The practice of general surgery has undergone a marked evolution in the last 20 years, which has been inadequately recognized and minimally addressed. The changes that have occurred have been disruptive to residency training, and to date there has been minimal compensation for these. Evidence is now emerging of significant issues in the overall performance of recent graduates from at least 3 sources- the evaluation of external agents who incorporate these graduates into their practice or group, the opinions of the residents themselves, and the performance of graduates on the oral examination of the American Board of Surgery during the last 8 years. The environmental and technological causes of this situation represent improvements in care for patients and are clearly irreversible. Hence, solutions to the problems must be sought in other areas. The problems brought about by the 80-hour workweek are somewhat different and dictate that more efficient and perhaps additional training is needed. To address the issues effectively, greater recognition and engagement is needed by the surgical community so that effective solutions can be crafted.