Assessing the surgeon's technical skills: analysis of the available tools

The concept of assessing competency in surgical practice is not new and has taken on an added urgency in view of the recent high-profile inquiries into "botched cases" involving surgeons of various levels in different parts of the world. Until very recently, surgeons in the United Kingdom and other parts of the world, although required to undergo formal and compulsory examinations to test their factual knowledge and decision making, were not required to demonstrate technical ability. Therefore, there existed (and still exist) no objective assessment criteria to test trainees' surgical skill, especially during the exit examination, which, if passed, provides unrestricted license to surgeons to practice their specialties. However, with the introduction of a new curriculum by various surgical societies and a demand from the lay community for better standards, new assessment tools are emerging that focus on technical competency and that could objectively and reliably measure surgical skills. Furthermore, training authorities and hospitals are keen to embrace these changes for satisfactory accreditation and reaccreditation processes and to assure the public of the safety of the public and private health care systems. In the United Kingdom, two new surgical tools (Surgical Direct Observation of Procedural Skill, and Procedure Based Assessments) have been simultaneously introduced to assess surgical trainees. The authors describe these two assessment methods, provide an overview of other assessment tools currently or previously used to assess surgical skills, critically analyze the two new assessment tools, and reflect on the merit of simultaneously introducing them.