In Reply.—The article that Drs Pearlman, Norton, and Stiegmann refer to included the clinical results of radical pancreaticoduodenectomy within the context of a surgery resident education program, as well as observations regarding the educational value of this complex and demanding operation.
The purpose of complex surgical experience during residency is to provide a demanding exercise in the integration of knowledge, technical skill, and judgment in a patient care situation in which the stakes are high but the environment is controlled by an experienced faculty supervisor so that maximum patient safety is achieved. In our article we sought to support this conceptual approach to one operation, radical pancreaticoduodenectomy. We hoped to provide evidence that the resident training environment provides consistent pressure for improved results through identification of critical judgment and technical factors.
Drs Pearlman, Norton, and Stiegmann are obviously distressed that the current conduct of resident training may not impart