Surgical tracheostomy is an essential operation that trainees must be competent in. There is a lot of research currently looking into assessing trainees’ surgical abilities, particularly into assessments that can be used to demonstrate progress, so this article is very topical. In the UK, the Intercollegiate Surgical Curriculum Programme uses assessments such as procedure based assessments (PBAs), however critics suggest that it is difficult to demonstrate progress with this. This was a study from Saudi Arabia in which they developed the objective surgical tracheostomy skills (OSTS) tool. This comprised of 10 domains, each rated using a five-point Likert scale. There was also a global rating from unsatisfactory to excellent at the end. The OSTS tool was developed by otolaryngology consultants, fellows and specialists in medical education, and tested on 44 residents at varying stages of their training. There was good reliability and internal consistency, and its validity was established based on a significant improvement in senior resident scores compared to junior resident scores. There was good face validity with positive feedback from both assessors and trainees. An important limitation in this study was the lack of ability to assess inter-rater reliability, as only one assessor was present during any one procedure. This study provides an interesting assessment tool that could be incorporated into other training programmes, and could be replicated for other index ENT surgical procedures.