Background: To improve accountability and reflect patient and societal needs, the Royal College of Physicians and Surgeons of Canada proposed Competence by Design (CBD) for all residency programs. This study compares neurosurgical patient values and expectations of their neurosurgeon to resident competences proposed by CBD curriculum. Methods: Semi-structured interviews of 30 neurosurgical patients and family members were recorded, transcribed and analyzed for themes. Results: Of the first 13 interviews (8 males, 5 females; median age 54), 10 had English as a first language, all completed post-secondary education, and 8 had a brain tumor. In addition to expecting excellent surgical skills and comprehensive medical knowledge, participants expected “good” neurosurgeons to be human (compassionate, empathetic, no ego), transparent communicators, accountable, passionate, collaborative, emotionally composed and highly intuitive. However, there were marked differences in minimum set of competencies required and the expectations of the thresholds to determine competence for neurosurgeons. Conclusions: Patient perspectives show commonalities and marked differences of the expected competencies compared to CBD and significant variability of the thresholds of competence. Further investigations should explore these themes in other specialties. The existing CBD curriculum will need to expand its framework to include humanistic values to improve public perceptions of competence.