Letter to the editor regarding “Operating without direct supervision during pediatric surgery fellowship: When, how, and why”

We read with great appreciation the article “Operating Without Direct Supervision During Pediatric Surgery Fellowship: When, How, and Why” by Gollin et al. [1], which provides valuable insight into the current state of operative autonomy in pediatric surgery training. Their finding that only 7 of 44 programs had formal criteria for unsupervised operations and none required explicit parental consent for “teaching assistant” (TA) cases underscores a critical governance and ethical gap within competency-based surgical education.