Assessing operative skill

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7188.887 (Published 3 April 1999)
Cite this as: BMJ 1999;318:887

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Needs to become more objective

  1. Ara Darzi, Professor of surgery (a.darzi@ic.ac.uk),
  2. Simon Smith, Clinical research fellow,
  3. Nick Taffinder, Specialist registrar
  1. Division of Surgery, Anaesthesia, and Intensive Care, Imperial College School of Medicine at St Mary's, London W2 1NY

    Pressure is mounting for surgeons to demonstrate that they can operate well, maintain their performance, and deliver acceptable results. Improved data collection after the Bristol affair may provide more information on the performance of individual surgeons, but a large number of failures are needed before statistical significance is reached,1 and, for patients, this will be a case of shutting the stable door after the horse has bolted. We need to be able to measure operative skill, set standards, and assess surgeons before any damage is done.

    Although many factors influence surgical outcome, the skill of the surgeon in the operating theatre is very important. A skilfully performed operation is 75% decision making and 25% dexterity2; in some specialties, such as minimally invasive surgery, dexterity becomes more important. Though surgeons have formal examinations in surgical knowledge, there is no such requirement to show operative dexterity. …

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