The need for technical skills assessment in surgery

Abstract

There are many factors which determine surgical competence. Elements such as knowledge, communication, judgement and professionalism are all measurable qualities, however the measurement of dexterity and technical competence still remains the most problematic. Technical skill, although constituting only a part of ‘‘surgical competence’’, is still a significant area that is not formally examined or objectively assessed during any training programme. The present system relies on feedback concerning operative ability from a trainee’s present consultant supervisor; this evaluation can only be regarded as subjective, unstructured and possibly biased. With the restructuring of surgical training in the United Kingdom and the introduction of official accreditation prior to independent practice, there is even more pressure to properly appraise all aspects of clinical competence. This must include technical ability. For performance assessment to be used with confidence, three issues must be tackled; namely validity, reliability and feasibility. To address these points it requires both an appropriate and standardised simulation model, and an objective measure of appraising technical skill. Once these