Recently, I was asked to discuss the subject of “Surgery” at commencement ceremonies for graduating chief surgical residents. At first glance, the topic seemed suitable for a straight-forward exposition. Surely, surgery and what made up a surgeon would not be difficult to describe by anyone engaged in the surgical specialties.Yet, when I began to set my thoughts in order, the concept of surgery and what it takes to be a surgeon proved to be elusive. Each word or definition suggested more words and more description. It began to look as if there was just too much material to describe this entity, almost “too many notes.”[1] The topic would not reduce itself. I became engrossed with finding a way to adequately describe surgery and the characterization of a surgeon.Before outlining the result of my study, however, first let Webster define the subject. Surgery is the “medical diagnosis and treatment of injury, deformity, and disease by manual and instrumental operations.” In Webster's view, a surgeon is “a physician specializing in surgery.”[2] The definitions are succinct and to the point as Webster establishes that surgery is a branch of medicine and that operations are only performed to relieve suffering, deformity or disease. More to the point, a surgeon is defined as one who practices this profession. But do these definitions adequately describe surgery at the beginning of the year 2000 CE ? And what makes up a surgeon? The answer must be, “not exactly.”Medicine, one of “the three common, noble and learned professions,” that also includes Law and Divinity, has been recognized as a profession for a very long time.[3] One of the earliest references to this subject occurred in Religo Medici, written by Sir Thomas Browne in 1635:And to speak more generally, those three noble Professions which all civil Commonwealths do honour, are raised upon the fall of Adam and are not in any way exempt from their infirmities; there are not only diseases incurable in Physick but cases indissolvable in Laws, Vices incorrigible in Divinity.[3]In this vein, Welch suggested that if surgery is to be acknowledged as a profession, it is imperative to characterize surgery by the attributes of a profession.[4] Wright, in the Canadian Bar Review, reading 21, elucidated six elements that distinguished a profession.[5] The first element was an offer of service that incorporated the moral duty of not refusing a client or patient without cause or explanation. The second constituent of a profession was a special skill that the professional person professed to have. A third component was that training and education were necessary for its mastery. The professional must be educated in a broad-based manner that allows that person to apply his or her work to the life of man and mankind. In the fourth element, a profession was recognized by the state and had certain privileges derived from that relationship. A fifth consideration was that a profession is a self-disciplined group. Finally, a profession was distinguished by an unselfish aspect of public service.A profession, therefore, is a self-disciplined group of individuals who present themselves to the public as possessing a special skill derived from training or education, and who are prepared to exercise that skill primarily in the interest of others.[5]Few, therefore, would argue that surgery, along with medicine, is not a profession. It is a profession, but a profession that is also a science and an art. Surgery is a science in that it involves itself with, “the observation, identification, description, experimental investigation, and theoretical explanation of natural phenomenon.”[2] And surgery is an art, for an art is defined as “a specific skill in adept performance, held to require the exercise of intuitive faculties that cannot be learned solely by study.”[2]Surgery as a science can best be described by the intensive training program that must be completed before a resident is eligible to sit for the examinations given by the American Board of Surgery. The training is long and arduous. For example, a program in general surgery must consist of at least 5 years of graduate training in surgery after completion of medical school. An opportunity must be provided for residents to learn, in depth, the fundamentals of basic science as applied to clinical surgery. In addition, experience must be provided in preoperative, operative, and postoperative care for patients in all areas that constitute general surgery. The components of an acceptable program, institutional organization, facilities, educational program, teaching staff, scholarly environment, supervision, responsibilities, working hours and evaluations are precisely detailed and carefully monitored. A surgical resident's work week can average 80-100 hours per week.[6]The Residency Review Committee for Surgery (RRC), which consists of representatives nominated by the Council on Medical Education of the American Medical Association, the American College of Surgeons and the American Board of Surgery, reviews and approves educational programs in surgery in the United States. Accreditation authority is vested in the Accreditation Council for Graduate Medical Education (ACGME).[7]Surgery is also an art. That is to say, a complete surgeon must have “a specific skill in adept performance, held to require the exercise of intuitive faculties that cannot be learned solely by study.”[2] A surgeon is not only a physician, but a physician of high ethical character who also operates and who harnesses physical skills to a well-developed intellect.A physician becomes a surgeon by intensive training, didactic exercises, education, practice, and, most importantly, by prolonged exposure to skilled mentor-surgeons who have sound morals and high ethics. Mentor-surgeons who exhibit those qualities of dedication, self-effacement, self-criticism, and self-sacrifice that enhance and ennoble the art of surgery. And, while these qualities may be intuitive, they can be acquired by the exposure of surgical residents to mentor-surgeons of good character.From all the above, my review of this subject has led me to conclude that surgery is a branch of medicine that is a profession and, indeed, a “noble” profession. It is, in addition, a science and an art. Surgery is composed, therefore, of three parts, and to emphasize one at the expense of the others would be to diminish the subject as a whole. John Donne (1572-1631) captured the essence of this indivisibility in his poem No Man Is An Island.[8]No man is an island, entire of itself;every man is a piece of the continent a part of the main;if a clod be washed away by the sea,Europe is the less,as well as if a promontory were,as well as if a manor of thy friends or of thine own were;any man's death diminishes me, because I am involved in mankind;and therefore never send to know for whom the bell tolls;if tolls for thee.A one-sentence definition of surgery does not begin to encompass the totality of this magnificent specialty or what we do as surgeons. The human experience of our profession, our science, and our art is more grand than Webster's accurate, but ultimately, unsatisfactory characterization.