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It is both an honor and a privilege to be asked to become an associate editor for the 11th edition of Schwartz’s Principles of Surgery. Much has changed since the first edition was published in 1969, particularly in terms of how adult learners obtain knowledge. Today, approximately nine out of ten American adults use the internet and internet use by college graduates is nearly universal. Journal articles on any and all topics are available with a few keystrokes, with over 1,000 new articles being added daily to archives such as PubMed Central. Additionally, there are a multitude of online textbooks, videos of procedures, interactive surgical simulator applications, and other web-based resources that are widely available to medical students and professionals. So, one might ask, do we still need surgical textbooks?

The debate about whether textbooks are obsolete is not a new one. Opponents of textbooks suggest that they are expensive and inconvenient to access. Their content can be argued to become quickly outdated and to be unengaging to the modern learner who prefers interactive, multimedia content. On the other hand, proponents of textbooks note that evidence is lacking that comprehension is improved with digital technology. Furthermore, textbooks allow teachers to provide content within a clear framework, to ensure uniform delivery of content, and to have ease in re-referencing information.

What is the right answer? Modern and future learners should have textbooks available to them in multiple media formats. One media type does not fit all learners. Like surgery, optimal learning must be personalized based on an individual’s preferences. The editors and publishing company behind Schwartz’s Principles of Surgery have embraced this idea—the hardcover continues to be the best-selling general surgery textbook worldwide and there are no plans to eliminate the printed version. At the same time, the content is widely available on an interactive digital platform—Access Surgery—that includes access to multiple textbooks, quick references, a video atlas, and test review questions.

Regardless of the format, knowledge must come from a reliable source of information. For example, each chapter in the 11th edition of Schwartz’s Principles of Surgery is written by at least one, and often two or more, authors who are experts in the subject matter. These authors have frequently built on work by those who have preceded them. Furthermore, each chapter is supported by the evidence and vetted by one or more senior surgeons serving as editors. This new edition continues to provide up-to-date information on age-old topics in surgery such as the physiologic basis of disease as well as on the clinical diagnosis and management of surgical diseases.

The 11th edition deftly balances core knowledge that has stood the test of time with contemporary advances in science and technology. Examples include updated chapters on “Molecular Biology, The Atomic Theory of Disease, and Precision Surgery” and “Minimally Invasive Surgery, Robotics, and Natural Orifice Transluminal Endoscopic Surgery.” Additionally, there are multiple chapters focused on non-technical skills, which are often more important than technical skills, such as the first chapter of the textbook on “Leadership in Surgery.” This 11th edition also boasts five new chapters: “Enhanced Recovery after Surgery,” “Understanding and Evaluating Evidence for Surgical Practice,” “Ambulatory/Outpatient Surgery,” “Skills and Simulation,” and “Web-Based Education and Implications of Social Media.”

The fact that the 11th edition of Schwartz’s Principles of Surgery marks the textbook’s 50th anniversary is a testament to its continued relevance and contributions to surgical education. Moreover, its longevity is also a reflection of far-sighted editors-in-chief, first Dr. Seymour Schwartz followed by Dr. F. Charles Brunicardi, who have been able to not only keep up with but also to anticipate changes in the surgical landscape. Not only is surgery a continuously changing discipline, but also the world in which surgeons practice is constantly evolving, as reflected by the digital era. Nonetheless, textbooks and the knowledge they carry will continue to play an important role, regardless of their format and packaging.

Lillian S. Kao, MD
Jack H. Mayfield, MD, Chair in Surgery
Professor and Chief, Division of Acute Care Surgery
Vice Chair of Research and Faculty Development
Vice Chair of Quality of Care
Co-Director, Center for Surgical Trials and
Evidence-based Practice (C-STEP)
Department of Surgery
McGovern Medical School at the
University of Texas Health Science Center at Houston

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