Training tomorrow's surgeons: what are we looking for and how can we achieve it?

The aim of a surgical residency program is to produce competent professionals in a safe and pedagogically efficient environment. For many years, there has been an overemphasis on technical attributes as the fundamental competencies of a trained surgeon. With the advent of new frameworks for defining the outcomes of surgical training, such as CanMeds from the Royal College of Physicians and Surgeons of Canada and the six competencies outlined by the Accreditation Council for Graduate Medical Education in USA, there has been a broadening of the focus of surgical training. Although technical proficiency is definitely an important prerequisite for a successful outcome, other qualities such as intellectual abilities, personality and communication skills, and a commitment to practice are important elements in the profile of a competent surgeon. Recently, there is a growing appreciation for the heterogeneity in achievement of technical competence among our trainees, with some residents able to quickly master technical skill in contrast to others who may never achieve mastery in the technical domain. The questions of how to select, teach and grant privileges for independent practice requires an understanding of the components of surgical competence and implementation of evidence based tools for training and assessment of these competencies.