This presentation is a combination of personal experiences, observations, and hypotheses concerning the training and quality of surgeons made over the past quarter century. The title reflects the principle theme. Before I get on to serious thoughts, however, some personal anecdotes may be of interest.
As a young house officer in the late 1940s, rotating through different areas of surgery, including abdominal surgery, thoracic surgery, orthopedics, and other specialties, I was much like a small boy at a circus, fascinated with the show in each new tent to such a degree that I began to suspect the reliability of my own instincts, for each area seemed to be so attractive. However, the emerging field of vascular surgery soon became my first true abiding interest, perhaps because the area had the obvious characteristics that with precise diagnosis and an expert operative technique excellent results could almost always be obtained, usually in