title: Psychomotor ability testing and human reliability analysis (HRA) in surgical practice.
abstract: This review deals with the methodology that exists for assessing the intrinsic or innate abilities required for acquisition of the necessary skills with training so that operative competence and proficiency are reached by surgical trainees at the end of the training programme. In addition, it covers human reliability analysis (HRA) as a technique (long-used in high-risk industries) for ensuring safe execution of operations and a good clinical outcome. Both subjects are relatively new in surgery and most of the account is based on work carried out at Dundee University of Dundee Department of Surgery and Molecular Oncology and Surgical Skills Unit over a 10-year period. The methodology for both is still relatively crude but, nonetheless, progress has been made. In surgery the important role of psychomotor ability testing is in the selection of and the assessment of progress of trainees during the surgical residency. HRA applies both to surgical trainees when good habits and practice become ingrained and during the entire working career of consultant surgeons.