Abstract Background: Recent changes in the educational environment and in the content of specialty surgical education have highlighted limitations, both educational and logistic, of the current system of graduate surgical education. To address these issues, the Graduate Medical Education Committee of the American College of Surgeons conducted a study of the educational competencies desired of graduating medical students, and of surgical residents completing their first postgraduate year (PGY 1). Study Design: Surgeons representing all surgical specialties identified learning needs for graduating students and PGY 1 surgical residents. Responding to a questionnaire based on these learning needs, surgical educators assigned a priority of essential, desirable, or supplementary to each item. Additional questionnaires, limited to student-level items, were sent to graduating medical students matched to surgical residency programs, who assessed their competency. Results: Questionnaires were received from 350 senior surgeons and 83 graduating medical students. General agreement was found among surgeons of all specialties of the essential and desired competencies for medical students entering any surgical residency program. Although there was considerable specialty variation in the priority given to individual items, there was also a broad general consensus on many areas of essential or desirable knowledge and skill that all surgical interns should possess before continuing in advanced education in a surgical specialty, including general surgery. Conclusions: The evidence that many core proficiencies are held in common by all surgical specialties argues strongly for careful coordination and cooperation among the various residency programs in an institution to achieve these objectives in a common learning program.