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I venture to guess that no one with interest and involvement in graduate medical education in surgery would argue with what I perceive to be the principal message of this interesting communication: active methods of learning that involve self-discipline are more effective instruments in achieving an adequate cognitive database, at least as measured by success on the qualifying examination (QE) of the American Board of Surgery, than are passive instruments (grand rounds, tutorials, CME lectures, etc). It also is gratifying to observe that residents who, early on, program for themselves textbook review, conscientiously pursue SR, and test themselves using SESAP appear to have a leg up on the QE, which is, after all, a measure of the depth of a resident's cognitive knowledge base. In fact, one might view these three instruments as sort of a continuum: the textbook providing the basic overview, the SR honing the finer points of