Surgical Endoscopy

, Volume 28, Issue 11, pp 3179-3185

First online:

Establishing technical performance norms for general surgery residents

  • Dimitrios StefanidisAffiliated withDepartment of Surgery and Carolinas Simulation Center, Carolinas HealthCare System, University of North Carolina Charlotte Email author 
  • , Harsh GrewalAffiliated withDepartment of Surgery, School of Medicine, Temple University
  • , John T. PaigeAffiliated withDepartment of Surgery, LSU Health New Orleans School of Medicine
  • , James R. KorndorfferAffiliated withDepartment of Surgery, Tulane University Health Sciences Center
  • , Daniel J. ScottAffiliated withDepartment of Surgery, University of Texas Southwestern Medical Center
  • , Dmitry NepomnayshyAffiliated withDepartment of General Surgery, TUFTS Medical School, Lahey Clinic
  • , David A. EdelmanAffiliated withDepartment of Surgery, Wayne State University
  • , Chris SieversAffiliated withDepartment of Surgery and Carolinas Simulation Center, Carolinas HealthCare System, University of North Carolina Charlotte

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access



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.

Study Design

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.


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.


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.


Simulation Surgery residents Technical performance assessment Simulator proficiency Performance norms