Teaching operative procedures is complex, involving both teacher and trainee in a dynamic relationship which relies on cognitive ability, motor skills, communication, and professionalism. Sandhu and colleagues at the University of Michigan¹ had previously studied progressive faculty entrustment as 1 strategy to achieve the autonomy of residents in the operating room. In a study in this issue of JAMA Surgery, Sandhu et al² used the OpTrust observational assessment tool³ to find that faculty entrustment behaviors were the primary factors affecting the entrustability of residents (defined as the ability of the trainee to carry out specific tasks unsupervised after the attainment of sustained competence in those tasks). Case difficulty and faculty experience were not found to affect faculty entrustment or resident entrustability, but the postgraduate year of participating residents was associated with resident entrustability. The authors concluded that “it is faculty behavior that propels resident entrustability forward” and suggested that resident autonomy could be addressed by education designed to improve faculty behaviors. While I agree that faculty teaching styles and behaviors are very important to successful surgical training, this is only 1 piece of a complex educational puzzle.

教学操作程序很复杂，老师和受训者都处于动态关系中，这种关系依赖于认知能力，运动技能，沟通能力和专业水平。密歇根大学^1的桑德胡（Sandhu）及其同事以前曾研究过将教职员工委托作为一种策略来实现手术室居民自治的策略。在本期《JAMA外科》的一项研究中，Sandhu等人²使用了OpTrust观察评估工具³发现教师的委托行为是影响居民可委托性的主要因素（定义为受训者在获得持续能力后，不受监督地执行特定任务的能力）。案例难度和教职经验未发现影响教职委托或居民可委托性，但参与居民的研究生学历与居民可委托性有关。作者得出的结论是“是教师行为推动居民的信任度向前发展”，并建议通过旨在改善教师行为的教育来解决居民自治。尽管我同意教师的教学风格和行为对于成功的外科手术培训非常重要，但这只是一个复杂的教育难题中的一小部分。