BACKGROUND: TWO complimentary examinations designed to comprehensively assess competence for surgical practice have been developed. The Objective Structured Assessment of Technical Skill (OSATS) evaluates a resident's operative skill, and the Patient Assessment and Management Examination (PAME) evaluates clinical management skills. METHODS: Twenty-four postgraduate year (PGY)-4 and PGY-5 general surgery residents from four training programs were examined. Each examination had eight stations, with a total of 6 hours of testing time. RESULTS: Interstation reliability for the OSATS was 0.64, for the FAME was 0.71, and for the total test was 0.74. Examination scores discriminated between PGY-4 and PGY-5 residents for the OSATS (t = 4.39, P < .01), the FAME (t = 1.86, P < .05), and the total examination (t = 3.90, P < .01), Year of training accounted for 40%, of the variance of scores. CONCLUSIONS: This comprehensive examination is a reliable and valid method of assessing critical skills in senior surgical residents and may be useful for the formal assessment of readiness for practice. (C) 2000 by Excerpta Medica, Inc.