William Halsted is generally credited with having established the first “true” surgical residency in the United States, based on German models, at Johns Hopkins Hospital beginning in the 1880s. By 1940, only about ten such residencies existed in the United States. While undeniably successful in producing an academic elite, these programs had little immediate influence at the community level. In 1915, the Mayo Clinic and the University of Minnesota formalized a competing, “graduate school model” of surgical education. Nonetheless, much surgical training remained on an ad hoc basis, a source of growing concern to surgical leaders by the 1930s. The existence of three competing but overlapping national organizations compounded the problem of reforming surgical education. The American College of Surgeons, founded in 1913 and modeled on the Royal College of Surgeons of England, had initially focused its efforts on certifying and improving the qualifications of surgeons already in practice. The American Board of Surgery (1937) was the product of a younger generation of academic leaders dissatisfied with the College’s certification standards. At the same time the American Medical Association continued to approve hospitals for internships and residencies. Minnesota provides an interesting case study of how demands for well-trained surgeons and surgical training were negotiated at the local level. During the study period, essentially all possible models of graduate surgical education existed within the same state. Private preceptorship, a large private clinic fellowship, a university-based academic program, public hospital programs, and, in response to the demand for surgical education following the war, community hospital-based programs all existed in an uneasy relationship. Tension between the University and the community hospitals arose over the conflicting agendas of full-time directors and hospitals oriented to private, paying patients and their private practice physicians. The insistence of University leaders on original laboratory research as a defining characteristic of the true surgical residency caused particular conflict. Consequently, affiliations with community hospitals would be organized and dropped throughout this period. Superimposed upon this local turmoil were demands made by the national organizations supervising residency training. This paper will examine these tensions as part of the larger national story and demonstrate the contingent nature of surgical education during this period.