Assessment of surgical skills of trainees in the UK

Abstract

Surgical training and assessment in the UK has been criticised in the past for lacking transparency, reliability and validity. The new Intercollegiate Surgical Curriculum Programme (ISCP) has a well-defined, competence-based syllabus and a system of workplace-based assessments and examinations that map to the syllabus. The main aims of workplace-based assessment are to aid learning through objective feedback and to provide evidence that the competencies required to progress to the next level of training have been achieved. Reduction in surgical experience means that more training will need to be undertaken on simulations, although experience and assessment in the operating room must remains the 'gold-standard'. Simulation training will require the provision of properly resourced surgical skills facilities in every hospital. The key to reliable assessment and constructive feedback is well-trained trainers. Training is a skill that must be learned, and assessment and feedback techniques form part of this. In surgery, it has been assumed that all consultants are trainers but this is clearly not the case. Surgeons will need to follow the example of primary care, where trainers are selected from experienced general practitioners who demonstrate enthusiasm and ability. The reward for the trainer should be protected time for training. The reward for the National Health Service will be better trained surgeons.

Figure 1

Miller's triangle defines a simple hierarchy for the development and assessment of clinical skills.

Figure 2

An outline of the ISCP assessment system. Workplace assessments (indicated F) are formative tools, designed to facilitate learning; they should be undertaken as often as possible. Summative assessments are indicated S. The content of assessments is generic in early training, becoming increasingly specialised as training progresses. (1) Mini-PAT is undertaken at entry to specialty training (for most in ST1) and every 3 years thereafter (for most in ST4 and ST7). It can be repeated if there is any concern about a trainee's professional behaviour. (2) Mini-CEX and CBD should each be undertaken at least 6 times per year in ST1/ST2. Their use in specialty training will depend on the specialty and level of training. (3) Surgical DOPS and PBAs facilitate the acquisition of surgical skills. Surgical DOPS should be undertaken at least 6 times per year in ST1/ST2. PBAs focus on index procedures in each specialty and should be used every time an index procedure is performed.

Figure 3

A hierarchy for simulation training.