I understand the author’s view of the study is to help us understand the trainee’s contribution to operative timings and the subsequent impact on our patients. I do appreciate this is a large database-based retrospective study and it has limitations.

We have trainee(s) with us constantly and this involves being able to teach them through the process of providing care to our patients. This means that teaching time will be added to the training session, which can have a major impact on operating time. I believe this is seen as the outcome of the study.

It is also interesting that the mean age of the operating attending physician in this study is similar to the mean age of the residents, which implies that the level of expertise may be same. This may also suggest why there is little difference in the complication rates between the 2 groups because they may have been the same group.

I presume that all the trainees in the study were also supervised in some form, which may also imply why the complication rates were not different.

However, I do understand that the study tells us that the trainers are doing a good job for teaching laparoscopic hysterectomy by not compromising our patients with increased morbidity or mortality and therefore we will continue to teach with excellence with the cost of timing.