Deconstruction of operations into their component parts enables trainees to practise on simple simulations representing each component, and be assessed as competent, before undertaking the actual operation. Assessment of surgical competence by direct observation and video recording is feasible and reliable; such assessments could be used for both formative and summative assessment.

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.

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Surgical training is undergoing great change. no longer is apprenticeship applicable but the diminished hours and changing demands of society require a more explicit and planned form of surgical training. This requires appropriate selection criteria into surgery, an explicit surgical curriculum, creating an appropriate learning environment and objective assessments of a trainee's competency progression. This whole process of necessity needs to be trainee driven but delivered by trained trainers.