JB: I think that the study has three major implications. The first is that despite the inherent subjectivity of the process, it is in fact feasible, and practical, to measure the skill of operating surgeons. The second main finding is that, even among surgeons that are fully trained and practicing in a single specialty, there was remarkable variation in empirical ratings of their skill. And third, and perhaps most important: those empirical measures of skill were remarkably correlated to surgical outcomes, at least as reflected by risks of postoperative complications.

JB: I think my clinical observation, as well as previous studies by others, suggest that surgeons get on to the flat part of the curve of proficiency (with regard to technical skill and outcomes) by their mid-40s. The mean age of surgeons participating in this study was 45-50 years old, and thus I am not surprised that years of training and fellowship training were not a big driver of outcomes.