Verification of Proficiency (VOP) in Basic Surgical Skills

This work was been supported by an unrestricted educational grant from Ethicon Endosurgical

Phase 1 of the American College of Surgeons (ACS) and the Association of Program Directors in Surgery (APDS) Curriculum involves basic surgical skills instructional modules and a Verification of Proficiency (VOP) assessment1. Since 2005, the Department of Surgery at Southern Illinois University (SIU) has employed the Phase 1 Curriculum in its training laboratory for first-year surgical residents. The evaluation instruments contain a checklist of specific performance characteristics, a final global rating of overall performance and space for evaluator comments. All residents received protected time for the class and for subsequent testing.  Once the resident felt comfortable with the level of their performance they were videotaped with an automated video capturing system 2. Testing and remediation are completed during July and August before the residents have significant clinical duties. Residents scored as needing additional practice on this final rating are deemed to have failed that VOP and undergo a period of mandatory remediation. We refined the beta versions of Phase 1 VOP instruments 3 as follows:

Chest Tube Insertion

We have removed the checklist item on “failure to attach the chest tube to the draining system” as this was difficult to implement from a cost and logistic point of view.

Knot Tying Modules

All reference to time to completion has been deleted.


A number of individual checklist items were independent predictors of a final rating of failure to demonstrate proficiency, particularly the economy of time and motion item. Although the argument could be made to limit the number of checklist items to those items predictive of proficiency, each checklist item provides valuable feedback to the residents and therefore we would not recommend making any changes. A number of older versions of the evaluation forms use the term “demonstrates competence” as the final global rating. For consistency we would recommend changing this to “demonstrates proficiency” in keeping with the International Consensus Conference recommendations4. Finally the feedback from our faculty suggested that the term requires more practice as an alternative rating to “demonstrates competence / proficiency” is confusing. Residents may be proficient on a single performance but will always need more practice. Therefore we would recommend that the final global rating should read demonstrates proficiency (Yes or No).


  1. ACS/APDS. Surgical Skills Curriculum Information. American College of Surgeons: Division of Education. Accessed 4/8/13.
  2. METI® Learning    Accessed 4/8/13
  3. Sanfey H, et al. Verification of Proficiency in Basic Skills for Pgy1 Residents. SURGERY 2010; 148: 759 – 767.
  4. Satava RM, et al. Metrics for Objective Assessment: Preliminary Summary of the Surgical Skills Consensus Workshop. Surg Endosc 2003; 17:220–226

Download a full pdf