Teaching in the operating room (OR) is the cornerstone of surgical education. Giving immediate and specific feedback while operating requires deliberate practice for the instructor and should be done during every case. In recent years, surgical residents have been provided less and less independence in the OR as a consequence of regulatory and financial pressures. Coincident with this, or perhaps as a consequence, some graduating trainees may seem to be underprepared for independence in the OR. Teachers must constantly balance the quality and safety of patient care with the learner’s need to make independent decisions and gain hands-on experience. While it is tempting to sacrifice resident instruction in the name of short-term patient safety, teachers must also consider a long-term perspective on patient safety because surgeons who have insufficient operative training also place patients at risk. Finally, time is short, so leverage OR processes that are already in place for teaching.