title: Establishing technical performance norms for general surgery residents.
abstract: BACKGROUND
  Surgery residents are required to achieve performance milestones to advance in their residency. Level-specific, technical performance norms that could be used as milestones, however, do not currently exist. Our aim was to develop level-specific, technical performance norms for general surgery residents on select simulated tasks across multiple institutions.
  
  
  METHODS
  An IRB-approved, prospective, multi-institutional collaborative study with voluntary participation of residents was undertaken at the start of the 2011-2012 academic year. General surgery residents (PGY I-V) from seven institutions were tested on three laparoscopic and five open simulated surgical tasks, and their performance was assessed based on task time and errors. Means and standard deviations of performance for each resident level were calculated and compared. Residents with performance 1 standard deviation below the mean were considered outliers.
  
  
  RESULTS
  A total of 147 residents were evaluated. Mean resident age was 28 ± 3 years; 42 % were female; and they had attended 74 different medical schools. Senior residents (PGY III-V) had more clinical and simulator experience than junior residents (PGY I-II) (p < 0.001). Resident performance scores progressively increased in all tasks reaching a plateau at a lower PGY level for open tasks. Depending on the task, 0-18 % of residents were outliers. When surveyed, 66 % of residents agreed that national performance norms for residents should exist.
  
  
  CONCLUSIONS
  Performance norms were established for select tasks in a representative sample of US surgery residents. Such performance norms allow a more informed assessment of resident skill through comparison to national data and enable the identification of outliers who may benefit from additional training.
authors.affiliation: Department of Surgery and Carolinas Simulation Center, Carolinas HealthCare System, University of North Carolina Charlotte, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA, dimitrios.stefanidis@carolinashealthcare.org.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
authors.forename: Harsh
authors.initials: H
authors.lastname: Grewal
authors.forename: John T
authors.initials: JT
authors.lastname: Paige
authors.forename: James R
authors.initials: JR
authors.lastname: Korndorffer
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
authors.forename: Dmitry
authors.initials: D
authors.lastname: Nepomnayshy
authors.forename: David A
authors.initials: DA
authors.lastname: Edelman
authors.forename: Chris
authors.initials: C
authors.lastname: Sievers
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000193:education* / Q000592:standards; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education / Q000592:standards; D008297:Male; D011446:Prospective Studies; D013536:Suture Techniques / Q000193:education; D013647:Task Performance and Analysis