OBJECTIVE The aim of this article to outline proposals for the use of high stakes technical performance assessments, defined as assessments of technical skill that take place outside of the operating theatre, across the continuum of surgical training. SUMMARY BACKGROUND DATA Technological advancements have allowed for the assessment of operative technical skill outside of the workplace environment, developed and evaluated in line with modern concepts of assessment validity. With the introduction of competency-based education principles across surgical training curricula, increasing scrutiny is being placed on the validity and reliability of assessments used to inform high-stakes training decisions regarding selection, progression through training, autonomy granting and end-of-training certification. The role of performance assessments, conducted outside of the workplace environment, is yet to be fully established. METHODS This article discusses the use of high-stakes performance assessments across the continuum of surgical training, with reference to relevant theories of surgical skill acquisition and assessment, along with contemporary evidence from the performance science literature. RESULTS Assessments of increasing professional authenticity are required across the continuum of surgical training. In an attempt to capture inherent ability rather than skill at the time of trainee selection, assessments should be of deliberately low levels of professional authenticity. Assessment in early surgical training should focus on ensuring competence in core surgical skills, and then assessing for canonical competence across a series of commonly encountered procedures. Baseline competence in these procedures should ideally be assessed prior to the transition to (supervised) lead operator, with a view to ensuring patient safety and improving the efficiency of in-theatre training. Assessment later in training relies more heavily on the workplace, with simulation offering a complimentary role in ensuring a minimum competency standard in procedures less likely to be encountered in the workplace. CONCLUSION High-stakes performance assessments can play an important role as part of a programmatic approach to surgical training and certification. They can and should be designed with an appropriate level of professional authenticity to ensure adequate and appropriate representation of the assessment construct.

中文翻译：

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整个手术培训过程中的高风险技术绩效评估。


目的 本文的目的是概述使用高风险技术绩效评估的建议，其定义为在手术室之外、整个手术培训过程中进行的技术技能评估。摘要背景数据技术进步允许对工作场所环境之外的操作技术技能进行评估，并根据评估有效性的现代概念进行开发和评估。随着在外科培训课程中引入基于能力的教育原则，人们越来越多地审查评估的有效性和可靠性，这些评估用于为有关选择、培训进展、自主权授予和培训结束认证等高风险培训决策提供信息。在工作场所环境之外进行的绩效评估的作用尚未完全确立。方法本文参考手术技能获取和评估的相关理论以及绩效科学文献中的当代证据，讨论了在整个手术培训过程中使用高风险绩效评估的方法。结果 在整个外科培训过程中需要对不断提高的专业真实性进行评估。为了在选择学员时捕捉内在能力而不是技能，评估应故意降低专业真实性水平。早期手术培训的评估应侧重于确保核心手术技能的能力，然后评估一系列常见手术的规范能力。 理想情况下，应在过渡到（监督的）首席操作员之前评估这些程序的基线能力，以确保患者安全并提高手术室培训的效率。培训后期的评估更多地依赖于工作场所，而模拟在确保工作场所不太可能遇到的程序的最低能力标准方面提供了补充作用。结论 作为外科手术培训和认证程序化方法的一部分，高风险绩效评估可以发挥重要作用。它们可以而且应该具有适当水平的专业真实性，以确保评估结构的充分和适当的代表性。