Surgical education has changed significantly since the first formal program was established by William Halstead. Specifically, in the last ten years, surgical education has moved from the popular "See One, Do One, Teach One" model to a competency based model using distinct milestones. While these milestones and competencies have been successfully implemented in many fields, including Otolaryngology, there remains significant problems that need to be addressed. Specifically, the lack of assessment tools able to accurately measure whether trainee surgeons can perform steps or indeed an entire operation is a significant and underreported problem.