Accrediting bodies worldwide are now requiring residents to be deemed clinically competent in their specialty before certification is granted. Over time, residency training has shifted from the unstructured apprenticeship model to a more practice-based systems approach that includes ensuring that residents are competent to practice safe, effective medicine and surgery in practice. Surgical residency programs are adopting competency-based curricula with specialty-specific objectives that must be met by all residents. Although “medical competence” has yet to be defined in the literature, several governing bodies throughout the world have developed and implemented core competency frameworks designed for uptake by residency programs. Multiple valid and reliable assessment measures are now widely used to evaluate a resident’s ability to meet core competency requirements. These measures can be tailored to a specific specialty. In surgery, the assessment of technical skills is vital to ensuring competency, and various tools are available for this purpose. Although surgical educators are faced with numerous barriers, the development and implementation of a competency-based curriculum is fundamental to ensuring that surgical residents are capable of working as safe, certified surgeons.