There is a global interest in and growing knowledge about how best to select residents in surgery. In 2010, Paice et al claimed that selection was “the missing link in patient safety work”1. The starting point for collegial discussions on the matter and opinions about selection are things we know and have experience of; and we know that there is a spectrum running from excellent to unsuitable surgeons. Some continue to ask, are surgeons “born or made”, i.e., is it innate talent, or their training that matters? Is competence-based education better than the apprenticeship model?2,3.  Further, it is well-established that all facets of competence matter for patient outcomes, not only technical skill4-6. The detrimental effect a less competent or even dysfunctional colleague can have on patients and the workplace environment is also widely recognised7. Attrition from surgical residency programs has been reported to be up to 20%, reflecting bad investments of resources8. Another challenge is that surgery accounts for most adverse events in health care, and that up to 15 % of patients in elective surgery suffer a treatment-related injury9,10. We all want the next generation to be better than us. Selection is thus a foundational factor in raising the standard level of treatment and care, reducing adverse events, improving workplace collaboration and heightening the reputation of the profession.

There is a global interest in and growing knowledge about how best to select residents in surgery. In 2010, Paice et al claimed that selection was “the missing link in patient safety work”1. The starting point for collegial discussions on the matter and opinions about selection are things we know and have experience of; and we know that there is a spectrum running from excellent to unsuitable surgeons. Some continue to ask, are surgeons “born or made”, i.e., is it innate talent, or their training that matters? Is competence-based education better than the apprenticeship model?2,3.  Further, it is well-established that all facets of competence matter for patient outcomes, not only technical skill4-6. The detrimental effect a less competent or even dysfunctional colleague can have on patients and the workplace environment is also widely recognised7. Attrition from surgical residency programs has been reported to be up to 20%, reflecting bad investments of resources8. Another challenge is that surgery accounts for most adverse events in health care, and that up to 15 % of patients in elective surgery suffer a treatment-related injury9,10. We all want the next generation to be better than us. Selection is thus a foundational factor in raising the standard level of treatment and care, reducing adverse events, improving workplace collaboration and heightening the reputation of the profession.

Some characteristics have been found important for surgeons to be successful, such as having a strong academic background and commitment to lifelong learning; possessing sufficient manual dexterity and fine motor skills to reach proficiency; displaying emotional stability; extroversion and conscientiousness; good communication skills and ability to work in teams; critical thinking ability; situational awareness; robust decision-making and problem-solving skills11-14. A more recent addition to the list is “technical orientation”, i.e. willingness and ability to work in a technology-based environment15.

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How often do surgical patients experience pain, anxiety, stress, and sleep disturbance during their hospital stay? And how severe are these symptoms? In collaboration with numerous Dutch hospitals, we set out to answer these questions, using an uncommon and innovative, but for our goals perfectly fitting method: a flash mob study.

A flash mob study is a novel research design in which data is collected on a single day, simultaneously in multiple centres. It’s an efficient way to address clinically relevant questions on a large scale – in our case the point prevalence of surgical patient pain, anxiety, stress, and sleep disturbance. But this approach also requires meticulous planning: there’s only one shot to get it right.

The preparation for the project took a year. We started by developing the methodology and drafting the study protocol, followed by compiling all necessary documents for submission to the Medical Ethics Review Committee (MERC). While awaiting approval, we reached out to all hospitals across the Netherlands. Through secretaries and outpatient clinics, we found surgeons and residents in 29 Dutch hospitals who were eager to participate and helped forming a local research team and arranging institutional approval from the hospital board.

Retirement is a major transition for any professional, but for surgeons, it is particularly complex. The identity, purpose and intense commitment associated with surgical practice make stepping away from the operating room both a psychological and logistical challenge. To ensure a smooth transition, surgeons must plan their exit strategy. Here are 10 commandments for retiring gracefully from surgical practice:

The key to a seamless retirement is early and thoughtful planning. Ideally, this process should begin 5–10 years before retirement. This period allows time for assessment of financial security, professional succession planning, and gradual disengagement from clinical duties. Developing a timeline ensures that retirement is a proactive decision rather than a reactive necessity due to declining health or external pressures. Such planning is the key to a graceful landing in the post-retirement life.

Financial security is crucial to a stress-free retirement. Surgeons should work with financial planners to evaluate their savings, investments and retirement benefits. Diversifying income sources—such as pensions, savings, and passive investments—ensures stability.1It is also wise to consider medical insurance coverage post-retirement, and planning to safeguard wealth for future generations.

Residency, and especially surgical residency is hard1. Burnout, depression, harassment, emotional exhaustion, and stress are way too familiar with current surgery residents2-7. Unfortunately, the situation has not changed much since I was resident8, 9. But what has changed is that we acknowledge this now. I have to say though, it is good that I did not read these articles before I started my surgical career about 27 years ago.

Surgery residency and residency in general changes previous personal relationships and this is tied to evolving professional identity10. Strange working hours, and patient-doctor relationship confidentiality may lead to fewer talking points with non-medical friends and family11. Further, these relationships with non-medical friends and family may not thus provide the support they used to,11, 12 especially when dealing with work-life and residency.