Objective assessment of technical skills in surgery

Editor—Moorthy et al highlight the need to assess surgical trainees' skills reliably and accurately, outlining options available to achieve this end.1 Inadequate objective skill based assessment and poor knowledge of basic science are major concerns for both trainers and trainees alike. However, the context in which skills and facts are acquired is just as important as method of assessment. Basic and higher surgical training are currently clinically based, supplemented by courses, educational meetings, and tutorials. Unfortunately, many trainees attend the course for basic surgical skills well into their training. Some partially fund such courses because of limited deanery budgets or are denied study leave because of service commitments. Training schemes seldom offer revision of anatomy or physiology in the dissection room or laboratory from basic science staff. In contrast, trainee chartered accountants enjoy the benefit of several structured, month long, free courses between work placements. Pass rates exceed comparable surgical examinations, and trainees receive useful career preparation. The surgical royal colleges acknowledge that training needs restructuring.2 I suggest that protected, structured blocks of teaching and assessing basic sciences and skills should be provided throughout surgical training. Proposed changes to training present an ideal opportunity to implement such modules.3 Objections are predictable. It would be costly. Trainees would require release from some service commitments. Postgraduate training would have to be properly organised. Difficulties arise in the objective assessment of trainees.4 But if surgical teaching and assessment is to improve then the solution must be more radical than formulating another three day course, or adding an extra examination.