Acquisition and maintenance of surgical competence

Rapidly developing and emerging technologies, unprecedented scientific advances, significant changes in societal expectations, intense focus on physician competence, concerns regarding patient safety, and new mandates all have had a major impact on both surgical practice and surgical education. The definition of 6 general competencies by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties and the introduction of the concept of maintenance of certification require surgical educators, and indeed all surgeons, to reevaluate the methods currently in use to ensure competence in surgery. The multidimensional aspects of competence make verification and certification of a competent surgeon an extremely challenging task. However, a combination of traditional and innovative approaches may be used to facilitate achievement of the general competencies. Such approaches should be based on principles of adult education and experiential learning. Education research has yielded valuable information on the validity and reliability of a number of innovative methods that may be used to teach and assess several general competencies. Additional efforts are needed to address the other competencies effectively using novel approaches. The American College of Surgeons and other surgery specialty societies are well positioned to play a pivotal role in supporting the learning needs of practicing surgeons, residents, and medical students within the context of the general competencies and facilitating their continuing professional development.