A simple test: please draw the incision. It is not as easy as we may think.

[PURPOSE] Book knowledge and preparation is important to the education of a surgeon. The ability of a trainee to apply book knowledge to the actual performance of a procedure is perhaps underestimated by experienced surgeons, as is the role of the teacher in the translation of this information in the operating theater. The purpose of this study is to reveal some of the obstacles in surgical training and to underscore the importance of attending surgeon guidance in overcoming these hurdles.

[METHODS] Residents in an integrated plastic surgery program were instructed to prepare for their first carpal tunnel procedure with the senior author by reading standard surgical texts. At the beginning of the procedure, the resident was asked to draw the incision. A photograph to document the incision was taken for later reflection and discussion.

[RESULTS] The markings of 16 residents over 12 years are presented. They demonstrate a great difficulty in the initial application of book knowledge in the operating room.

[CONCLUSIONS] Surgical education is a complex process. Whereas book knowledge is important, there is no substitute for the learning process that occurs in the operating room between teacher and trainee.