What is the single greatest challenge to training the future generation of surgeons? How can we overcome it?

In this article, we argue that the single greatest challenge to training the future generation of surgeons is the prioritization between trainees' education and patients' safety. The key issues include the lack of training time and the lack of exposure to different diseases, due to factors such as the Working Time Directives and subspecialization at major centres. In order to overcome these challenges, it is essential to implement a systematic, competence-based training model, where complex procedures are learnt in small components. With the aid of simulation and new technology, skills can be practised repeatedly before a surgeon is put in front of the operating table. Attachments to hospitals abroad, especially in less developed countries, may also be considered. Targeted courses and seminars would help to increase trainees' exposure to less common pathologies. Rotation of trainees across centres of different expertise would also minimize discrepancy in training programmes.