The modern surgeon and competency assessment: are the workplace-based assessments evidence-based?

INTRODUCTION: The assessment of higher surgical training has changed in the last decade or two, with a greater emphasis on work-based assessments (WBAs) to prove competency. The aim of this study was to determine the evidence underpinning the use and number of WBAs in surgical training.
METHODS: In July 2013, a systematic electronic literature review was undertaken using PubMed (Medline), Embase, Google Scholar and the Cochrane library.
RESULTS: A total of 27 studies met the inclusion criteria of which 25 were observational studies and only five assessed WBAs in a surgical setting. Validity and feasibility in surgical training were assessed in two studies, respectively, with the results suggesting that WBAs maybe neither feasible nor valid in surgical training. The number required to achieve reliability in surgical training was demonstrated to be three in two separate studies. The evidence for the reliability, feasibility and validity of WBAs in other non-surgical fields was conflicting.
CONCLUSION: There is a paucity of evidence supporting the use of WBAs as a tool to determine competency in surgical training, and as such, they should only have a limited role in training until more evidence is available. There appears to be no justification or evidence underpinning the use of a specific number of WBAs to determine surgical competency.