Completeness of training in thoracic surgery: the perfect operative log book

One of the most important and difficult aspect of surgical training is to assess the competence of a trainee. Miller’s pyramid of clinical competence in surgery has been described as a ladder which starts with knowledge, followed by understanding of the pathophysiology (1). Then the trainee is expected to show how the procedure can be performed and then actually performs the procedure under the guidance or assistance of a mentor.