THE STATE OF TRANSCATHETER AORTIC VALVE IMPLANTATION TRAINING IN CANADA: A NATIONAL SURVEY OF CARDIAC SURGERY RESIDENTS AND PROGRAM DIRECTORS

Abstract

The volume of transcatheter aortic valve implantation (TAVI) has increased globally with a subsequent increase in demand for clinicians trained in performing this procedure. However, the state of TAVI training for Canadian cardiac surgical residents is unknown. The objectives of this study were: 1. To establish a national inventory of TAVI educational resources 2. Understand the role of residents in TAVI programs 3. Understand the attitudes and perspectives of residents and program directors (PD). Two National web-based surveys targeting residents and PDs in Royal College of Physicians and Surgeons (Canada) accredited cardiac surgery programs were developed. The survey examined available TAVI educational resources, the attitudes towards TAVI training, and barriers to becoming competent in performing TAVI. An electronic invitation was sent to 100 residents and 12 PDs across Canada between February and April 2017. Descriptive analyses were used to summarize data in an aggregate and anonymous manner. Chi-square testing was used to compare responses between residents and PDs. Thematic analysis using a realist approach was undertaken to analyze patterned responses to open-ended survey questions. 73 of 100 (73%) residents and 10 of 12 (83%) PDs completed the survey. Broad representation from all 12 residency programs across Canada programs and all post-graduate years of training was obtained. A minority of residents (15.1%) and PDs (40%) reported that TAVI training in the their program was adequate (Chi-square(1)=3.692; p=0.055). Only 30% of PDs report that their residents had access to TAVI simulation training. While 98.6% of residents and 90% of PDs agreed that TAVI was important to the trainee’s future practice (Table), 68.5% of residents and 60% of PDs agreed that TAVI should be a focus of fellowship training (Chi-square(1)=0.289; p=0.591). Furthermore, 27.4% of residents and 40% of PDs agreed that there was not enough time in residency to teach TAVI (Chi-square(1)=0.680; p=0.401). Reoccurring patterns from the thematic analysis of barriers to TAVI training were identified as: a perceived lack of interest from interventional cardiologists to teach surgical residents, competition from TAVI fellows, and lack of time (Figure). Educational resources for TAVI training are limited for residents across Canada. While almost all respondents agreed that TAVI will play a vital role in the trainees’ future clinical practice, there are many perceived barriers to providing adequate training during residency. Finally, there is a lack of consensus as to whether TAVI competency should be acquired primarily in residency or fellowship training.View Large Image Figure ViewerDownload Hi-res image Download (PPT)