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

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.