Surgical Endoscopy

, Volume 28, Issue 11, pp 3179–3185

Establishing technical performance norms for general surgery residents

  • Dimitrios Stefanidis
  • Harsh Grewal
  • John T. Paige
  • James R. Korndorffer
  • Daniel J. Scott
  • Dmitry Nepomnayshy
  • David A. Edelman
  • Chris Sievers

DOI: 10.1007/s00464-014-3582-y

Cite this article as:
Stefanidis, D., Grewal, H., Paige, J.T. et al. Surg Endosc (2014) 28: 3179. doi:10.1007/s00464-014-3582-y



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.


SimulationSurgery residentsTechnical performance assessmentSimulator proficiencyPerformance norms



Accreditation Council for Graduate Medical Education


American Board of Surgery


Analysis of variance


Association of Program Directors in Surgery


Association for Surgical Education


Fundamentals of Laparoscopic Surgery (FLS), University of Texas Southwestern’s


Institutional review board


Operating room


Post-graduate year

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Dimitrios Stefanidis
    • 1
  • Harsh Grewal
    • 2
  • John T. Paige
    • 3
  • James R. Korndorffer
    • 4
  • Daniel J. Scott
    • 5
  • Dmitry Nepomnayshy
    • 6
  • David A. Edelman
    • 7
  • Chris Sievers
    • 1
  1. 1.Department of Surgery and Carolinas Simulation Center, Carolinas HealthCare SystemUniversity of North Carolina CharlotteCharlotteUSA
  2. 2.Department of Surgery, School of MedicineTemple UniversityPhiladelphiaUSA
  3. 3.Department of SurgeryLSU Health New Orleans School of MedicineNew OrleansUSA
  4. 4.Department of SurgeryTulane University Health Sciences CenterNew OrleansUSA
  5. 5.Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  6. 6.Department of General Surgery, TUFTS Medical SchoolLahey ClinicBostonUSA
  7. 7.Department of SurgeryWayne State UniversityDetroitUSA