Graduate medical education is at the brink of a paradigm shift in educating the next generation of physicians. Over 100 years ago, the Flexner report helped usher in the Halstedian residency, based on timed exposure and knowledge assessment as the cornerstones of medical education. The addition of operative case logs and respective board examinations to the current model of surgical education has served to establish practice minimums; however, they do not provide any assessment of actual operative capability or clinical competence. Although these facets have been tempered over time, one could argue that they currently exist only as surrogates for the true goal of all graduate medical education: the development of competent, graduating physicians, capable of independent and ethical practice. There now exists a growing body of evidence that competency-based medical education is this century’s Flexnerian revolution. By the objective, subjective, and global assessment of competence, it is thought that we can more effectively and efficiently educate our trainees, provide much needed accountability to our individual patients and to the public as a whole, and establish a lasting model of self-motivated, lifelong learning.