This paper traces the history and describes the status of surgical training in Pakistan. A key revelation is that excellent surgeons are produced through systems which on formal review might appear to lack standards. Personal characteristics of residents modify outcomes in high volume surgical training units, and consequent variation in quality of outputs is noted. Attention needs to be given to (i) develop new educational systems which are not prolonged costly and cumbersome, and which produce the adequate number, types and spread of highly skilled and cognitively developed empathic surgeons for the country, (ii) the improvement of the health systems which currently impede the development of surgeons and (iii) novel wars of tackling rural urban disparities in health delivery.