A brief history of the development of surgery and early surgical training and practice is presented, starting in colonial America in the 18th century and extending to modern times in the USA. An abridged, but comprehensive overview of the metamorphosis and transformation of training programs in the United States is described and discussed, together with some of the most relevant rationale and justifications for the changes mandated, established and in progress. The current status of the accreditation requirements, oversight, and governance of general surgery training programs, together with the incorporation of the multiple technical and technological advances in general surgical practice; and, therefore, the addition of the required training modules and systems concurrently to the training programs; and their secondary implications, consequences, and impact upon the programs, are discussed. These include financial and other resource impediments, the 80 hour work week constraints, the technological explosion, the demands of the required expanded general surgical curriculum and operative case experience, the continued erosion of general surgery by surgical and medical specialists, the increasing workload coupled with decreasing reimbursement for general surgeons and their services, together with the difficulties of amalgamating all of these confounding or conflicting factors into an effective general surgery program which will be successful in attracting, recruiting, and retaining the best and brightest surgical candidates in the future in order to ensure the continuation of optimal general surgical care. Finally, the insights, opinions, experiences, and philosophy of the author regarding general surgery training and practice, accumulated during the more than half century served as a student, resident, clinician, scientist, administrator and educator, are incorporated into the presentation.