Ever since humans have been performing surgical treatments on their peers, a high degree of competency has been a reasonable expectation by both the patient and society. Recently, the assessment of technical skills competency has brought the critical topic of expertise to the forefront. This review addresses technical skills expertise in the domain of neurosurgery to advance the designs of research programs dedicated to improving the training, assessment, and certification of “expert” surgeons. First, the definitions of technical skills expertise in surgery are explored. There is a growing concern that expertise, as defined by surgeons, is only a representation of competency. The lack of clear definitions is presented and the consequences of this issue are discussed. The assessment of surgeons’ skills, primarily technical skills, are reviewed in the context of an expert performance approach to expertise.
As defined by Ericsson and Charness, expert performance is a laboratory technique that could allow the assessment of the extent of expertise in a context that is as close as possible to the real tasks. Multiple tools to assess technical skills of surgeons were designed and validated in the past 2 decades, and their results are reviewed. The evidence relating expert performance and surgical simulation are discussed and the training of neurosurgeons to achieve an “expert” level of technical performance reviewed. The literature outlining the path to expertise in surgery is appraised in the context of a theoretical training curriculum focusing on the combination of expert performance assessment, deliberate practice, and simulation in neurosurgery.
From: Surgical Expertise in Neurosurgery: Integrating Theory Into Practice by Gélinas-Phaneuf et al.