Teaching technical skills is one of the most important tasks of a surgeon. This article discusses current issues in teaching and testing technical skills. For the most part, the level of technical skills cannot be predicted before a surgical resident starts a program. Different methods of teaching technical skills are reviewed (in and out of the operating room). For optimal effectiveness in teaching residents, we must apply principles of adult learning to the surgical domain. A methodologic framework for skill acquisition, adapted from the educational psychology literature, is discussed. Five methods of assessing technical skills are presented. Structuring the assessment process has resulted in higher levels of reliability and improved validity.