Can we define or measure manual skills in surgical training?

Neurosurgery requires manual dexterity. But should tests be devised to assess manual skills as part of a selection process for training or used as a means of determining surgical competence? The paper debates this fundamental question and proposes that manual skills for neurosurgical tasks need to be defined within the overall context of a recognised and fully assessed training programme. The importance of training as a means of transferring competence, part of which is manual skills, is emphasised. In conclusion the paper points out the inadequacy of solely measuring manual skills, were it possible, in assessing neurosurgical competence.