Commentary: The Integrated 6-Year Program and Early Specialization Program provide attractive pathways to train in cardiothoracic surgery

Abstract

Central MessageThe I-6 program is a good training paradigm. The Early Specialization Program doesn't shorten training, but it is likewise attractive and has much less attrition.See Article page 297. The I-6 program is a good training paradigm. The Early Specialization Program doesn't shorten training, but it is likewise attractive and has much less attrition. See Article page 297. The very best and most talented physicians have pursued cardiothoracic surgery, yet our profession has faltered at attracting the large/growing pool of diverse students who, up until recently, have not often joined our ranks. To that end, during the past decade there have been additional pathways proposed and implemented. Baker1Baker C. What is the optimal cardiothoracic surgery residency model?.J Thorac Cardiovasc Surg Open. 2021; 7: 297-301Google Scholar describes well many of the programmatic difficulties associated with the Integrated 6-Year Program (I-6), compared with the traditional pathway that exists at the University of Southern California. He shows that with the right setup, the I-6 is a successful training paradigm. It is clearly very highly sought after by medical school graduates. University of Southern California has demonstrated ways to navigate the attrition associated with taking residents straight out of medical school, as have many other programs. The Early Specialization Program (ESP) offered at Washington University in St Louis/Barnes Jewish Hospital and other programs, is another relatively new training pathway. Residents complete 3 years of traditional general surgery training then, during postgraduate years 4 and 5, they complete 12 months of cardiothoracic surgery, followed by 2 final years of cardiothoracic surgery training. Unlike the I-6, it requires collaboration with the general surgery training program (ESP residents are excellent and hence are well liked; our general surgery program has been happy to continue to accept them). Unlike the I-6, the attrition rates in ESPs are low (0 in the Washington University in St Louis program in 12 years). This is likely due to the fact that upon entering the ESP, residents have already had several years of surgery training, and a much better understanding of what the additional training entails, if they like it, and if they are good at it. Unlike the I-6, the ESP pathway does not shorten training by a year. However, like the I-6, it is very attractive to medical students. The ESP paradigm also allows for faculty to discern who is a good match for the cardiothoracic surgery program because years of experience with applicants occur (vs hours) before accepting them. Compared with traditional training, test scores and perceived readiness for a career have been superior after ESP.2Klingensmith M.E. Potts J.R. Merrill W.H. Eberlein T.J. Rhodes R.S. Ashley S.W. et al.Surgical training and the early specialization program: analysis of a national program.J Am Coll Surg. 2016; 222: 410-416Google Scholar Although the I-6 program has many terrific qualities, the setup requires commitment to training a much younger/less-prepared group of residents, and the unavoidable attrition must be accounted for (with a plan to make accommodation). The ESP provides another pathway that produces incredibly well-trained surgeons and avoids many of the pitfalls and attrition that occur in an I-6 program. The traditional pathway is still a good paradigm and likely will not be abandoned soon. But both the I-6 and ESP pathways are attractive to medical students and should be developed so that we can attract the best and brightest into the challenging and rewarding practice of cardiothoracic surgery. What is the optimal cardiothoracic surgery residency model?JTCVS OpenVol. 7PreviewFeature Editor's Introduction—In the 21st century, we have witnessed great advancements in a wide range of fields, such as big data, computer sciences, and pharma. While these other fields have evolved and transformed, why do we insist on training future cardiothoracic surgeons using 100-year-old methods? The field of cardiothoracic surgery has experienced a great deal of change since its inception, yet it is only in the last 15 years that the training and educational paradigm in this field has begun to shift. Full-Text PDF Open Access