How do you educate someone to have the skills of an orthopaedic surgeon?

The landscape of orthopaedic surgical education is changing because of many factors, including advances in surgical procedures and musculoskeletal basic science along with an increased focus on ethics and patient education. Over the course of 5 years, a training program must navigate resident physicians through many rotations and effectively teach trainees to become competent orthopaedic surgeons. Each rotation must best balance service requirements and educational experiences to optimize resident education and patient outcomes. Factors such as the 80-hour work week and the current medicolegal climate limit the ability of residents to learn basic surgical skills in the operating room. The benefits of performing simulator-based surgical procedures in cadavers and using simulation for other procedures are becoming increasingly important to teach basic psychomotor skills to residents. Allowing a technically incompetent resident to graduate is a disservice to the medical profession, society, patients, and (ultimately) to the resident. Dealing with such a resident is challenging but necessary to ensure that residency programs continue to graduate competent medical professionals.