The Landscape of Mandated Assessments of Surgical Skills: A Document Analysis

The landscape of surgical skills assessments in graduate medical education is broad and complex. To map the required assessments from the start of training to initial certification, we systematically catalogued the requirements for assessing surgical skills across the 9 surgical specialties mandated by the Accreditation Council for Graduate Medical Education (ACGME) and specialty certifying boards.

We performed a qualitative document analysis to examine specialty-specific ACGME documents. Surgical specialty board websites were also reviewed for information about assessment requirements prior to initial certification. Findings were iteratively coded, and document summary tables were created to analyze the assessments.

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About 32 ACGME documents and 9 board websites were examined. Among ACGME documents, all specialties mandated case logs as a measure of surgical experience and 6 specialties stipulated minimum case log numbers for select procedures or procedure categories. All specialties distinguished between resident roles (e.g., assistant surgeon versus resident surgeon) other than plastic surgery. Only otolaryngology-head and neck surgery and ophthalmology specified the assessment of skills in surgical simulation labs. All specialties mandated programs to have semi-annual evaluations of surgical competence, but none specified a format for the assessment. Out of 68 patient-care milestones for the 9 specialties, only 20 included assessments of competency performing specific surgeries. No specialty mandated the use of any specific standardized instruments or workplace-based assessments. However, select specialty boards required workplace-based assessments such as general surgery and orthopedic surgery (skills program). General surgery, thoracic surgery, and obstetrics and gynecology also required specific surgical skills training programs such as fundamentals of laparoscopic skills.

ACGME mandated skill assessments in surgical specialties often lack specificity for the types of assessments to be used and/or the procedures to be evaluated. However, many boards are showing interest in using more novel assessment instruments.