The evolution of surgical training in the UK

Figures & data

Figure 1 Miller’s pyramid of clinical competence.

Notes: Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65(9 Suppl):S63–S67.¹⁸
Abbreviations: PBAs, procedure-based assessments; DOPS, direct observation of procedural skills; mini-CEX, mini clinical evaluation exercises; EMQs, MCQs, multiple choice questions.

Table 1 Part 1 of the PBA form, assessment of generic surgical skills

Generic skills	N/D/S
Follows an agreed, logical sequence or protocol for the procedure
Consistently handles tissue well with minimal damage
Controls bleeding promptly by an appropriate method
Demonstrates a sound technique of knots and sutures/ staples
Uses instruments appropriately and safely
Proceeds at appropriate pace with economy of movement
Anticipates and responds appropriately to variation, eg, anatomy
Uses assistant(s) to the best advantage at all times

Abbreviations: N, not observed or not appropriate; D, development required; S, satisfactory standard for CCT (no prompting or intervention required); CCT, certificate of completion of training.

Table 2 Part 2 of the PBA form, assessment of specific skills in laparoscopic cholecystectomy

Specific skills	N/D/S
Creates a pneumoperitoneum safely (eliminated from simulation)
Safely inserts an appropriate number of ports
Dissects cholecystectomy triangle safely
Safely ligates and divides cystic duct
Safely ligates and divides cystic artery
Carefully mobilizes gallbladder off the liver
Safely extracts gallbladder from a port site

Abbreviations: N, not observed or not appropriate; D, development required; S, satisfactory standard for CCT (no prompting or intervention required); CCT, certificate of completion of training.

MillerGEThe assessment of clinical skills/competence/performanceAcad Med1990659 SupplS63S672400509

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