The goal of graduate surgical education is to ensure that the graduate is competent to practice in his or her chosen specialty. Traditionally, surgical learning has been based on an apprenticeship model; that is, the long-term observation and assessment of the trainee over a prolonged period of time. Patient expectations, work hour restrictions, and expectations of increased faculty oversight have led to decreased resident autonomy and independence. Graduates completing surgical training with less surgical autonomy may have lower clinical competence, which may affect patient safety, patient outcomes, and career satisfaction. This will require the modification of current assessment and training methods.