LAUSR

T he word Surgery derives from ‘cheirourgia’ – from the Greek ‘‘cheir’’ meaning ‘‘hand’’ and ‘‘ergon’’ meaning "work.’’ Therefore, it is not surprising that the mental image created by the word ‘‘surgeon’’ is that of an individual working with his or her hands in the operating room. Indeed, through the past 2 centuries, a surgeon has been thought of, primarily, as someone who has acquired sufficient dexterity to perform operations safely, and an accomplished surgeon as someone who possesses a higher level of manual skill, and can perform an operation with speed, efficiency, and elegancy. With that in mind, training of surgeons has focused almost exclusively in the development of the necessary skills to carry out operations. Individualism – individual responsibility for the total care of the surgical patient – has also been a major focus in the training or surgeons. In the past 25 to 30 years, things have changed dramatically. With the advent of modern anesthetic and resuscitation techniques, speed, once a major determinant of the immediate outcome of an operation, is now relegated to the back burner. Laparoscopy and robotics, as intermediaries between the surgeon and the tissues, have substantially changed the concept of ‘‘elegancy,’’ and the ability of the entire operating room team to observe every detail of an operation in real time through high-resolution imaging has brought to the forefront the concept of ‘‘accuracy’’ and ‘‘accountability.’’ Moreover, complexity in the operating room, and also in the pre and postoperative care, has created the need for the involvement of other experts. Thereby, pluralism has replaced the individualistic concept so deeply embedded in the minds and hearts of surgeons of the past. The word ‘‘Master’’ is used to denote the highest level of achievement within a certain domain. In this essay, we identify 10 elements that we believe are needed to achieve mastery in the practice of surgery, in addition to excellent technical skills. It should be clear that technical expertise plays a substantial role in the outcomes of an operation, and that the concepts expressed in this paper are not intended to diminish its importance. In fact, delicate handling of tissues, accuracy in the performance of a resection or a reconstruction, quick discovery and resolution of complications, all with rapid thinking and appropriate calmness, are as essential to success in today’s surgical procedures as they ever were. Yet, even when they remain essential, they are no longer enough to achieve true mastery in the profession. So, what are these