Determinants of outcome include technical skill, volume of work, and case mix

Surgery can be a risky business. Members of the public are now attuned to that fact and appreciate that their surgeon's performance is a key determinant of success. Outcome after surgery is of course relatively easy to assess; you survive the operation or you don't, the anastomosis holds or it doesn't, the hernia recurs or it doesn't, and so on. In an era of increased scrutiny it is perhaps no surprise that surgeons feel under pressure or that they account for a third of the referrals to the newly established National Clinical Assessment Authority in England.1

What then are the determinants of surgical performance, and is a poorly performing surgeon easy to spot? Technical skill is vital, but it is by no means the only essential ingredient for success. Thorough training, compassion, sound judgment, good communication skills, honed clinical skills, and knowledge are all critically important. Surgeons do not work in isolation and success depends on effective collaboration and team working. This is not to submerge the surgeon in anonymity—surgical teams need …