy laboratory, where cadavre dissections allowed the stu-
dents to acquire the fundamental notions of specialized anatomy.
Role-playing and simulation became the supports for surgical train-
ing in France in the 21st century. The development of laryngeal
and tracheal surgery simulation modules helps to promote mas-
tery of surgical techniques, which may be difficult to learn due to
the urgent nature of real-life situations [64].
The development of minimally invasive surgery and robotic
surgery have also modified the conditions of surgical training [65]
by placing the teacher in a learning situation before he can pass
on his acquired knowledge to his students. Robotic surgery also
has a special role by accelerating the surgeon’s learning curve by
avoiding repeating the errors of his predecessors [66]. Robotic sim-
ulation modules [67], together with virtual reality, are now part
of the complementary teaching methods set up to overcome the
difficulties of access to cadavre dissections and the limitations of
mentoring. In fact, mentoring represents a training method that is
particularly adapted to surgery, although it can raise various ethical
[68], regulatory or even financial [69] problems.
From a legislative point of view, the Decree of 21 April
2017 defines the clinical, technical and behavioural objec-
tives required for validation of the specialist diploma (DES) in
otorhinolaryngology-head and neck surgery [70]. Theoretical train-
ing is based on real-life or on-line DES and university diploma (DU)
or inter-university diploma (IUD) courses. Since 2017, “Formation
spécialisée transversale” (FST) (specialized cross-disciplinary train-
ing) in oncology also allows early specialization in head and neck
cancer surgery.
Sharing of knowledge is completed by participation in
congresses, particularly those organized by the “Société
française de carcinologie cervico-faciale”, “Groupe d’étude
des tumeurs de la tête et du cou” and the “Société française
d’ORL”. The “Société française d’ORL” has established national
good clinical practice guidelines (https://www.orlfrance.org/
recommandations-de-bonne-pratique/), including in the field of
head and neck cancer. These guidelines, now published in the
European Annals of Otorhinolaryngology, Head and Neck Diseases,
also constitute a form of mentoring. The essential challenge faced
by these guidelines is to ensure the continued dissemination of
good quality scientific knowledge at a time when otorhinolaryn-
gology, like all fields of biomedicine since the beginning of the 21st
A.-S. Touzé et al.
century, is threatened by two phenomena: perversion of statistics
and the development of predatory journals [71–73].
Beyond acquiring technical skills, the moral and humanistic
training of otorhinolaryngologists is primordial, more particularly
in the approach to cancer patients. “As medicine is an art the prac-
tice of which is based on science, it is a school of uncertainty” [74].
It is therefore up to tomorrow’s teachers to take on this “complex
task of teaching this difficult combination of Science and Art” [75].
Disruption of the patient’s bodily integrity, a subject now prepared
in advance by simulation in a learning situation, goes beyond the
most complex technical skills. “Surgical practice, despite the pre-
cise and scientifically established rules on which it is now based,
remains and will always be ‘an art’; i.e., a mode of activity in which
the individual plays a leading role, as a result of particular faculties
of invention and skill which are a personal gift and therefore cannot
be rigorously taught” [76].
5. Conclusion
The history of throat cancer surgical training reflects the cre-
ation of a recent specialty, otorhinolaryngology-head and neck
surgery. Until the 19th century, head and neck cancer surgery and
teaching of surgical techniques were ensured by general surgeons.
Head and neck cancer surgery only fused with the field of otorhino-
laryngology in France at the turn of the 20th century as the result
of the work of a number of great men, by highlighting the medical
and surgical mix of the specialty. The difficulties of recognition of
otorhinolaryngology-head and neck surgery are illustrated by the
obstacles encountered to establish formal theoretical and practical
training. With the advent of technical innovations and new ethi-
cal imperatives, the organization of this training appears to be in
perpetual motion.
The evolution of surgical training methods, from empirical
transmission to scientific teaching, is the result of a confluence
between medical doctrines and educational innovations at a given
era. The current methods of surgical training are only extensions
of the technical, scientific and ethical advances highlighted in this
historical review, including mentoring, which still remains the best
learning process.
Disclosure of interest
The authors declare that they have no competing interest.
Acknowledgements
None.
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