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In 2003, the Accreditation Council for Graduate Medical Education (ACGME) issued regulations affecting the structure of surgical residency training programs. These regulations placed work hour restrictions on residents. There has been significant resistance by the surgical leadership, including program directors and officers in academic organizations, to the adoption of the changes required by these regulations. The need for these changes to the structure of the resident’s work environment, and the resistance to the incorporation of these changes, provide an opportunity to examine the ethos and culture of surgical residency for a potential source of this conflict. This thesis claims that a significant element of this resistance is the recognition that the required changes will not only affect the structure of surgical residency training, but also the culture of residency training and the adoption of a traditional surgical identity by the trainees immersed in that culture. There is increasing evidence of significant ethical problems resulting from the traditional structure of surgical residency training. The norms perpetuated by the traditional approach to surgical training are antithetical to the current ethical norms expected regarding patient care and the surgeon’s personal and professional development. Critical ethical issues addressed in this thesis include those raised by both the apparent generational break between surgeons trained before and after work hour reform, and the conflict in balancing visions of surgical identity and concerns of patient and personal safety. The thesis argues that there is no well grounded reason for the resistance to incorporating the changes required by the ACGME. Instead, the development of the structure and culture of the surgical residency may have evolved in response to dysfunctional influences, rather than being built on sound pedagogical theory. The resulting surgical identity molded by this culture may then be appreciated as a potentially flawed, dysfunctional social construct. Changes prompted by the ACGME may result in both a healthier surgical work force and the ability to attract a greater diversity of applicants to the field of surgery. The reframing of what is essential to the surgical identity may allow the creation of new models of surgical training.