Workplace-Based Assessment in Orthopaedic Training: A Commentary on Evolution and Growing Pains.

While competency-based programmatic assessment systems have become widespread worldwide, there are few comparisons of competence assessment in orthopaedic surgery between countries. In this paper, we provide a narrative overview of current systems in the United States, Canada, United Kingdom and Ireland, and Australia. We explore what types of workplace-based assessments are used, how many data points are gathered to inform entrustment and progression decisions and whether there is validity evidence using a modified Kane framework. Significant concordance and some variation were found between the programs, and the issues identified are discussed along with the challenges and potential solutions for enhancing competence assessment.