Is myocardial revascularization safe in trainees' hands?

Abstract

This editorial refers to ‘Clinical outcomes after myocardial revascularization according to operator training status: cohort study of 22 697 patients undergoing percutaneous coronary intervention or coronary artery bypass graft surgery’[†][1], by D.A. Jones et al ., on page 2887 This issue of the European Heart Journal includes an analysis, which shows that there is no evidence that outcome of patients after myocardial revascularization (coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) would depend on primary operator grade, trainee versus consultant.1 This is the largest surgical CABG dataset with the longest follow up looking at trainee grade and outcome, which coupled with similar and still unpublished findings in PCI procedures results in a large and important revascularization dataset. Great news, trainees are as good as experienced cardiac surgeons or experienced interventional cardiologists! Hurray for the quality of the trainees, hurray for the quality of the training programmes! The results of the investigation however may not be lumped to this simple message and should be carefully analysed in order to develop the right insights leading to adequate measures and decisions with regard to training in myocardial revascularization. Who are these trainees performing CABG and PCI as a primary operator? In the UK system the MD has to complete Foundation Training before starting his specialization ( Figure 1 ). The specialization in Cardiology comprises three modules: Core Medical Training (or Acute Care Common Stem), Cardiology Core training and Advanced Specialist Area Modules.2 This training takes up 7 full-time years, of which 5 years are devoted to cardiology, after which the trainee is expected to be entirely autonomous as a specialist practitioner. The specialization programme in the UK is in accordance with the requirements of the ESC Core Curriculum for the General Cardiology (2013), which includes a module of Internal Medicine and General … [1]: #fn-1