Systematic Reviews
Copyright ©The Author(s) 2021.
World J Orthop. Apr 18, 2021; 12(4): 234-245
Published online Apr 18, 2021. doi: 10.5312/wjo.v12.i4.234
Table 3 Existing methods for determining surgical competency
MethodBasic structureAssessmentProcedure examplesValidated1 for




Practicing surgeons
Surgical trainees
Licensing bodies assessments
State Medical Boards[50-52]Mandatory to practice. Required to demonstrate competency through CME. However, states individually may evaluate professional conduct when a physician fails to provide appropriate quality of careMust regularly participate in CME activities and may require board certification. May have competency evaluation by independent evaluator or approved assessment program if signs of dyscompetence-Unclear-
ABMS[18,19]Voluntary certification to show knowledge of standards of practice. Rigorous process of evaluation every 10 yr with MOCMOC consists of 4-part assessment: Licensure/professional standing, participation in CME programs, cognitive expertise through examination, and documentation of quality of care and/or audits or peer review-Unclear-
Provincial Licensing Bodies in Canada[53-55]Mandatory to practice. Required to demonstrate competency through CME. Provincial licencing bodies identify those with deficiencies in competence, requiring peer reviewMust regularly participate in CME activities. If evidence of dyscompetence, rigorous individualized assessment of the surgeon’s practice is performed, with emphasis on quality of care-Unclear-
Fellows of the RCPSC[56,57] Voluntary certification to show commitment to competent practice. Evaluation and successful completion of MOC program every 5 yrMust participate in CPD activities. MOC based on 3 section framework: Group learning, self-learning, and assessment-Unclear-
Non-licensing bodies assessments
OSATS[58-61]Multi-station and timed with bench and live model simulations or surgical procedures. Peer evaluated with rating scaleChecklist and global rating scale by expert examiner to evaluate technical skill. Does not assess decision making or concrete surgical aspectsLaparoscopic Gastric Bypass Saphenofemoral dissection. Meniscectomy transtibial or anteromedial femoral tunnelYesYes
C-SATS[26,31]Video recorded surgical performance and evaluated with validated with rating scaleCrowds of anonymous and independent reviewers, including those nonmedically trained, evaluate surgical skill with validated performance tools such as OSATSUrinary bladder closure. Robotic surgery skillsNoYes
O-SCORE[27,62]Surgical procedure peer evaluated with rating scaleSurgical experts rate performance with 9 item tool and scaling system to assess competence to perform procedure independentlyOpen reduction internal fixation of hip, wrist, or ankle. Arthroplasty (total hip or hemi). Knee arthroscopyNoYes
GOALS[63,64] Laparoscopic procedure peer evaluated with rating scaleSurgical experts evaluate performance with 5-point rating scale of 5 items unique to laparoscopyLaparoscopic cholecystectomyNoYes
GEARS[65,66]Robotic procedures peer evaluated with rating scaleSurgical experts evaluate performance with 5-point rating scale of 6 items unique to robotic surgeryInanimate simulators–continuous suturing. Prostatectomy NoYes
Direct Objective Metric Measures[67,68] Skill/surgical procedure measured with concrete aspectsMeasurement of stiffness and failure load for each repair construct, with comparison to expected rehabilitation loadsTibial plafond fracture reduction. Distal radius fracture reductionNoYes