Editorial Commentary: Accurately Assessing Surgeon Skill: Yardstick or Caliper?

The Fundamentals of Arthroscopic Surgery Training Program benchtop simulator is a valuable platform for learning basic arthroscopy skills and provides a solid foundation for the development of more complex techniques. Rating and assessment tools must be accurate, specific, reliable, and relevant to the skill being assessed. Global rating scales and similar subjective tools are not well suited to the evaluation of procedural skill. The objective assessment of errors has been shown to be the most discriminatory when evaluating surgical proficiency. Objective benchmarks are valuable for summary feedback and for informing the trainee of specific deficiencies. A proficiency benchmark should be based on the operative performance of a cohort that is reasonably homogeneous and whose observed skill is reflective of the designation assigned, typically "experienced." Time and repetition-based formats are substantially less effective than a proficiency-based progression curriculum. Construct validity assessments based on measures of efficiency (time, path motion, etc.) are not as meaningful as those based on objective skill metrics. The demonstration of transfer validity is challenging and demands careful objective assessments that are similar for pre- and postcourse operating room evaluation if we are to draw valid conclusions.