Global Differences in the Training, Practice, and Interrelationship of Cardiac and Thoracic Surgeons

Abstract

Training and certification for general thoracic surgeons varies enormously between countries. There is little knowledge about training and certification for general thoracic surgeons, and the relationship between thoracic surgery and cardiac surgery around the world. A 38-item survey was designed to assess training, practice, demographics, and relationships of general thoracic and cardiac surgeons. Eighteen cardiothoracic societies representing surgeons on six continents were contacted, and 15 submitted the survey to their membership. The survey was advertised through CTSnet, and 928 surgeons from 105 countries were contacted directly in regions not covered by the professional societies. In all, 1,520 survey respondents were tabulated, representing 95 separate countries. Non-US respondents were younger, more commonly had practices exclusively in cardiac or thoracic surgery, less commonly obtained general surgery certification, less commonly performed esophageal surgery, and had shorter overall surgical training but longer specialized training in cardiothoracic surgery, although US respondents received greater length of cardiac surgery specific training (all p < 0.05). The US respondents thought that cardiac surgery training was more important for the practice of general thoracic surgery than did non-US respondents, and that it was important for thoracic surgeons and cardiac surgeons to be aligned in public policy and specialty advocacy. Marked differences in training and certification across the world result in discrepancies in clinical practice, levels of collaboration between cardiac and thoracic surgeons, and culture and attitude differences that are relevant to the feasibility of alliances relating to public policy. These findings also provide important data to inform any decisions about changes in US cardiothoracic training. Greater international cooperation may diminish these differences in order to propagate improvements in cardiothoracic education, and improve patient access and outcomes through shared specialty advocacy.