How to educate and evaluate cardiothoracic surgeon

Abstract

The history of cardiovascular surgery began with the first clinical usage of a cardiopulmonary bypass in 1953. Subsequently, new operations for congenital heart disease, valvular heart disease, ischemic heart disease, aortic disease, and transplantation were developed in a short-time period. Thoracic surgery, as well, was also expanded with the introduction of endoscopic surgery, lung volume reduction surgery, and lung transplantation. In addition, operative results have improved considerably due to findings in new operative procedures and instruments, assist devices, new drugs, and perioperative managements. During a 50to 60-year span, we have experienced the best and brightest time in cardiothoracic surgical advancement. With further progress in cardiothoracic surgery being developed, there will be an increase in need for greater technical skills and the education of said skills. The evaluation of surgical competency and the assessment of the education and continued competency of practicing surgeons will be more crucial than before. We have learned technical skills through several methods until now. However, procedural training has been unsystematic and unstructured, and proper teaching methods have not been established. Surgical skill training, for instance, has been performed using live patients and animals, human cadavers, and ex vivo animal tissue until now. With regard to these materials, there were several limitations due to ethical problems, the inexact replication of human anatomy, and the reality and expense for animals. In the past, performing on live patients and animals had been considered the best method for learning basic skills. Animal hearts from porcines and bovines, for instance, were useful tools given their similarities in size and anatomy to the human heart, as well as their beating operations. However, recently the methods used on live patients and animals are no longer viable due to the increasing complexity of cases, costs, and ethics. Human cadavers have proven the best alternative for studying the human anatomy, yet it is not prevalent here in Japan. Instead, ex vivo animal tissues have been used to teach basic technical skills for residents. During the last decade, operative methods have undergone significant changes compared to the classic styles, which are relatively invasive open surgery. Minimal invasive surgeries, however, have evolved in both thoracic and cardiovascular disease such as therapeutic bronchoscopy, endoscopic lung resection, robotic approaches to esophageal resection, off pump coronary artery bypass grafting, endovascular stent grafting to aortic disease, hybrid approaches to congenital heart disease, and endovascular repair to valvular heart disease. In such situations, it is important to evaluate the technical skills and surgical competency for the patient’s safety [1]. The simulation system is now spotlighted for learning both technical skills, situational simulation, and for evaluating competency performance and surgical skills objectively. Simulation training was found to improve subsequent performances compared with subjects cake received didactic training alone. This benefit was found to be durable and persistent in the long term. This presidential address was written at the invitation of the editorial committee.