Published 1/30/2026
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Petar Golijanin, MD; Jona Kerluku, BS; Lambert Li, MD
The American Board of Orthopaedic Surgeons (ABOS) was established to serve orthopaedic surgeons by setting standards for certification and lifelong professional competence in the interest of patient care and public trust. Recently, the ABOS developed the Knowledge, Skills, and Behavior (KSB) Program to assess continuous learning, professional development, and ethical practice more broadly beyond traditional examinations. The ABOS aims to provide residents and residency programs with validated tools to assess competency and support formative feedback. The KSB Program enhances education through evidence-based assessments of surgical skills and professional behavior in both operating room and clinical settings. Resident competence is evaluated in three areas: orthopaedic knowledge using the AAOS Orthopaedic In-Training Examination, surgical skills through real-time faculty feedback during actual cases, and professional behavior via end-of-rotation and annual 360-degree evaluations. Active engagement from both residents and faculty is essential to create meaningful learning opportunities during surgical training.
Optimizing surgical skills: The resident perspective
The surgical skills component of the ABOS KSB Program is designed to enhance resident learning through active engagement during surgical procedures and structured postoperative feedback. From the resident perspective, success begins with proactive communication and intentional planning, particularly for elective cases. Residents are encouraged to request evaluations across a range of procedures, from low- to high-complexity cases, to maximize meaningful feedback. Low-complexity cases allow residents to demonstrate competency and readiness for independent practice, while high-complexity cases provide opportunities to apply advanced medical knowledge and technical skills. Thoughtful planning and clearly defined learning goals help optimize the educational value of these assessments.
When covering an elective service, residents have ample opportunity to reach out to the attending surgeon before the case begins. Notifying faculty ahead of time to request an assessment increases the likelihood of the faculty member thoughtfully completing their evaluation. This preoperative briefing is the ideal time to clearly state learning goals: “I have done five total knees this week; today, I’d like to focus exclusively on refining my exposure and soft tissue balancing technique.” This not only helps resident learning by focusing on a different, more complex segment of the procedure each time, but it also directs the faculty member’s attention, making their ABOS KSB Surgical Skills assessment more learner focused. While this structured communication is sometimes harder to achieve during fast-paced trauma cases, the more an attending surgeon is aware of specific knowledge goals, the easier it is for them to focus their coaching. Therefore, communicating specific learning goals with the attending surgeon beforehand demonstrates an engaged learner, allowing the resident to drive the discussion on the type of cases for feedback.
Finally, when narrative feedback arrives, residents should reflect and follow up on it. Options include a simple email or a brief discussion in the clinic demonstrating appreciation for faculty time and expertise. Following up also reinforces commitment to growth and validates faculty effort in providing high-quality ABOS KSB feedback.
Residents should also be aware that their Surgical Skills and Professional Behavior assessments are not shared publicly and will only be used during a resident’s tenure, much like other evaluation information. During training, the only people who have access to KSB data are the resident, the program director, and program coordinator. In addition, each Professional Behavior assessment is blinded to the resident, allowing faculty to provide an honest assessment. The ABOS shares case information only with the Accreditation Council for Graduate Medical Education as part of the Case List information. Additionally, the ABOS does not share data between institutions. For example, if a resident transfers residency programs, the feedback provided at the previous institution will not be transferred to the new institution without appropriate resident permission. Also, the ABOS KSB Program is not intended for use in any part of the fellowship application process or by future employers or credentialing entities.
The shift to competency based surgical education: Faculty perspective
From the faculty perspective, the transition to required resident participation in the ABOS KSB program is an invitation to redirect focus from mere completion of administrative tasks to a higher-quality, higher-fidelity trainee evaluation process. The most critical adaptation is recognizing that quality feedback always outweighs quantity. While residents must drive the volume of assessments, the faculty’s role is to deliver highly specific, actionable coaching. This effort is substantially easier — and more rewarding — when residents take the initiative to communicate their goals. Seeing a resident proactively plan their surgical focus, such as dedicating repetition to the high-risk or most technically demanding segments of a complex case, not only demonstrates their commitment but can be an invitation to collaborate on the delivery of highly tailored surgical skills assessments. To maximize the full potential of this process, faculty should be open and proactive in meeting with residents prior to the rotation or block and conducting mid-term check-ins to create a resident-specific plan for competence development.
For Surgical Skills evaluations, faculty should consider a resident’s performance on a case-by-case basis and refrain from using it as a summative evaluation (such as a postgraduate year 3 [PGY3] residents always receiving lower ratings than PGY4s based on graduate year). Currently, the ABOS has not set goals (such as PGY3 residents receive majority 3 ratings), and there is no expectation for certain grade levels at certain PGY levels. The ABOS KSB tools are applicable across all PGY levels and should be specific to the particular surgical case. The Professional Behavior assessments can be used in a summative manner at the end of a rotation to evaluate a resident’s overall progress. These are assessment tools that can help program directors follow resident progression and continuously evaluate where residents stand regarding the acquisition of orthopaedic knowledge, surgical skills, and professionalism.
The key to high-quality feedback is specific, actionable assessments of a resident’s performance. The literature shows that the more specific feedback, the easier it is to incorporate into long-term practice. Faculty may choose to pay attention to one or two specific parts of a case, which can be facilitated by communication with the resident beforehand. This is an opportunity to ask residents about their learning objectives to individualize feedback in a more precise fashion.
The first year of mandatory resident participation in the ABOS KSB Program highlights how its success depends on a shared commitment between residents and faculty to intentional communication, thoughtful assessment, and meaningful feedback. When residents actively define learning goals and faculty members provide specific, case-based coaching, the program becomes a powerful tool for growth rather than a procedural requirement.
Program directors and faculty should consider reviewing the ABOS KSB Learning Module. ABOS Diplomates who complete the ABOS KSB Learning Module are eligible to earn ABOS Self-Assessment Examination credit.
Lambert Li, MD, is currently a third-year orthopaedic surgery resident at Case Western Reserve/University Hospitals, Cleveland.
Jona Kerluku, BS, is currently a third-year medical student at Carle Illinois College of Medicine at the University of Illinois Urbana-Champaign and is interested in applying to orthopaedic surgery for residency.
Petar Golijanin, MD, is currently a fifth-year orthopaedic surgery resident at The University of Texas at Austin Dell Medical School and will be pursuing a sports medicine fellowship at The Steadman Clinic in Vail, Colorado.