Problems and pitfalls in modern competency-based laparoscopic Training

Traditionally, surgical training has been a matter of apprenticeship. The surgical trainee learned to perform surgery under the supervision of a trained surgeon until he or she was believed capable of performing surgery independently. The opinion of the supervising surgeon was about the only informal standard that had to be met—a standard hard to define, second to none, but the hand of God himself, as perceived both within and without surgical societies. This is illustrated by literature, in which a capital for “Surgeon” is allowed in both ancient and recent publications [1–3]. At the beginning of the new millennium, a paradigm shift in medical education thinking became apparent. Public opinion developed into a powerful force, a force affected by messages such as the rate of iatrogenic complications in U.S. hospitals. If extrapolated to the airline industry, this would be the equivalent of three large jet crashes every two days [4]. In addition, patient safety and quality-of-care movements together with forces from technological innovation and governmental attention demanded safer and more transparent health care systems, systems whose very foundation must be build on the principle of accountability, hence, systems able and actively seeking for self-reflection of performance. Consequently, these must be systems that actively seek for opportunities to improve medical education and thereby ultimately create optimal conditions for near-future patient care [5–7]. The combination of the aforementioned forces, all stressing the need to reform medical education, led to the development of standards for physician competence.