Under the microscope: assessing surgical aptitude of otolaryngology residency applicants

Application to otolaryngology residency is a highly competitive process. Programs identify the best candidates by evaluating academic performance in medical school, board scores, research experience, performance during an interview, and letters of recommendation. Unfortunately, none of these metrics completely assess an applicant's capacity to learn and perform surgical skills. We describe a direct assessment of an applicant's ability for rapid surgical skill acquisition, manual dexterity, and response to stress that can be performed during the interview process.

A retrospective study at an academic otolaryngology residency program.

After orientation, applicants were seated at a microsurgical training station and allotted 20 minutes to suture an incision using 10-0 nylon suture on a latex practice card. Their performance was graded using a 1-to-5 scoring system for the following categories: microscope use, respect for tissue, instrument handling, knot tying and suture control, skills acquisition, and attitude toward the exercise. Applicants were given some instruction and assessed on their ability to incorporate what they had learned into their technique.

The average total applicant score was 23.2, standard deviation (SD) 3.6 (maximum 30); 13.4% of applicants scored <1 SD below the mean, 66.1% scored within 1 SD of the mean, and 20.5% scored >1 SD above the mean.

The value of applicant screening tests in predicting surgical competency is controversial. We describe a direct assessment tool that may prove useful in identifying outliers, both high and low, to aid in final applicant ranking.