Letter to the editor regarding “Operating without direct supervision during pediatric surgery fellowship: When, how, and why”

jpedsurg.org

We read with great appreciation the article “Operating Without Direct Supervision During Pediatric Surgery Fellowship: When, How, and Why” by Gollin et al. [1], which provides valuable insight into the current state of operative autonomy in pediatric surgery training. Their finding that only 7 of 44 programs had formal criteria for unsupervised operations and none required explicit parental consent for “teaching assistant” (TA) cases underscores a critical governance and ethical gap within competency-based surgical education.

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Article · Oct 2025 · 1 min read

In brief

This letter responds to research on operative autonomy in pediatric surgery fellowships, highlighting the lack of formal criteria for unsupervised operations across training programs. The authors emphasize critical gaps in governance and ethical standards, particularly regarding parental consent for teaching assistant cases in competency-based surgical education.

Only 7 of 44 pediatric surgery programs have formal criteria for unsupervised trainee operations, revealing significant governance gaps.
No programs require explicit parental consent when trainees operate as 'teaching assistants,' raising ethical transparency concerns.
Competency-based surgical education lacks standardized frameworks for granting operative autonomy to fellows.
Formal criteria and informed consent protocols are needed to balance trainee autonomy with patient safety and ethical standards.

Written by the GCMD Library team from the article.

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