title: Optimizing the Selection of General Surgery Residents: A National Consensus.
abstract: BACKGROUND
  Surgical programs strive to recruit trainees who will graduate as competent surgeons; however, selection processes vary between institutions. The purpose of the present study was to (1) solicit program directors' (PDs) opinions on the proportion of trainees who have difficulty achieving competence and (2) establish consensus on the desired attributes of general surgery (GS) candidates and the technical skills that would be most indicative of future performance.
  
  
  METHODS
  Delphi consensus methodology was used. An open-ended questionnaire, followed by a closed-ended questionnaire, formulated as a 5-point Likert scale, was administered. A Cronbach α ≥ 0.8 with 80% of responses in agreement (4-agree and 5-strongly agree) determined the threshold for consensus.
  
  
  RESULTS
  The first and second rounds were completed by 14 and 11, of a potential 17, GS PDs, respectively. PDs felt that 5% or less of trainees have difficulty reaching competence in clinical knowledge, 5% to 10% in decision-making, and 5% to 15% in technical skill by the time of completion of training. Consensus was excellent (α = 0.92). The top attributes for success in GS included work ethic and passion for surgery. Technical skills that felt to be most appropriate were open tasks (one-handed tie and subcuticular suture) and laparoscopic tasks (coordination, grasping, and cutting).
  
  
  CONCLUSIONS
  PDs indicate that of the 3 domains, the largest proportion of trainees had difficulty reaching competence in technical skill. Consensus among PDs suggests that top personal attributes include work ethic and passion for surgery. Consensus of technical tasks for inclusion into selection was basic open and laparoscopic skills.
authors.affiliation: Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: marisa.louridas@mail.utoronto.ca.
authors.forename: Marisa
authors.initials: M
authors.lastname: Louridas
authors.affiliation: Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Szasz
authors.affiliation: Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Sandra de
authors.initials: S
authors.lastname: Montbrun
authors.affiliation: Royal College of Physicians and Surgeons of Canada, ‎Ottawa, Ontario, Canada.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Harris
authors.affiliation: Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D002170:Canada; D003697:Delphi Technique; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D013502:General Surgery / Q000193:education*; D017408:Guidelines as Topic / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D010560:Personnel Selection / Q000592:standards*
keywords: Medical Knowledge; Practice-Based Learning and Improvement; general surgery; post graduate education; selection; surgical residency; technical skill