Journal of Surgical Simulation 2022; 9: 127 - 137

Published: 16 January 2023


Original article

Evaluating the role of simulated practical skills assessments in the UK neurosurgical national selection process

Tom J. Grundy, Thomas W. Fallows Peter C. Whitfield and Ian D. Kamaly-Asl
Corresponding author: Tom J. Grundy, Manchester Centre for Clinical Neurosciences, Salford Royal Foundation Trust, Stott Lane, Salford, M6 8HD, UK. Email:


Background: The selection and training of surgeons is an important undertaking for recruitment and development of a neurosurgical workforce. Meaningful and reliable assessment of practical skills can be problematic due to several factors. We aimed to appraise the performance of candidates in the national neurosurgical recruitment exercise to establish correlation with specific practical skill simulations to assess the value of each simulation in discriminating between candidates.

Methods: We reviewed 1078 anonymised candidate records between 2009 and 2018 and analysed the prospectively collected Objective Structured Assessment of Technical Skills (OSATS) scores. Statistical evaluation of correlation between simulated assessment scores was performed to establish potential relationships between scoring domains. Correlation coefficients were calculated to establish potential relationships between skill simulation domains. A cohort of candidates was assessed for stereoblindness, and score domains were compared against this trait to assess the role of three-dimensional vision in candidates’ performance.

Results: Significant correlation was noted between specific skill simulation assessments, including microsurgical bead manipulation and suture placement tasks (ρ = 0.155, P < 0.001); 94% of applicants demonstrated stereoscopic vision. Stereo-blind candidates did not perform significantly poorer in tasks requiring visuospatial skills. A significant degree of correlation was observed between skill domains across assessments suggesting reliability in the testing methods.

Conclusions: OSATS are a reproducible and established method of assessing simulated surgical skills. Specific scoring domains demonstrated high degrees of correlation, suggesting that they test similar skills. Stereovision does not appear to affect candidates’ scores, potentially a result of practical compensation; therefore they may be deemed equally appropriate candidates for neurosurgical selection.


neurosurgery; OSATS; national selection; stereovision; practical skills;