Trainee Selection and the Correlation Between Cognitive and Technical Skill Evaluation

PURPOSE: Better understanding the predictive relationship between surgical trainee interview performance, technical skill assessment, and performance during training will allow optimisation of the selection process to identify the best candidates.

METHODS: Three annual cohorts of Reconstructive Microsurgery fellows at MD Anderson Cancer Center, comprising 20 trainees, were included in the study. At interview, subjects were rated using seven criteria, as well as on overall impression. At the start and end of the fellowship, subjects were rated on their microsurgical technical skill both in the laboratory and in the OR using a validated tool. At the end of the fellowship there was a final evaluation of performance using criteria adapted from the six ACGME core competencies. Scores were compared in multiple ways to determine associations and predictive factors. 

RESULTS: Microsurgical skill assessment in the OR at the start of training correlated with all domains evaluated at interview. The highest correlation was with Plastic Surgery Training Experience. Microsurgical skill assessment in the OR at the end of training also correlated with scores on the majority of final assessment criteria, most closely with Medical Knowledge and Patient Care.

CONCLUSIONS: Microsurgical technical skill tracked with all domains evaluated at interview, and also with the majority of ACGME evaluation criteria. These results validate the use of the current selection process in choosing candidates with the highest level of both cognitive and technical skill, and also support the effectiveness of the one-year microsurgical fellowship at improving microsurgical skill in all trainees.