Assessing surgical residents’ readiness for independent surgical performance: a scoping review

Purpose Historically, procedure counts have served as a proxy for readiness for independent practice, but growing emphasis on competency-based education has shifted attention toward quality of performance instead. Assessing clinical performance is only one part of this decision, and how supervisors integrate it when granting autonomy remains poorly understood. This scoping review aimed to comprehensively identify studies describing supervisors’ thoughts and methods for identifying surgical independence among residents. Methods This scoping review searched five databases. All peer-reviewed empirical publications using quantitative and qualitative methodologies were included. Results In total, 2727 publications were screened after duplicates were removed, of which 122 were eligible for review. Most of the included studies were conducted in North America and were within the scope of general surgery. Thirty-one different assessment tools and frameworks were identified, focusing on supervisor interaction, combined summative evaluations of independence, and supervisors’ intuitive judgements. Qualitative interview studies showed that surgical trust develops as an ongoing, multidimensional process rather than through a single assessment. Conclusion There is a significant diversity in methods for assessing operative trust within the supervisor-resident relationship.