The examination assessment of technical competence in vascular surgery

Background: The European Board of Surgery Qualification in Vascular Surgery is a pan-European examination for vascular surgeons who have attained a national certificate of completion of specialist training. A 2-year study was conducted before the introduction of a technical skills assessment in the examination. Methods: The study included 30 surgeons: 22 candidates and eight examiners. They were tested on dissection (on a synthetic saphenofemoral junction model), anastomosis (on to anterior tibial artery of a synthetic leg model) and dexterity (a knot-tying simulator with electromagnetic motion analysis). Validated rating scales were used by two independent examiners. Composite knot-tying scores were calculated for the computerized station. The stations were weighted 35, 45 and 20 per cent, respectively. Results: Examiners performed better than candidates in the dissection (P < 0·001), anastomosis (P = 0·002) and dexterity (P = 0·005) stations. Participants performed consistently in the examination (dissection versus anastomosis: r = 0·79, P < 0·001; dexterity versus total operative score: r = −0·73, P < 0·001). Interobserver reliability was high (α = 0·91). No correlation was seen between a candidate's technical skill and oral examination performance or logbook-accredited scores. Conclusion: Current surgical examinations do not address technical competence. This model appears to be a valid assessment of technical skills in an examination setting. The standards are set at a level appropriate for a specialist vascular surgeon. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.