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Comment & Response
September 15, 2021

Competence Is About Skill, Not Procedure Case Numbers

Author Affiliations
  • 1ORSI Academy, Melle, Belgium
  • 2School of Medicine, Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
  • 3Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
  • 4Department of Urology, OLV Hospital, Aalst, Belgium
  • 5ProOrtho Clinic, Kirkland, Washington
JAMA Surg. 2022;157(1):81. doi:10.1001/jamasurg.2021.4414

To the Editor Purdy et al1 have unambiguously verified what surgeons already suspected, ie, residents’ operating experience was significantly affected by the COVID-19 pandemic. Declining surgical case volumes are not a new development. Significantly reduced resident operative training volume experience has been the reality for more than a decade.2 However, what is surprising is that the surgical establishment continues to believe that defined operative volumes for training will strongly equate to operative skill. The implicit assumption is that more experience equals better skill. Objective verification for that assumption is lacking. Surgery has failed to learn that the best (but not only) predictor of safe surgery is the actual skill of the operating surgeon.3

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