The focus of this study is how anaesthetic trainees teach and learn to teach within the operating room (OR) and how this might be improved. Methods of study included interviews, action learning groups (ALG), and a questionnaire. The data were collected within the confines of a case study drawing on the principles of action research. The anaesthetic trainees taught mainly in the OR and interacted with three types of learner, defined by their relation to the anaesthetic community of practice. The primary responsibility for patient safety presented a significant challenge to OR teaching and required the clinicianteacher to balance the needs of the patient and the learner. The ALG acted as an effective educational initiative for anaesthetic trainees to enhance and develop good educational practice in the OR. The experiences of a group surgical trainees lent support to the wider generalisability of the use of ALGs. The survey of 36 anaesthetic and surgical trainees confirmed that the OR was a good place to learn although teaching was challenging and patient safety an issue. Results are distilled into a new model which places the patient at the centre of teaching and learning in the OR.