Best Practices / Research Oral Abstract

Surgical Competence and Performance (O028)

Pam Montgomery (Royal Australasian College of Surgeons); Ian Graham (SED Health Consulting); David Watters (Deakin University and Barwon Health) 


To develop a framework for assessing the performance of consultant surgeons and an assessment and feedback tool to support self-reflection, peer review and multisource feedback.


The project considered methods to define and assess surgical performance and resources/support available for surgeons. The Non-Technical Skills for Surgeons (NOTSS) system was adapted and expanded. A group of practising surgical leaders oversaw the project and there was extensive consultation with this group.


The project has resulted in:

  • A system describing three patterns of behaviour across all nine RACS competencies, each exemplified by four ‘good’ and four ’poor’ behaviours (216 in total)
  • An assessment tool supporting self-reflection and feedback from peers/co-workers suitable for use in the surgical workplace
  • Demonstration that it is possible to assess the performance of consultant surgeons in a routine, acceptable and non-intrusive manner
  • Potential models for integration of performance assessment into the CPD program.

Applications and Future Directions

Surgical performance is increasingly under public scrutiny and its measurement is a complex and sensitive issue. CPD programs do not assess surgical performance, particularly non-technical skills. This work has made a significant contribution to addressing this gap by developing a performance assessment system that can be implemented on a routine basis with all surgeons. This will contribute to improvements in the quality and safety of surgical care.

Funding Sources

Funding from the Medical Indemnity Insurance Association of Australia enabled the engagement of Dr Ian Graham, Project Consultant.