Procedure Based Assessment (PBA)

The PBA assesses the trainee’s technical, operative and professional skills in a range of specialty procedures or parts of procedures during routine surgical practice up to the level of certification. PBAs provide a framework to assess practice and facilitate feedback in order to direct learning. The PBA was originally developed by the Orthopaedic Competence Assessment Project (OCAP) for Trauma and Orthopaedic Surgery and was further developed by the Specialty Advisory Committees for surgery for use in all the surgical specialties.

The assessment method uses two principal components:

• A series of competences within 5 domains. Most of the competences are common to all procedures, but a relatively small number of competences within certain domains are specific to a particular procedure.
• A global assessment that is divided into 8 levels of global rating. The highest rating is the ability to perform the procedure to the standard expected of a specialist in practice within the NHS (the level required for certification or equivalent).

The assessment form is supported by a worksheet consisting of descriptors outlining desirable and undesirable behaviours that assist the assessor in deciding whether or not the trainee has reached a satisfactory standard for certification, on the occasion observed, or requires development.

The procedures chosen should be representative of those that the trainee would normally carry out at that training level and will be one of an indicative list of index procedures relevant to the specialty. The trainee generally chooses the timing and makes the arrangements with the assessor. The assessor will normally be the trainee’s Clinical Supervisor or another surgical consultant trainer. One of the assessors must be the trainee’s current Assigned Educational Supervisor. Some PBAs may be assessed by senior trainees depending on their level of training and the complexity of the procedure. Trainees are encouraged to request assessments on as many procedures as possible with a range of different assessors.

Assessors do not need to have prior knowledge of the trainee. The assessor will observe the trainee undertaking the agreed sections of the PBA in the normal course of workplace activity (usually scrubbed). Given the priority of patient care, the assessor must choose the appropriate level of supervision depending on the trainee’s stage of training. Trainees will carry out the procedure, explaining what they intend to do throughout. The assessor will provide verbal prompts, if required, and intervene if patient safety is at risk.