How to teach uncommon and highly complex operations.

The Surgical Council on Resident Education (SCORE) was officially formed by six surgical organizations in 2006 with the goal of improving general surgery residency training through the development of an explicit curriculum. As a result, SCORE has identified a group of "essential" operations which believes that residents should be competent to perform by the end of training. Other "complex" operations require additional training beyond residency. Currently, operative data submitted by residents suggest that there are significant gaps between ideal and actual operative experience. A particularly difficult challenge is to train residents to perform procedures that are rarely encountered.