An increased awareness of the need for safety in medicine in general and in surgery in particular has prompted comparisons between the cockpit and the operating room. These comparisons seem to make sense but tend to be oversimplified.Attempts in healthcare to mimic programs that have been credited for the safety of commercial aviation have met with varying results. The risk here is that oversimplified application of an aviation model may result in the abandonment of good ideas in medicine. This paper describes in more depth the differences between medicine and commercial aviation: from the hiring process, through initial operating experience, recurrent training, and the management of emergencies. These programs add up to a cultural difference. Aviation assumes that personnel are subject to mistake making and that systems and culture need to be constructed to catch and mitigate error; medicine is still focused on the perfection of each individual's performance. The implications of these differences are explored.