Original article Competence assessment of senior vascular trainees using a carotid endarterectomy bench model S. A. Black 1,2 , R. H. Harrison 2 , E. J. Horrocks 2 , V. A. Pandey 1,2 and J. H. N. Wolfe 1 1 St Mary’s Hospital Regional Vascular Unit, St Mary’s Hospital, and 2 Department of Biosurgery and Surgical Technology, Imperial College School of Medicine, London, UK Correspondence to: Mr J. H. N. Wolfe, St Mary’s Hospital Regional Vascular Unit, St Mary’s Hospital, Praed Street, London W2 1NY, UK (e-mail: John.Wolfe@St-Marys.nhs.uk) Background: Competency-based assessment is being introduced to surgical training. The value of bench- top technical skills assessment using a synthetic carotid endarterectomy (CEA) model was evaluated in vascular trainees and consultants. Methods: Forty-one surgeons (13 junior trainees, 15 senior trainees and 13 experienced consultants with experience of more than 50 CEAs) performed a three-throw knot-tying exercise on a jig and a CEA on the bench model. A composite score for knot-tying was calculated, incorporating electromagnetic motion analysis. CEA technical skill was assessed using validated rating scales by blinded video analysis. Results: Senior trainees performed better than junior trainees in knot-tying (P = 0·025) as well as generic (P < 0·001) and procedural (P < 0·001) skills on CEA model assessment. There was no difference between senior trainees and consultants on any of these measures. The CEA model interobserver reliability was high for all rating scales (generic α = 0·974, procedural α = 0·952, end-product α = 0·976). Conclusion: Senior trainees achieved the same score as consultants, suggesting a similar level of basic technical skill and knowledge required to perform CEA, and were significantly better than junior trainees. Performance on the bench model could provide an early assessment for suitability to proceed to operative training in a competency-based training and assessment programme. Presented to a meeting of the Association of Surgeons of Great Britain and Ireland, Edinburgh, UK, May 2006 Paper accepted 4 June 2007 Published online 19 June 2007 in Wiley InterScience (www.bjs.co.uk). DOI: 10.1002/bjs.5794 Introduction Media headlines such as ‘Bad surgeons can’t be detected’ 1 and, more specifically for carotid endarterectomy (CEA), ‘low volume surgeons (performing fewer operations) had death rates 64 per cent higher than high volume ones’ 2 have focused minds on the need for objective training and assessment in surgery. Vascular surgery is a particularly low-volume/high-complexity specialty where scrupulous assessment of technical skill is paramount. This is exemplified by CEA for which the consequences of poor surgical technique are severe: an operative stroke risk of twice the national average negates the advantage of surgery. This paper evaluated the use of a synthetic bench- top CEA model (Limbs & Things, Bristol, UK) for the evaluation of basic technical skill in vascular trainees. Methods Forty-one vascular surgeons were recruited and classified by experience into three groups: 13 junior vascular trainees who had performed no CEAs and had limited experience of assisting (all had attended a basic surgical skills course and had at least 6 months’ vascular experience at basic surgical trainee level); 15 senior vascular trainees who had performed between one and 49 CEAs, and had substantial experience of assisting; and 13 senior consultants who had performed at least 50 CEAs. Knot-tying Using a commercially available knot-tying assessor (Limbs & Things), each surgeon performed a standard three- throw reef knot at depth, over a hook, using a 2/0 Vicryl TM (Ethicon, Johnson & Johnson Medical, Livingston, UK) Copyright  2007 British Journal of Surgery Society Ltd British Journal of Surgery 2007; 94: 1226–1231 Published by John Wiley & Sons Ltd