BackgroundThe surgical mind is geared to make important decisions and perform highly skilled tasks. The aim of this review is to explore the cognitive processes that link these actions.MethodsThe core of this review is derived from a literature search of a computer database (Medline).Results and conclusionThe surgical image is one of action. However, the effective performance of surgery requires more than mere manual dexterity and it is evident that competent surgeons exhibit the cognitive traits that are held by all experts. The changes that are occurring in surgery indicate a need to place greater emphasis on the cognitive processes that underpin the practice of surgery. It is important that surgeons do not become victims of their own cult image. Copyright © 2002 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.