Also, I agree more with Llenroc about what makes a good surgeon. There shouldn't be much improvising done in surgery--each surgery should be almost cookie-cutter in nature, with the few exceptions of variable anatomy, complications, etc. What makes a good surgeon to me is being able to perform surgery with finesse and speed. You can always tell when a surgeon doesn't know what he/she is doing...they are clumsy, cause undue trauma, and are not confident in their next step. I have seen a surgeon like this, and once he stopped, looked up at the scrub nurse, and said, "What do you think we should do next?"
😱[/QUOTE]
I think that performing certain procedures with out variation is good, it also gets compotent surgeons into a lot of trouble. I've seen several routine lap chole's result in large amounts of blood loss (with surgeons trained at different institutions) because they were trying to "cookie-cutter" the operation, missed a ligation or had poor technique (despite the operation's facility.)
I agree with you that the correct answer to the question (and the ideal one) is that both view points are valid: a good surgeon should confidently move from one action to the next knowing exactly where he is going next, but changing his actions as need be. Decision making is so individualized on a patient by patient basis, that true "cookie cutter" operations can be deadly. Good call on the technique and speed! I would also add something about creativity though. (How many times have you heard your attending say, "well, S$&T! I guess this tumor's stuck closer to the IVC than I thought. We're gonna have to .... did you prep his....?")
waffle
