Abstract
To the Editor: The ultimate objective of surgical training is to produce competent surgeons capable of meeting the health care needs of our society. Surgical training programs tend to emphasize the achievement of cognitive, professional and technical competence. The recent article by Mickelson and MacNeily1 provided an important and comprehensive approach on how urology training programs can integrate the assessment of the core competency domains outlined in the Canadian Medical Education Directives for Specialists (CanMEDS) initiative. It also highlighted a critical shortcoming of CanMEDS as it is applied to surgery. Despite the importance of a good foundation of surgical skill, technical competence has historically been ill-defined and consequently poorly assessed.2 Using CanMEDS as an example, technical competence is not defined explicitly, but is hidden among definitions of the other core competencies under nonspecific subcategories like “medical expert – demonstrates proficient and appropriate use of procedural skills, both diagnostic and therapeutic.”3 This clearly does not do surgical educators, evaluators or trainees justice. As a surgical community, we must continue to strive toward the discovery and application of valid and reliable assessments of technical skill. The Objective Structured Assessment of Technical Skills (OSATS) on simulators in the skills lab is an important start. The time has come, however, for intra-operative evaluations of competency linked to patient outcomes.
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