Did Cocaine Addiction Inspire Modern Medical Residencies?

Researchers propose that the enduring structure of modern medical residencies, pioneered by William Stewart Halsted, may have been shaped by his cocaine addiction in the late 1800s. Halsted, a celebrated American surgeon, developed a tiered, pyramidal training system at Johns Hopkins Hospital where residents advanced based on seniority and responsibility.

This program, while advancing surgical practice and producing pioneers like the father of neurosurgery, is now believed to have served a dual purpose. The study suggests Halsted designed this system partly to conceal his own declining surgical precision and speed, delegating tasks to his most trusted senior residents.

While Halsted's program was a departure from earlier apprenticeship models, its core principles of graded responsibility and continuous learning within a hospital setting have proven foundational. Although contemporary residency programs are far more structured and guarantee completion, they still bear the imprint of Halsted's influential, albeit controversially inspired, training model.