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“See one, do one, teach one”: inadequacies of current methods to train surgeons in hernia repair



Residency/fellowship training in hernia repair is still too widely characterized by the “see one, do one, teach one” model. The goal of this study was to perform a needs assessment focused on surgical training to guide the creation of a curriculum by SAGES intended to improve the care of hernia patients.


Using mixed methods (interviews and online survey), the SAGES hernia task force (HTF) conducted a study asking subjects about their perceived deficits in resident training to care for hernia patients, preferred training topics about hernias, ideal learning modalities, and education development.


Participants included 18 of 24 HTF members, 27 chief residents and fellows, and 31 surgical residents. HTF members agreed that residency exposes trainees to a wide spectrum of hernia repairs by a variety of surgeons. They cited outdated materials, techniques, and paucity of feedback. Additionally, they identified the “see one, do one, teach one” method of training as prevalent and clearly inadequate. The topics least addressed were system-based approach to hernia care (46 %) and patient outcomes (62 %). Training topics residents considered well covered during residency were: preoperative and intraoperative decision-making (90 %), complications (94 %), and technical approach for repairs (98 %). Instructional methods used in residency include assisted/supervised surgery (96 %), Web-based learning (24 %), and simulation (30 %). Residents’ preferred learning methods included simulation (82 %), Web-based training (61 %), hands-on laboratory (54 %), and videos (47 %), in addition to supervised surgery. Trainees reported their most desired training topics as basic techniques for inguinal and ventral hernia repairs (41 %) versus advanced technical training (68 %), which mirrored those reported by attending surgeons, 36 % and 71 %, respectively.


There was a consensus among HTF members and surgical trainees that a comprehensive, dynamic, and flexible educational program employing various media to address contemporary key deficits in the care of hernia patients would be welcomed by surgeons.

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The members of the SAGES Hernia Task Force are: Gina L. Adrales, Dartmouth-Hitchcock Med Ctr, Lebanon, NH, Igor Belyansky, Anne Arundel Med Ctr, Annapolis, MD, Parag Bhanot, Georgetown Univ Hsp, Washington, DC, Ibrahim Bulent Cetindag, University of Iowa, Iowa City, IA, Andrew J. Duffy, Yale Univ School of Med/New Haven Hsp, New Haven, CT, David Bryan Earle, Baystate Med Ctr, Springfield, MA, Robert J. Fitzgibbons, Creighton Univ Med Ctr, Omaha, NE, B. Todd Heniford, Carolinas Medical Ctr, Charlotte, NC, Brian P. Jacob, Mount Sinai Medical Center, New York, NY, Dennis R. Klassen, Queen Elizabeth II Health Sciences Ctr, Halifax, NS, Karl A. Leblanc, Louisiana State Univ, Baton Rouge, LA, Brent D. Matthews, Carolinas Med. Ctr., Univ. of N.Carolina, Charlotte, NC, John D. Mellinger, Southern IL Univ School of Med, Dept of Surgery, Springfield, IL, Philip A. Omotosho, Duke University Medical Center, Durham, NC, Adrian Park, Anne Arundel Medical Center, Annapolis, MD, Richard A. Pierce, Vanderbilt University Department of Surgery, Nashville, TN, Carla Marie Pugh, University of Wisconsin, Madison, WI, Bruce J. Ramshaw, Advanced Hernia Solutions, Daytona Beach, FL, John Scott Roth, Univ of KY, Lexington, KY, Douglas S. Smink, Brigham and Women`s Hospital, Boston, MA, Monica Torres-Jimenez, Alexandra Marine and General Hospital (Goderich), Goderich, ON, Shirin Towfigh, Beverly Hills Hernia Center, Beverly Hills, CA, Melina C. Vassiliou, McGill Univ, Montreal, PQ, Guy R. Voeller, University of Tennessee, Memphis, TN.

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Correspondence to Adrian E. Park.

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Drs. H. Reza Zahiri, Adrian E. Park, Carla M. Pugh, Melina Vassiliou, and Guy Voeller have no conflicts of interest or financial ties to disclose.

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Zahiri, H.R., Park, A.E., Pugh, C.M. et al. “See one, do one, teach one”: inadequacies of current methods to train surgeons in hernia repair. Surg Endosc 29, 2867–2872 (2015).

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  • Hernia
  • Residency
  • Education
  • Clinical trials
  • Quality control
  • Outcomes