Abstract: The outcomes of modern ophthalmic surgery, especially cataract surgery, continue to improve and patients now realistically expect an excellent and speedy outcome with good vision and few complications. Social and regulatory demands for greater transparency and accountability in medicine have increased, highlighting a fundamental ethical tension in medical education—balancing the needs of trainees (who have not yet mastered the technique) to gain experience by performing surgery, with patient safety and the needs of the public to be protected from risk. Patient safety and well-being are the paramount considerations in any training program and must be the first consideration in program design. A variety of different educational strategies, each implemented with the aim of improving operative skills assessment and teaching, has recently been described in the literature. Effective use of these educational tools, combined with a structured approach to teaching and providing meaningful feedback, could improve outcomes, decrease complications and improve the quality and efficiency of surgical training in ophthalmology. Supervisors must assess their teaching style and communication, as being a good surgeon does not necessarily make a good trainer. Open disclosure must be given to patients about who will be performing the surgery, and communication during surgery between supervisors and trainees must be clear, respectful and appropriate.