Surgical skills assessment: an ongoing debate

What makes a good surgeon? There are many attributes required of a surgeon, e.g. core knowledge of basic sciences, clinical decision-making skills, communication skills, operative theory and the ability to deal with intraand postoperative problems, the skill of providing safe postoperative care, and the ability to both think and work in stressful environments. Only 25% of a skilfully performed operation is thought to be attributed to manual dexterity, yet traditionally a surgeon's skill has been measured by assessing the clinical outcome of his or her patient [1]. Changes in patient expectations and a few high-pro®le surgical cases suggesting that poor clinical outcome was the result of individual failure to conduct an adequate operation have resulted in surgeons having to prove their surgical competence. This, together with political pressure, changes in training and technological advances, have set the scene for a more formal measurement of surgical skills, and the setting and maintaining of surgical standards. Assessing the performance of surgeons is not necessarily bad. Feedback serves to differentiate training from practice and thus assessment will aid surgical training. Formal assessment of a surgeon will enable the Royal Colleges to provide a license for technically sound surgeons and help in the revalidation process. Finally, it will serve to restore public con®dence in the surgical profession. This review discusses the requirement of a good assessment process and the mechanisms that are currently in existence.