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Difficult or high risk? Objective task assessment vs. faculty perceptions of surgical skills

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With increasing competency demands within limited training opportunities, instruction must be efficient. We compared intern performance and faculty expectations to identify opportunities to optimize basic surgical skills instruction.


After completing a basic surgical skills curriculum, 35 surgical interns were scored (5-point Likert scale) on ten suturing, knot-tying, and vessel ligation tasks. Thirteen surgical faculty was surveyed on their perceptions of difficulty and risk of patient harm associated with each task. Correlation between faculty-perceived difficulty and risk was evaluated using Pearson’s coefficient. The difference between actual score and expected score based on faculty perception of difficulty was assessed for each task.


Among participating interns, mean scores were lowest for atraumatic tying at-depth, tying under tension, and running subcuticular suturing and highest for simple running suture (superficially). Faculty perceived ligation with suture, tying under tension, atraumatic tying (superficially and at-depth) and tying around clamp to be the hardest and highest-risk tasks. Simple running suture (superficially and at-depth), running subcuticular suture, vertical mattress suture, and 2-handed tie were considered the easiest and lowest-risk tasks. Faculty perceptions of task difficulty and risk were strongly correlated (r(8) = 0.75, p = 0.01). Interns performed better than expected on ligation with suture and tying around clamp and worse than expected on running subcuticular and vertical mattress sutures.


Our findings suggest differential task difficulty and misalignment between intern performance and faculty expectations, which may be influenced by risk of patient harm. These findings provide insights for refining learning progression and instruction of these skills.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.


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CYH is part of the Biostatistics Core that is generously supported by the UCSF Department of Surgery.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations



All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AG and C-YH. The first draft of the manuscript was written by AG and KB, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shareef M. Syed.

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Our Institutional Review Board (IRB) declared the study exempt.

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A waiver of informed consent was granted by our IRB given exempt status.

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Greenberg, A.L., Barnes, K.E., Karimzada, M.M. et al. Difficult or high risk? Objective task assessment vs. faculty perceptions of surgical skills. Global Surg Educ 2, 50 (2023).

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