A paradigm shift is underway in the training of general surgery residents with emphasis placed on learning skills on simulators before patient encounters. To that end, national skills curricula have been proposed, but their adoption by regional programs is unknown. The purpose of this study was to assess the adoption of surgical skills training in residency programs in North and South Carolina. Surveys were sent electronically to faculty members overseeing surgical skills training at the 10 residency programs in North and South Carolina. Surveys included seven questions related to skills training implementation and allocated resources at each training program. Eight programs responded and all reported the existence of a formal skills curriculum with mandatory resident participation policies. Programs allotted from 0 to 8 hours of protected time per month for skills training, but actual resident participation was less (0 to 4 hours). The type of skills curricula used varied among institutions and included time-based, proficiency-based, and the use of the national skills curriculum. Six programs (75%) had dedicated protected time for faculty trainers and had hired personnel sponsored by the hospital/surgical department to assist with running the skills lab. Equipment and resources varied among institutions; all but one program reported receiving funding/resources from industry. Five programs reported they had active simulation research protocols. Variability and lack of standardization exists with regard to surgical skills training in residency training programs in North and South Carolina. Collaborative efforts to promote standardization are needed and are presently underway.