Resident education in the operating room and surgical resident autonomy represent two enormous challenges within cardiothoracic (CT) training programs. The goal of surgical educators and CT trainees is to ensure the graduating resident's ability to safely operate independently at the completion of training. The field has come a long way from the notion of see one, do one, teach one, which was once the norm. Cardiothoracic surgery continues to become more specialized and the patients more complex with greater scrutiny of outcomes. There are many challenges that are faced in contemporary CT training to make intraoperative teaching harder than ever.