Surgical EducationAssessment of technical and nontechnical skills in surgical residents

•Assessment for surgical competency requires assessing both technical and nontechnical skills.•Context specificity likely accounts for low interstation reliability identified in our study.•Nontechnical skills are not consistently correlated with technical skills.•Multiple stations testing both skills are therefore needed for surgical competency assessments.

BackgroundSurgical competence encompasses both technical and nontechnical skills. This study seeks to evaluate the validity evidence for a comprehensive surgical skills examination and to examine the relationship between technical and nontechnical skills.MethodsSix examination stations assessing both technical and nontechnical skills, conducted yearly for surgical trainees (n = 120) between 2010 and 2014 are included.ResultsThe assessment tools demonstrated acceptable internal consistency. Interstation reliability for technical skills was low (alpha = .39). Interstation reliability for the nontechnical skills was lower (alpha range −.05 to .31). Nontechnical skills domains were strongly correlated, ranging from r = .65, P < .001 to .86, P < .001. The associations between nontechnical and technical skills were inconsistent, ranging from poor (r = −.06; P = .54) to moderate (r = .45; P < .001).ConclusionsMultiple samplings of integrated technical and nontechnical skills are necessary to assess overall surgical competency.