“Tools with the req-uisite levels of reliability and validity for summa-tive assessment include the OSATS and MISTELS programs. For example, the MISTELS program might be used to assess a resident’s performanceof basic laparoscopic skills.”

“A requisite level of performance would be required before the resi-dent would be allowed to perform a laparoscopic cholecystectomy. Similarly, OSATS stations could be used for open surgery. Residents would thus be trained in the laboratory until preset criteria had been met and would only then be allowed to participate in the graduated performance of pro-cedures in patients. Competence-based advance-ment, rather than time served, would become standard in surgical training.”

Richard K Reznik et al., “Teaching Surgical Skills – Changes in the wind”, the new England Journal of medicine, 2006