The assessment of surgical competency in the UK

The assessment of surgical competence is a vital component of the surgical training process, the accreditation of specialists, and the maintenance of public confidence in the surgical profession [Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J. Assessment of technical surgical skills. Eur J Surg 2002;168:139-44.]. The introduction of the Calman system, the European Working Time Directive, the Hospital at Night project, and financial pressures to increase productivity has nearly halved the surgical case load that trainees are exposed to. With less time to acquire surgical proficiency, surgeons may be insufficiently skilled at completion of training [Moorthy K, Munz Y, Sarker SK, Darzi A. Objective assessment of technical skills in surgery. BMJ 2003;327:1032-7.]. We look at the current methods of assessing surgical competency and what new innovative methods are on the horizon.

A Medline search was performed in April 2005 using the keywords 'surgical training', 'surgical competence', 'surgical simulation' and 'virtual reality'. Only papers published in English have been cited in this review. Articles were reviewed for relevance, impact within the field, and applicability to the UK training system.

A large number of articles explore the potential of training techniques - including wet and dry laboratories, computer simulators and virtual reality trainers - to complement traditional 'apprenticeship' surgical training. All of the methods demonstrate the ability to distinguish surgeons of varying competence.

The advantages of the training methods discussed are many and there is great enthusiasm for introducing skills assessment within a nationally standardised and validated surgical curriculum [Aggarwal R, Moorthy K, Darzi A. Laparoscopic skills training and assessment. Br J Surg 2004;91:1549-58.], as well as using it as an adjunct to traditional methods of training.