In this article by Paice et al. [1], the authors make a case for using the lessons learned in the selection of air crew to improve the quality of surgical trainees. This comparison of surgery to aviation has been increasingly discussed in health-care circles worldwide. At best, the analogy is only partially correct and I believe we have now reached the limit of its usefulness. The most apparent limitation is that while flying an advanced aircraft can be compared to the performance of a complex surgical procedure, there is much more to being a surgeon than operating. Remember that most patients seen by most surgeons do not have operations. I have two main problems with the ideas expressed in this article. The first is that it assumes that correcting the ‘‘problem’’ of incorrect selection for surgical training will reduce surgical error. So what evidence is there that such alleged faulty selection is responsible for these errors? Will a change in selection policy reduce the subsequent error rate? Or is error a systemic problem? We live in an era of team work (although the team seems to be less important as soon as something goes wrong), so do we believe that altering the selection process for one team member will have a measurable effect on the error rate? In general terms, the incidence of surgical error can presumably be reduced by fostering a risk-averse culture, e.g., if everything is not OK in the preflight check, the aircraft does not fly. In emergency situations, the surgeon often does not have this option, and indeed surgeons currently are the medical individuals who take ‘‘risks’’ out of necessity. Decision-making with incomplete information is what we do. If we extirpate risk-taking, do we promote dithering? The second problem is that the authors suggest moving to different methods of surgical selection without deciding precisely what it is that we are looking for. It is said that a surgeon is an internist (a physician) who operates. The diagnostic, empathetic skills of a medical specialist should also be present in competent surgeons. In addition, the ability to care for postoperative patients and manage their complications and other disappointments in an objective but sympathetic manner is a crucial quality. It is not clear to me that selection of surgeons primarily on the basis of their visual-spatial ability or their coping strategies in a crisis will improve overall surgical care. The ‘‘ideal’’ surgeon is a multiskilled individual, but we have not yet decided what weight to allocate to each of the component abilities of this ideal individual, or how to assess many of them. I agree with the authors that it is likely that each surgical specialty would weight each characteristic differently. A breast surgeon, for example, would need exceptional empathetic skills, while technical ability would be more important in a cardiac or vascular surgeon. I suppose that some relatively simple tests eventually may have a role in excluding some candidates early in training, thus saving time, but comprehensive aptitude testing is a far distant prospect. Finally, the authors seem to assert that academic ability alone is currently the criterion by which career progression is judged. This is manifestly not so. There is still (in the UK at least) an apprenticeship-type assessment that prevents progression if operative technique, or other abilities, are deficient. In any event, it is clear that we should not allow progression if academic ability is below standard; tests of knowledge, however unfashionable, are still necessary and already have the advantage of being objective. Sooner or later, robots will fly airplanes. Robots are already used to perform operations. However, do we want P. N. Rogers (&) Gartnavel General Hospital, Glasgow G12 0YN, Scotland, UK e-mail: pn.rogers@btinternet.com