See one, do one, teach one: A randomized controlled study evaluating the benefit of autonomy in surgical education

Am J Surg. 2019 Feb;217(2):281-287. doi: 10.1016/j.amjsurg.2018.10.037. Epub 2018 Nov 1.


Introduction: "See one, do one, teach one" has represented the model for surgical education for over a century, however recent changes in education have reduced autonomy in training. The goal of this study was to assess the impact of autonomy on learning a procedural skill.

Methods: Senior medical students were randomized and trained to performance a vascular anastomosis utilizing progressive autonomy vs. constant supervision. Performance was tested using videotaped technical grading and anastomotic pressure testing.

Results: Mean baseline performance times and technical ratings were similar in both groups. Final completion times was faster in the autonomy group, 14:03min vs. 19:09min (p = 0.02). Final technical ratings were similar, 40.0 vs. 39.2points (max = 50), for each group and both demonstrated similar improvement in leak test against a standardized sample.

Conclusion: Teaching a procedure, as a final step in graded autonomy, results in superior performance in timing while maintaining equal technical performance compared to trainees with less autonomy.

Keywords: Autonomy; Simulation; Surgical education; Teaching.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anastomosis, Surgical / education
  • Clinical Competence*
  • Computer Simulation*
  • Curriculum
  • Education, Medical, Graduate / standards*
  • Educational Measurement / methods*
  • Female
  • General Surgery / education*
  • Humans
  • Internship and Residency / methods*
  • Learning
  • Male
  • Personal Autonomy*