Intended for healthcare professionals

Clinical Review

Objective assessment of technical skills in surgery

BMJ 2003; 327 doi: (Published 30 October 2003) Cite this as: BMJ 2003;327:1032
  1. Krishna Moorthy, clinical research fellow (,
  2. Yaron Munz, clinical research fellow1,
  3. Sudip K Sarker, clinical research fellow1,
  4. Ara Darzi, professor of surgery1
  1. 1 Department of Surgical Oncology and Technology, Imperial College, St Mary's Hospital, London W2 1NY
  1. Correspondence to: K Moorthy
  • Accepted 4 September 2003

In the past few years, considerable developments have been made in the objective assessment of technical proficiency of surgeons. Technical skills should be assessed during training, and various methods have been developed for this purpose


Surgical competence entails a combination of knowledge, technical skills, decision making, communication skills, and leadership skills. Of these, dexterity or technical proficiency is considered to be of paramount importance among surgical trainees. The assessment of technical skills during training has been considered to be a form of quality assurance for the future.1 Typically surgical learning is based on an apprenticeship model. In this model the assessment of technical proficiency is the responsibility of the trainers. However, their assessment is largely subjective.2 Objective assessment is essential because deficiencies in training and performance are difficult to correct without objective feedback.3

The introduction of the Calman system in the United Kingdom, the implementation of the European Working Time Directive, and the financial pressures to increase productivity4 have reduced the opportunity to learn surgical skills in the operating theatre. Studies have shown that these changes have resulted in nearly halving the surgical case load that trainees are exposed to.5 Surgical proficiency must therefore be acquired in less time, with the risk that some surgeons may not be sufficiently skilled at the completion of training.6 This and increasing attention of the public and media on the performance of doctors have given rise to an interest in the development of robust methods of assessment of technical skills.7 We review the research in this field in the past decade. Our objectives are to explore all the available methods, establish their validity and reliability, and examine the possibility of using these methods on the basis of the available evidence.


We collected information for this review from …

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