Assessment and feedback in the skills laboratory and operating room

Significant advances have been made in recent years in the accurate and reliable assessment of surgical skill. The many applications for such a facility range from selection and training to certification, revalidation, and the implementation of new technologies. In the process of developing an assessment procedure it is necessary to select elements that safely, feasibly, and reliably capture variations in technical and nontechnical performance. The laboratory lends itself well to the assessment of deconstructed skills in a safe environment, whereas the operating room demands integration of technical and nontechnical skill in a high-risk setting. Therefore, both have an important role to play and should coexist within a continuous assessment pathway.