The purpose of this study was to assess mental factors related to surgical excellence among surgeons. In-depth interviews were conducted with 33 highly proficient surgeons involved in high- (51%) and low- (49%) mortality-risk surgery. A "Surgeon Interview Guide" was developed for eliciting relevant qualitative and quantitative data. The success elements from Orlick's "Model of Human Excellence," based on work with elite athletes, were used as the basic framework for the qualitative analysis of the interview transcripts. Of the three major readiness factors rated by the surgeons--mental, technical, and physical--surgeons rated mental readiness as most important for performance excellence in surgery; 49, 41, and 10%, respectively. Mental readiness was also the factor that showed the most significant change between successful and disappointing surgical performances (p = 0.003). The following mental factors were identified as important among highly qualified surgeons and in surgeons performing high-mortality-risk surgery: commitment, self-belief, positive imagery, mental readiness, full focus, distraction control, and constructive evaluation. Highly successful experienced surgeons perform at an exceptional level largely because of the quality of their mental skills. Residents in surgery may benefit from systematic mental training in similar mental skills. This approach has been effective in other high-performance disciplines and could likewise play a meaningful role in helping surgeons improve their mental readiness for the challenges they face.