Observational tools for assessment of procedural skills: a systematic review

Ahmed K, Miskovic D, Darzi A, Athanasiou T, Hanna GB. Am J Surg. 2011 Oct;202(4):469-480.e6. doi: 10.1016/j.amjsurg.2010.10.020. Epub 2011 Jul 28.






Assessment by direct observation of procedural skills is an important source of constructive feedback. The aim of this study was to identify observational tools for technical skill assessment, to assess characteristics of these tools, and to assess their usefulness for assessment.


Included studies reported tools for observational assessment of technical skills. A total of 106 articles were included.


Three main categories included global assessment scales evaluating generic skills (n = 29), task-specific methods assessing procedure-specific skills (n = 30), and combinations of tools evaluating both generic and task-specific skills (n = 47). In most studies, content validity was not evaluated using an accepted scientific method. All tools were assessed for inter-rater reliability and construct validity. Data on feasibility, acceptability, and educational impact were sparse.


There is evidence of validity and reliability for observational assessment tools at the trainee level. In most studies a comprehensive analysis of the tools was not achieved. Evaluation of technical skill using current observational assessment tools is not reliable and valid at the specialist level. Future research needs to focus on further systematic tool development and analysis, especially at the specialist level.

PubMed ID: 21798511