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Workplace-Based Assessment in Orthopaedic Training: A Commentary on Evolution and Growing Pains
Bryan Ashman1,2, Jason R Frank3, Maura Kempin2
1Department of Medicine, Australian National University, Canberra, Australia.
JB & JS Open Access
|April 8, 2026
Summary
Competency-based assessment in orthopaedic surgery shows global similarities and variations. This study compares systems in the US, Canada, UK, Ireland, and Australia, identifying challenges and solutions for improving surgical training evaluation.
Area of Science:
- Medical Education
- Surgical Training
- Competency-Based Assessment
Background:
- Competency-based programmatic assessment systems are increasingly adopted globally.
- Few comparative studies exist on orthopaedic surgery competence assessment across different countries.
Purpose of the Study:
- To provide a narrative overview of current orthopaedic surgery competence assessment systems in the US, Canada, UK/Ireland, and Australia.
- To compare assessment methods, data collection for progression, and validity evidence.
Main Methods:
- Narrative review of existing competency-based assessment systems.
- Analysis of workplace-based assessments, data points for entrustment/progression, and validity evidence using a modified Kane framework.
Main Results:
- Significant concordance was observed across the compared national systems.
- Variations in assessment practices and data utilization were identified.
- Validity evidence using the modified Kane framework was explored.
Conclusions:
- Orthopaedic surgery training programs exhibit both commonalities and differences in competence assessment.
- Identified challenges and potential solutions can enhance future assessment systems.
- International collaboration can improve the consistency and validity of surgical competence evaluation.
