Real-world assessment of trainee surgical competence and autonomy must occur in the operative environment. It is unclear if or how workplace-based operative skills assessments are systematically incorporated into summative evaluations. In this study, intraoperative surgical skills assessment tools were reviewed for actual or proposed incorporation into summative evaluations.

A scoping review was conducted. The Cochrane Central Registrar of Clinical Trials, Embase, Medline, and Web of Science were searched for articles published from January 2012 to December 2021. Articles describing an educational assessment paradigm of a post-graduate surgical trainee performing an open surgical procedure were selected. Using the PRISMA Extension Guidelines for Scoping Reviews, two independent reviewers completed data extraction including literature quality, assessment paradigm, assessment quality, incorporation into summative evaluations, and facilitators and barriers to implementation. Finally, a narrative synthesis of extracted data was completed.

Twenty-two articles met inclusion criteria describing 11 different surgical assessments. All were cohort studies, of which 21 involved the evaluation of an assessment tool and one involved participant perceptions of the assessment tool. All studies discussed the possible use of their assessment to track progress over time, but no study explicitly outlined the incorporation of the tool into a summative review. Four types of assessments automatically integrated results, which reportedly were utilized at Clinical Competency Committee (CCC) meetings. Facilitators and barriers of surgical assessment integration into summative assessments was not described.

While proponents of formative intra-operative assessment have claimed that their potential use in supporting summative evaluation and tracking learning trajectories are major benefits, a systematic method of integrating workplace surgical assessments into summative resident evaluation has not been described or uniformly implemented.