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Acad Med. 2017 Sep 26. doi: 10.1097/ACM.0000000000001902. [Epub ahead of print]

Assessment of Technical Skills Competence in the Operating Room: A Systematic and Scoping Review.

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C. Fahim is a PhD candidate, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. N. Wagner is a PhD candidate, Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada. M.T. Nousiainen is orthopedic surgeon and assistant professor, Sunnybrook Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. R. Sonnadara is director of education science and associate professor, Department of Surgery, McMaster University, Hamilton, Ontario, Canada, and associate professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ORCID:



While academic accreditation bodies continue to promote competency-based medical education (CBME), the feasibility of conducting regular CBME assessments remains challenging. The purpose of this study was to identify evidence pertaining to the practical application of assessments that aim to measure technical competence for surgical trainees in a nonsimulated, operative setting.


In August 2016, the authors systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews for English-language, peer-reviewed articles published in or after 1996. The title, abstract, and full text of identified articles were screened. Data regarding study characteristics, psychometric and measurement properties, implementation of assessment, competency definitions, and faculty training were extracted. The findings from the systematic review were supplemented by a scoping review to identify key strategies related to faculty uptake and implementation of CBME assessments.


A total of 32 studies were included. The majority of studies reported reasonable scores of interrater reliability and internal consistency. Seven articles identified minimum scores required to establish competence. Twenty-five articles mentioned faculty training. Many of the faculty training interventions focused on timely completion of assessments or scale calibration.


There are a number of diverse tools used to assess competence for intraoperative technical skills and a lack of consensus regarding the definition of technical competence within and across surgical specialties. Further work is required to identify when and how often trainees should be assessed and to identify strategies to train faculty to ensure timely and accurate assessment.

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