Teaching uncommon and highly complex operations: maximizing the teaching and learning.

Teaching complex and uncommon operative procedures require instruction on technical skill and cognitive decision-making frameworks. To understand this dynamic process, several adult learning theories are discussed including the Fitts-Posner's three stage theory, transfer learning theory, and expert performance theory. By understanding how trainees can deconstruct complex task and transfer learning from more basic operative cases, surgical educators can reflect on how they structure and stratify operative and simulation experiences to maximize learning.