What do master surgeons think of surgical competence and revalidation?

Background: There has been on-going debate and public interest in surgical competence in recent years. Methods: A Delphi reiterative opinion survey was conducted among master sur geons on selection of surgical trainees, methods of assessment of progress of surgical trainees, and revalidation of established consultant surgeons. Results: Selection-the current methods of trainee selection were considered inadequate and in need of revision. The important attributes recognized by group are cognitive factors, innate dexterity, and personality, Important aspects of personality include decision-making ability, insight, team spiri t, and emotional stability. Assessment during training-the majority view wa s that this should be based on clinical judgement/skills, operative skills, and cognitive ability. Assessment of technical ability should be based on standardized checklists. Research within training programs was encouraged b ut academic achievement does not reflect surgical competence, There was a m ajority verdict for an exit clinical examination. Revalidation-the group ag reed on the need for competence checks during the professional career of su rgeons. These should cover knowledge, clinical, operative, and humanistic s kills; but expressed concern on the feasibility of a revalidation system th at can reliably assess the range of skills needed for surgical competence. There was a majority vote against an internal appraisal system. External as sessment by nationally appointed 'assessors' was considered preferable. Conclusions: Both selection and assessment of surgical trainees require cha nges and standardization. Although revalidation is necessary, concern was e xpressed on the reliability and validity of existing and proposed systems. (C) 2001 Excerpta Medica, Inc. All rights reserved.