Correlation between experience targets and competence for general surgery certification

Background: Working time restrictions and public expectation have stimulated competence-based assessment in surgery. Nevertheless, certification of completion of training, and board accreditation across the developed world, still rely on experiential models based on indicative numbers as markers of operative competence. This study assessed the correlation between trainer assessment of competence and completion of indicative numbers. Methods: Analysis of UK Intercollegiate Surgical Curriculum Programme portfolios of general surgical trainees in a single Local Education and Training Board allowed comparison of Procedure Based Assessment (PBA) scores (level of competence) for cholecystectomy, segmental colectomy and Hartmann's procedure with operative numbers. Results: Among 121 trainees, there was a positive correlation between operative numbers and 1058 PBA scores for cholecystectomy (r(S) = 0.532, P < 0.001), segmental colectomy (r(S) = 0.552, P < 0.001) and Hartmann's procedure (r(S) = 0.663, P < 0.001). Of those who completed the indicative numbers defined for each procedure to achieve certification of completion of training, only eight of 30 performing cholecystectomy, eight of 52 undertaking segmental colectomy and seven of 36 performing Hartmann's procedure had achieved three PBAs at the level considered to represent independent operating (level 4). More than half of all assessments (259 of 428, 60.5 per cent; 85 of 132 cholecystectomy, 140 of 217 colectomy and 34 of 79 Hartmann's) performed after trainees had completed their indicative numbers were scored below level 4. Conclusion: A minimum number of index procedures did not reflect competence in a significant proportion of trainees. A more reliable tool is required for certification.