In-training assessments used in the United States surgical residency programmes

Introduction Quality and safety concerns have always been the impetus for evaluating surgical competence. This paper provides a focused overview of key historical events that lead to the development and implementation of surgical training standards and competency assessments in the United States. Methods Focused review of surgical literature. Results The following events were found to correlate with the development and implementation of training standards and competency assessments: (i) The Flexner Report issued in 1910; (ii) The American Medical Association's 1928 endorsement of the Essentials of Approved Residencies and Fellowships'; and (iii) The formation of several major surgical organizations - American College of Surgeons (1913), American Board of Surgery (1937), Residency Review Committee for Surgery (1950) and Association of Program Directors in Surgery (1966). Discussion The process by which competence is assessed in the US surgical training programmes is multifactorial and heavily linked to the structure and function of several national organizations in surgery and medicine.