Surgical Competence and Surgical Proficiency: Definitions, Taxonomy, and Metrics

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Abstract
The report of the Institute of Medicine, “Too Err Is Human,” 1 Kohn L.I. Corrigan J.M. Donaldson M.S. To err is human Building a safer health system. National Academy Press, Washington DC 1999 Google Scholar has raised awareness of not only the significant number of medical errors committed, but also the deficiencies in evaluating performance and competence of surgeons. A critical infrastructure needs to be developed to support the assessment of competence. This infrastructure includes the following issues: 1) providing a precise, measurable definition of “surgical competence”; 2) defining the components of competence; 3) developing an appropriate taxonomy of the components; 4) agreeing on the metrics (preferably objective) for the components of competence; 5) developing tools to measure competence (eg multiple choice questions, objective structured clinical examinations and surgical simulation); 6) creating curricula that use these tools to train and evaluate residents and surgeons; and 7) deriving outcomes measures that can be standardized by the use of criteria.

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