Objective To compare the difference between procedure-based assessment and outcome-based assessment in plaster fixation examination and provide basis for assessing the clinical competency of surgical residents.Methods A total of 31 postgraduate year 1 (PGY1) surgery residents who had been trained in the Surgical School of Peking University First Hospital for 1 year were enrolled in the study. A station of plaster fixation was set to simulate lateral malleolus fracture and subjectively evaluated by procedure-based assessment. Besides, the plaster fixation final results were assessed by subjective assessment, empirical judgment andObjective measurement in order to compare the difference, similarity and correlation among them.Results The average score of the plaster test was (80.32±7.19), and the average dressing time was (8.90±2.12) min. The average heel pressure at the end of dressing was (20.94±18.25) mmHg, while the ankle pressure was (5.74±5.01) mmHg. There was no significant difference in subjective score of the group whose ankle pressure up to standard and the group whose were not. There was no significant difference in the heel pressure between moderate group and looser group considered by clinical tightness (P＞0.05), while there was significant difference in the ankle pressure (P＜0.05). The consistency between the three methods was 67.7%, but there was no correlation between the three methods. In addition, there was significant difference in score between the residents who have had or not the orthopedic rotation.Conclusions The study suggests that existing procedure-based assessment could not evaluate the actual result of plaster fixation effectively, while outcome-based assessment could compensate this kind of deficiency. It could help improve residents' competency efficiently and effectively based on standardizing their operation.