SCIENTIFIC ARTICLE Objective Structured Assessment of Technical Skill in Upper Extremity Surgery Ann VanHeest, MD, Bradley Kuzel, MD, Julie Agel, MA, Matthew Putnam, MD, Loree Kalliainen, MD, James Fletcher, MD Purpose Objective assessment of technical skills in hand surgery has been lacking. This article reports on an Objective Structured Assessment of Technical Skills format of a multiple bench-station evaluation of orthopedic surgery residents’ technical skills for 3 common upper extremity surgeries. Methods Twenty-seven residents (6 postgraduate year [PGY] 2, 8 PGY 3, 8 PGY 4, and 5 PGY 5) participated in the examination. Each resident performed surgery on a cadaveric specimen at 3 stations, trigger finger release (TFR), open carpal tunnel release, and distal radius fracture fixation. A board-certified hand surgeon evaluated trainee performance at each station, using a procedure-specific detailed checklist, a validated global rating scale, and pass/fail assessment. A resident post-testing evaluation was collected. Results Construct validity with correlation between year in training and detailed checklist scores was demonstrated for TFR and carpal tunnel release; between year in training and global rating scores for TFR and distal radius fracture fixation; and between year in training and pass/fail assessment for TFR. Criterion validity was demonstrated by the correlation between global rating scale scores, detailed checklist scores, and pass/fail assessment for TFR, carpal tunnel release, and distal radius fracture fixation. Time to complete the surgery was not correlated with surgical performance. Residents rated the multiple-station Objective Structured Assessment of Technical Skills format as highly educational. Conclusions This study reports that a surgeon’s ability to release a trigger finger does not correlate specifically to his or her ability to perform a carpal tunnel release or to perform plate fixation of a radius fracture. The results of this study would indicate that, for 3 different surgical simulations representing procedures of varying complexity, assessments by a single assessment tool is not adequate. To completely understand a resident’s abilities, assessment by checklist (understanding the steps of the surgery), global rating scales (assessment of basic surgical skills in light of lesser or greater complexity surgeries), and pass/fail assessment (examination of adverse events) are all necessary components. (J Hand Surg 2012;37A:332–337. Copyright © 2012 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic II. Key words Carpal tunnel, distal radius, education, simulation, trigger finger. From the Department of Orthopaedic Surgery and Department of Surgery, University of Minnesota, Min- neapolis, MN; Department of Plastic and Hand Surgery, Regions Medical Center, St. Paul, MN. Received for publication March 2, 2011; accepted in revised form October 25, 2011. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. The project was funded using an American Orthopaedic Association OMeGA grant for the purchase of laboratory materials. Stryker Medical donated the Variax volar plates and screws. Corresponding author: Ann VanHeest, MD, University of Minnesota, Department of Orthopaedic Surgery, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55455; e-mail: vanhe003@umn.edu. 0363-5023/12/37A02-0020$36.00/0 doi:10.1016/j.jhsa.2011.10.050 332  ©  ASSH  Published by Elsevier, Inc. All rights reserved.