A Scoping Review of the Objective Structured Assessment of Technical Surgical Skills (OSATS)

BACKGROUND: Objective structured assessment of technical skills (OSATS) offers an objective tool for assessing bowel anastomosis on a benchtop. It was developed in 1997 to set appropriate standards and expectations for the surgical trainee. OSATS have become the gold standard of assessment across many disciplines. A global Likert rating scale, including respect for tissues, instrument handling, economy of movement, and flow of the operation predominates the literature. This has led to many questioning OSATS objectivity, claiming the process to be time-consuming, subjective, demanding human resources, and requiring extensive training of the trainer. We believe OSATS scoring has omitted the 22-point binary task specific checklist included in the original paper detailing some of the ergonomics pertaining to basic surgical skills. OBJECTIVES: The objectives of this study were to examine the application of the OSATS in the context of open surgery, with particular attention to surgical specialty and trainee grade. The study also aimed to determine the types of simulation models utilized, including synthetic, organic, or tissue-based models. In addition, we sought to establish whether task-specific checklists were incorporated into the assessment process. Furthermore, the study aimed to ascertain whether participants performed procedures in a standing or sitting position, reflecting the primary consideration of operative ergonomics. We also explored ergonomic factors related to instrument handling, suturing techniques, and tissue handling. Finally, the study investigated whether any additional objective assessment tools or modalities were employed alongside OSATS. ELIGIBILITY CRITERIA: This scoping review included peer-reviewed papers on OSATS, including all systematic reviews, scoping reviews, and commentaries on surgical training and assessment, of open operations published from the year 2000 onward. SOURCES OF EVIDENCE: We followed the PRISMA-ScR framework. A literature search was performed using PubMed (February 2025) and Web of Science (June 2025) and exported to EndNote 20. All studies and abstracts, published in English from 2000, and pertaining to open surgery were included. CHARTING METHODS: Inclusion and exclusion were done by two experts in the field of education and surgery according to title-if in doubt, the abstracts were examined. Every paper was subsequently read to look for any checklists or objective measurement of technical skills or ergonomics of operating. RESULTS: This study found 26 reviews of OSATS, which showed OSATS is ubiquitously used and applied to trainees at many levels. Many authors concluded they are time consuming and dependent on financial and human resources. Most of the assessments involved synthetic tissue. Only 20% of trainees were standing (mostly in the operating room). Only 12 papers offered any specifics relating to instrument handling and accuracy of stitching. CONCLUSIONS: OSATS is widely used; however, its application appears to focus primarily on the observation of secondary characteristics of surgical performance, such as flow and lightness of touch, which are inherently subjective. Binary checklists introduce a degree of objectivity into the assessment, but they require greater detail and specificity to capture technical competence accurately. Future work should aim to standardize and refine these assessment tools to enhance both their reliability and validity in evaluating surgical skills.