OBJECTIVE Surgical training programmes are evolving from time-based to competency-based schedules, which define expected learning outcomes in surgical knowledge, clinical and technical skills according to training levels. This article aims to review current models in surgical skills acquisition and to propose an integrative process-driven, outcomes-based model for surgical skills acquisition and mastery. METHODS A literature review was conducted on the theories of motor skills acquisition using PubMed, Web of Science and Google Scholar from 2010 to February 2020. The review was limited to theories and models on surgical skills acquisition and mastery. Four models of surgical skills acquisition were included: Fitts and Posner's three-stage model of motor skills acquisition, Bandura's social learning theory, Ericsson's deliberate practice model and Jeannerod's motor simulation theory. These models are deficient in that there is no universally accessible opportunity to practise the surgical procedure outside of the operating theatre and without access to physical simulators. RESULTS We propose an innovative model that allows deliberate practice of the procedure without the need for expensive physical simulators, and provides an on-demand, self-directed practice by the trainees to achieve the level of mastery. This new model, which incorporates motor imagery and mental practice, augmented by deliberate practice, will provide an alternative training path for expert performance in surgical procedures. CONCLUSIONS The innovative model provides a solution to the reduced opportunity for practice by surgical trainees to achieve mastery in surgical motor skills.