Surgical education for the twenty-first century: beyond the apprentice model.

Traditionally, surgery has been taught by an apprentice model, where the learner imitates the actions of a skilled mentor. Although effective, this model is inefficient because it requires learners to be exposed to a large number of surgeries performed by a limited number of dedicated teaching faculty. In addition, competence is proved with subjective evaluations. Because of changes in modern medical practice, specifically reimbursement issues, resident work hour restrictions, and need for reliable and valid credentials, the critical components of the apprentice model are eroding. A paradigm shift is needed in modern surgical education.