Experienced surgeons are often critical of modern residency training, and question the competence of new graduates. I've been hearing about a competency crisis ever since the 2003 work hour rules, but it's now 23 years later and the sky hasn't fallen yet. A simple question for SurgTwitter: As incompetent and underprepared surgeons have made up more and more of the surgical workforce over the last 20 years, and the more capable surgeons have slowly retired, shouldn't surgical outcomes be getting worse? Why do surgical outcomes across pretty much all procedures keep getting better over time if they're being increasingly performed by young incapable surgeons?