• Conor Toale, Dara O Kavanagh, Michael Devine, and Marie Morris.
• Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin, Ireland.
• Ann. Surg. 2024 Sep 30.

ObjectiveThe 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 DataTechnological 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.MethodsThis 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.ResultsAssessments 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.ConclusionHigh-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.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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