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Assessing Technical Competence in Surgical Trainees: A Systematic Review.

Peter Szasz1, Marisa Louridas, Kenneth A Harris

  • 1*Department of Surgery, University of Toronto, Toronto, Ontario, Canada †Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada ‡Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

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This systematic review analyzed methods for assessing surgical trainee technical competence. Current assessment tools often lack clear standards for defining competence, highlighting a need for further research in this area.

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Area of Science:

  • Medical Education
  • Surgical Training
  • Competency Assessment

Background:

  • Shift from time-based to competency-based surgical education paradigms globally.
  • The definition of surgical competence remains ambiguous.
  • Assessment methods within competency-based surgical education require clarification.

Purpose of the Study:

  • To systematically review and analyze methods for assessing technical competence in surgical trainees.
  • To evaluate the validity and reliability of existing assessment tools.
  • To identify research gaps in the assessment of surgical competence.

Main Methods:

  • Systematic review of literature from MEDLINE, EMBASE, PsychINFO, and Cochrane databases.
  • Inclusion criteria applied to abstracts, followed by full review of selected studies.
  • Assessment methods categorized, and their validity, reliability, and quality (using GRADE) evaluated.

Main Results:

  • 85 studies involving 2369 surgical residents were included.
  • Assessment methods grouped into Likert scales, benchmarks, binary outcomes, novel tools, and surrogate outcomes.
  • Established validity and reliability for most methods; high GRADE for RCTs, low for observational studies.

Conclusions:

  • The definition of technical competence in surgery is still debated.
  • Predominant assessment methods were originally designed for technical skill evaluation, not competence definition.
  • A significant research gap exists in standard-setting approaches to differentiate competent from non-competent surgical performers.