Teaching and assessing surgical competence.

Surgical competence and its assessment is one of the most hotly debated topics engaging the profession. In the current climate of diminishing working hours and shorter training, the surgical profession is having to address the complex issue as to how surgery as a craft specialty should be taught, and how to assess when an individual is competent within their chosen sphere as well as how that competence should be maintained. Internationally, there is political pressure upon the professional to achieve contracted activity to comply with political imperatives and, at the same time, to achieve a greater degree of specialisation. Within Europe, the working time directive has led to a shift system of rotas and this, along with a shorter overall period of training, has led to reduced time available to surgical trainees in which to learn their craft.