The last few years have been the most challenging period for the Residency Review Committee for Surgery (RRC-S) since its inception in 1950. As the first residency review committee to be established, the committee has a laudable history of contemplative deliberations before implementing any directive from the Accreditation Council for Graduate Medical Education (ACGME). For example, debate still surrounds the process for implementing the requirements for the 6 general competencies (patient care, medical knowledge, interpersonal/communication skills, professionalism, practice-based learning/improvement, and system-based practice). However, the ACGME has been unwavering in its advocacy of the competency template as the cornerstone of the learning continuum and outcome assessment. The 6 general competencies can actually be grouped into 3 basic categories: fund of knowledge, skills, and judgment. As highlighted in Table 1, these categories are essentially the same as what Aristotle espoused centuries ago. Nevertheless, pundits in the surgery arena continue to denounce the general competencies as superfluous and “unfunded mandates.” Such criticism has not derailed the process of incorporating these competencies into the curriculum. What appears to have broader support in the “house of surgery” is what is being labeled as the “seventh competency”—procedure-based competency (Table 2).