ACS Senior Resident Readiness Assessment

"The ACS SRRA fills a critical gap in surgical education by providing one of the first structured assessments of complex clinical judgment in the senior years of residency. It empowers faculty to make more confident entrustment decisions, guides residents with targeted formative feedback at a pivotal stage in their development, and supports patient safety by fostering purposeful autonomy. In a training landscape where high-stakes, real-time decisions are increasingly expected of senior residents, the SRRA offers a vital mechanism to ensure readiness and accountability."

Associate Dean, Assessment, Improvement, and Accreditation; ACS SRRA champion

What Is the ACS SRRA?

The ACS Senior Resident Readiness Assessment (SRRA) is a psychometrically validated, scenario‑based evaluation of clinical decision‑making—not simple recall—administered each September to incoming PGY‑4 surgery residents. Designed for formative purposes, it measures a resident’s ability to manage complex clinical problems, prevent and treat complications, prioritize patient care, and lead clinical teams.

Benefits for Your Program

Early Identification of Gaps: Receive individual results in early PGY‑4, allowing ample time for targeted development before independent practice.
Data‑Driven Feedback: Access detailed resident‑ and program‑level score reports with national benchmarking to inform Clinical Competency Committee reviews and curricular planning.
Accreditation Alignment: Provide objective evidence of decision‑making proficiency that directly supports ACGME milestone requirements and quality improvement efforts.

Unique, Evidence‑Based Approach

SRRA employs the internationally recognized “key‑features” methodology, presenting 40 brief, level-appropriate case scenarios across 27 high‑yield surgical topics. This methodology assesses the application of knowledge in realistic clinical scenarios—the very skills that distinguish safe, effective senior residents.

Developed by the ACS Division of Education with expert faculty, each question targets critical decision points rather than rote knowledge. Residents complete brief written responses and structured menu‑based items that mirror real‑world prioritization and complication‑management scenarios—ensuring the SRRA focuses on the critical decisions that directly impact patient safety and senior resident readiness for practice. Use ACS SRRA results to refine curricula, personalize learning plans, and ensure your graduates transition confidently and safely to surgical practice.

ACS SRRA is built on the proven methodology of the ACS ERRA for incoming interns.

Assessment Logistics

The ACS SRRA is a proctored assessment, requiring a staff member to monitor the room where residents take the assessment. The administration is allowed at any time within the administration window, indicated above. Each resident will need their own computer with strong Internet connectivity. Ideally, residents will take the assessment in the same window; however, it is possible to split administration. Contact the ACS SRRA staff for more information.

Residents are allowed up to three hours to complete the assessment; however, the average is closer to a two-hour duration. Results will be provided by late September.

ACS staff will be happy to provide training and assistance with the technical and administrative details of the assessment.

Intended for formative assessment and evaluation

Following the assessment, program directors and residents are provided with psychometrically sound, nationally benchmarked, individualized score reports for each resident. The reports identify specific areas of strength, clinical topics that need to be addressed, categories of potentially harmful decisions and actions, and corresponding suggested resources for additional study. Designed for formative purposes, the ACS SRRA score reports outline steps for residents to identify areas for improvement, develop a personalized learning plan, and meet with their program director to put their plans into action over the subsequent months.

Essential Content Areas

ACS SRRA cases cover the following 27 topic areas pertinent for senior residents:

Critical care
- Cardiac and Shock
- Mental Status Changes; Pain
- Pulmonary
- Renal
General surgical care
- Surgical Infections
- Nutrition
- Post-op care
- Pre-op care
GI, non-oncologic
- Bariatric
- Biliary, Liver, Pancreas
- Lower GI
- Upper and Lower GI
- Upper GI
Specialties
- Endocrine
- Hernia
- Peds
- Thoracic, Ortho, GU/GYN
- Vascular
Surgical oncology
- Breast
- General & Other Sites
- GI and Colorectal
Trauma
- Abdomen
- Airway & Cardiopulmonary
- Burns
- Neuro (Head, Spinal Cord)
- Pelvis and Extremities
- Special Circumstances (Pregnancy, Pediatrics, Prioritization)

Confidential, Actionable Results

After each administration, program directors receive confidential, resident‑level and program‑level score reports benchmarked against national peers. Resident reports are personalized and are meant to be distributed by program staff.

Individual Reports

Detail strengths and study needs by clinical topic.
Highlight three low‑performing areas and any potentially harmful decision patterns.
Include access to an Individual Learning Plan (ILP) template to guide focused goal setting and targeted development in the remainder of surgical residency.

Program Reports

Summarize cohort performance across all 27 topics.

Categorized under “Prioritize Study”, “Further Study”, or “Review” directives to inform curriculum adjustments.

Provide national comparison data to identify program‑wide trends.

All results are delivered confidentially to support data‑driven feedback, personalized learning, and continuous quality improvement.

Development and Authors

The ACS Division of Education methodically defined a validated domain of cases and recruited expert faculty to develop the assessment. Two pilot studies were conducted in a step-wise sequence with improvements made after each pilot. The first pilot was a small study that focused on the test takers’ understanding of the clinical cases, conducted in summer 2024. The psychometric pilot study was conducted during the winter of 2025 across 14 surgical residency programs nationwide. The results demonstrated validity and psychometric rigor. The development of ACS SRRA and the selection of its content areas have been published in the Journal of Surgical Education (doi: 10.1016/j.jsurg.2022.04.011).

Development is ongoing to protect the integrity and quality of the assessment.

Leadership Team

Kathy R. Liscum, MD, FACS, Co-Chair
Ajit K. Sachdeva, MD, FACS, FRCSC, FSACME, MAMSE, Co-Chair
Adnan A. Alseidi, MD, EdM, FACS
Enjae Jung, MD, FACS
Yoon Soo Park, PhD
Patrice Gabler Blair, DrPH, MPH
Kevin M. Wasielewski, MPH, MBA

ACS SRRA Authors

Adnan Alseidi, MD, EdM, FACS
Michael Anstadt MD, FACS
Georges Bordage, MD, MSc, PhD
Keith Delman, MD, FACS
Jonathan Dort, MD, FACS
Jeffrey Gauvin, MD, FACS
Nabil Issa, MD, FRCS, FACS, FCCM, MHPE
Enjae Jung, MD, FACS
James Lau, MD FACS
Eric Lazar, MD, MBA, MS, FACS, MAMSE
Kathy Liscum, MD, FACS
Mayur Narayan, MD, MPH, MBA, MHPE, FACS, FCCM, FICS
Kurt Schropp, MD, FAAP, FACS
Eric Silberfein, MD, FACS
Anne Stey, MD, MSc, FACS
Ranjan Sudan, MD, MBBS, FACS

Price

The cost of the SRRA is $160 per resident.

Enrollment

Open through August 1, 2025.

Enroll Now

Administration Dates

August 18–29, 2025

Complete the form below to request an ACS SRRA demonstration for program staff.

The Assessment and Score Reports

Approximately 80 questions across 40 cases

Two response formats
- Short, write-in answers (for example, listing possible diagnoses)
- Selection from menus (containing possible next steps in the investigation or management of the problem)
Individualized score reports for residents and program directors
- Specific details on strengths and areas for improvement in the identification and management of surgical care decisions across 27 topics

FAQ

View Frequently Asked Questions to learn more about ACS SRRA.

ACS Senior Resident Readiness Assessment (ACS SRRA)