American Board Of Thoracic Surgery Research Articles

The Congenital Heart Surgeons' Society Presidents and Their Contributions.

The Congenital Heart Surgeons' Society (CHSS) was founded by 16 congenital heart surgeons in 1973, who endeavored to share their clinical advances in an informal setting that would stimulate honest and forthright discussions. As the Society grew, prospective studies were organized from a centralized data center that was established and based first in Birmingham, Alabama, thence to Toronto, and recently in a collaboration between Toronto and the Cleveland Clinic. These studies formed the basis for a myriad of outcomes reports that favorably impacted surgical results. The Kirklin-Ashburn Fellowship was created and endowed by the membership which has been successful in training many congenital heart surgeons. The CHSS was then incorporated into a 501(c) (3) not-for-profit organization with bylaws, officers, and committees in 2002. Increased membership followed. The CHSS has become the face of congenital heart surgery in North America by affiliating with the World Journal for Pediatric and Congenital Heart Surgery, having one designated member on the American Board of Thoracic Surgery, and hosting joint meetings with the European Congenital Heart Surgeons Association. Since 2002, 11 presidents have been elected for two-year terms and have guided the advances that have been achieved by the CHSS. Their contributions and achievements are highlighted in chronological order.

The utilization of educational resources published by the Thoracic Surgery Residents Association

ObjectiveThe Thoracic Surgery Residents Association (TSRA) is a trainee-led cardiothoracic surgery organization in North America that has published a multitude of educational resources. However, the utilization of these resources remains unknown. MethodsSurveys were constructed, pilot-tested, and emailed to 527 current cardiothoracic trainees (12 questions) and 780 former trainees who graduated between 2012 and 2019 (16 questions). The surveys assessed the utilization of TSRA educational resources in preparing for clinical practice as well as in-training and American Board of Thoracic Surgery (ABTS) certification examinations. ResultsA total of 143 (27%) current trainees and 180 (23%) recent graduates responded. A higher proportion of recent graduates compared with current trainees identified as male (84% vs 66%; P = .001) and graduated from 2- or 3-year traditional training programs (81% vs 41%; P < .001), compared with integrated 6-year (8% vs 49%; P < .001) or 4 + 3 (11% vs 10%; P = .82) pathways. Current trainees most commonly used TSRA resources to prepare for the in-training exam (75%) and operations (73%). Recent graduates most commonly used them to prepare for Oral and/or Written Board Exams (92%) and the in-training exam (89%). Among recent graduates who passed the ABTS Oral Board Exam on the first attempt, 82% (97/118) used TSRA resources to prepare, versus only 48% (25/52) of recent graduates who passed after multiple attempts, failed, have not taken the exam, or preferred not to answer (P < .001). ConclusionsCurrent cardiothoracic trainees and recent graduates have utilized TSRA educational resources extensively, including to prepare for in-training and ABTS Board examinations.

Insights from the thoracic surgery residents association early-career development series

Insights from the thoracic surgery residents association early-career development series

Practice patterns of female cardiothoracic surgeons older than age 58 years: Are we making progress?

ObjectiveWomen remain a small minority of cardiothoracic surgeons, and within adult cardiac surgery, the gender gap widens. This study examines the career pathway and trajectory of female adult cardiac surgeons. MethodsFemale cardiothoracic surgeons were identified from the American Board of Thoracic Surgery diplomates over 58 years. Publicly available information was obtained to determine years in practice, practice type, academic and leadership title(s), and location of practice. ResultsThe average number of years in practice for female adult cardiac surgeons was 13.1. Those categorized as adult cardiac surgeons composed 25.4% (n = 90) of all female cardiothoracic diplomates and 134 (37.9%) were categorized as other subspecialty practice. Of the adult cardiac surgeons, 33.3% (n = 30) practiced privately and the remainder in academic practice. Academic titles were held by 47.8% (43 out of 90) and 30% (27 out of 90) held a position of leadership. Of those in academic practice, 25% (11 out of 42) are titled professor, whereas 43% (18 out of 42) are assistant professors. Most commonly, those in positions of leadership held the title “director,” which reflects 37% (10 out of 27) of individuals. Practice locations were distributed throughout the United States, with the highest number in the northeast (26.7%). ConclusionsOnly a small portion of female cardiothoracic surgeons pursue a career in adult cardiac surgery compared to their male counterparts. From 1999 to 2009, 1300 individuals were board certified cardiothoracic surgeons, of whom only 103 (7.9%) were female. Of these, the majority of female cardiothoracic surgeons entered academic practice. Although the overall number of practicing female adult cardiac surgeons has increased with a growth rate of 10.7%, this number remains extremely low. A discrepancy remains between gender representation of academic titles and leadership positions. Although the field has increased female representation over the past few decades, work remains to ensure all potential talent is encouraged and supported.

The path of the first female surgeon to open-heart surgery - Nina Starr Braunwald

Nina Starr Braunwald - first female heart surgeon, a pioneer in cardio-thoracic surgery, certified by the American Board of Thoracic Surgery and the first elected to the American Thoracic Surgery Association, a wonderful wife and mother of three daughters, teacher and mentor of several generations of doctors. We will tell everyone about this in more detail in our historical note Key words: female, heart surgeon; Braunwald-Morrow mitral valve, Braunwald-Cutter valve, mitral valve replacement

2020 Women in Thoracic Surgery Update on the Status of Women in Cardiothoracic Surgery

BackgroundWomen in Thoracic Surgery (WTS) has previously reported on the status of women in cardiothoracic (CT) surgery. We sought to provide a 10-year update on women in CT surgery. MethodsAn anonymous research electronic data capture survey link was emailed to female diplomats of the American Board of Thoracic Surgery. Survey questions queried respondents regarding demographics, training, accolades, practice details, and career satisfaction. The survey link was open for 30 days. Results were compared with The Society of Thoracic Surgeons 2019 workforce survey. Descriptive analyses were performed using frequency and proportions. Comparisons were performed using Student’s t tests, Fisher's exact tests, and χ2 tests. ResultsOf 354 female diplomats, 309 were contacted and 176 (57%) responded. The majority of respondents were aged 36 to 50 years (59%), white (67.4%), and had graduated from traditional-track programs (91.4%). Most respondents reported practicing in an urban (64%) and academic setting (73.1%). 36.4% and 23.9% reported a general thoracic and adult cardiac practice (22.7% mixed practice, 9.6% congenital). Fifty percent of respondents reported salaries between $400,000 and $700,000 annually; 37.7% reported salaries less than 90% of their male colleagues; 21.6% of respondents in academia are full professor; 53.4% reported having a leadership role. Whereas 74.1% would pursue a career in CT surgery again, only 27.3% agreed that CT surgery is a healthy and positive environment for women. ConclusionsThe number of women in CT surgery has steadily increased. Although women are rising in academic rank and into leadership positions, salary disparities and the CT surgery work environment remain important issues in achieving a diverse work force.

Nina Braunwald: The First Female Cardiothoracic Surgeon.

Dr Nina Braunwald is celebrated for her work as the first female cardiothoracic surgeon and her key role in the design and implementation of the first prosthetic mitral valve. She began her residency at Bellevue Hospital in 1952, a time in the United States where the scope of women's work was limited. Once her training took her to the National Institutes of Health (NIH), her historic flexible leaflet valve was developed and Dr Braunwald paved an innovative step toward the advanced prostheses of today. Afterward, she was recognized by the American Board of Thoracic Surgery in 1963. Her extensive research and educational passion for cardiothoracic surgery led to numerous publications, a leadership role with the NIH, and associate professorship at University of California San Diego and Harvard; leaving behind a significant legacy to be memorialized in awards and fellowships to women in academic cardiac surgery. Her work inspired continued evolution of the prosthetic valve and countless women to pursue surgery as a career before passing away in 1992, leaving behind a new generation of women surgeons. Despite her successful career, she was never promoted to full professor by her academic institutions.

Women in Thoracic Surgery Scholarship: Impact on Career Path and Interest in Cardiothoracic Surgery

Women remain underrepresented in cardiothoracic surgery (CTS). In 2005, Women in Thoracic Surgery (WTS) began offering scholarships to promote engagement of women in CTS careers. This study explores the effect of WTS scholarships on CTS career milestones. We assessed career development using the number of awardees matching into CTS residency/fellowship, American Board of Thoracic Surgery (ABTS) certification, and academic CTS appointment. Scholarship awardee data were obtained from our WTS database. Comparison data were gathered from the National Residency Match Program and ABTS. Details of the current roles of ABTS-certified women were determined from public resources. Qualitative results were gathered from post-scholarship surveys. A total of 106 WTS scholarships have been awarded to 38 medical students (36%), 41 general surgery residents (39%), and 27 CTS residents/fellows (25%). Among medical students, 26% of awardees entered integrated CTS residency (vs <0.1% for medical students, P < .001), and 37% entered general surgery residency (vs 4.8% for medical students, P < .001). Of general surgery awardees, 59% entered CTS fellowships (vs 7.7% for general surgery residents, P < .001), and of CTS resident/fellow awardees, 100% earned ABTS certification (vs 73% ABTS pass rate, P= .01). Of ABTS-certified awardees, 44% are practicing cardiothoracic surgeons at US academic training institutions (vs 33% of non-awardee ABTS-certified women, P= .419). All awardees reported that their scholarship was valuable in their development. Receipt of a WTS scholarship is associated with successful pursuit of CTS career milestones at significantly higher rates than contemporaries. These scholarships foster a supportive community for women trainees in CTS.

Resident perception of standardization and credentialing for high-risk bedside procedures in cardiothoracic surgery: Results from an institutional pilot study.

Though clear-guidelines are set by the American Board of Thoracic Surgery (ABTS) for the operative cases that cardiothoracic surgery residents must perform to be board-eligible, no such recommendations exist to assess competency for the wide range of high-risk bedside procedures. Our department created and implemented a multidisciplinary course designed to standardize common high-risk bedside procedures and credential our trainees. The aim of this study was to survey the attitudes of residents towards and query the efficacy of such a course. The course was designed with the goal of standardizing endotracheal intubation, arterial line insertion (radial and femoral), central venous line insertion, pigtail tube thoracostomy, thoracentesis and nasogastric tube placement. The course consisted of an online module followed by a 4-hour hands-on simulation session. Knowledge-based pre-and post-evaluations were administered as well as a Likert-based survey regarding multiple aspects of the residents' perceptions of the course and the procedures. Twenty-three (7 traditional and 16 integrated) cardiothoracic surgical residents participated in the course. Residents reported that 48% of the time, bedside procedures were historically taught by other trainees rather than by faculty. All residents endorsed increased standardization of all procedures after the course. Likewise, residents showed increased confidence in all procedures except for pigtail tube thoracostomy, thoracentesis as well as nasogastric tube placement. 43.5% of the participants demonstrated improvement in the pretest and posttest knowledge-based evaluations. Cardiothoracic residents have favorable attitudes towards standardization and credentialing for high-risk bedside procedures and utilizing such courses may help standardize procedural techniques.

Thoracic Surgery In-Training Exam Predicts Written But Not Oral Board Pass Rates: A 15-Year Single-Center Analysis

The purpose of the Thoracic Surgery Director's Association In-Training Exam (ITE) is to gauge competency and progression of thoracic surgery residents and to prepare residents for the American Board of Thoracic Surgery (ABTS) examinations. We sought to identify the relationship between traditional resident ITE scores and success at passing the written or oral portion of the ABTS examinations. ITE and ABTS examination records from 2003 to 2019 were examined for all 2-year traditional cardiothoracic surgery residents at a single institution. Paired t tests were carried out between residents on their first- and second-year ITE. Bivariate logistic regression was performed on each of the second ITE component with written or oral board passing rate as the outcome of interest. Sixty residents completed training and took both written and oral boards. First attempt board pass rates were 90% for written and 75% for oral board examination. There was a significant improvement in test scores for each resident between the first the second ITE (P< 0.001 for all scores). Both increasing overall raw (odds ratio 1.26, P = 0.022) and scaled (odds ratio 1.08, P = 0.006) ITE scores were associated with passing the written boards on first attempt. There were no associations identified for oral board passing rates. Traditional residents improved ITE scores from first to second attempt. Increasing ITE scores were associated with improved written but not oral ABTS component pass rates. The ITE serves prepare residents for the ABTS qualifying (written) exam and assists programs with gauging resident readiness for taking this exam.

COVID-19: Crisis management in congenital heart surgery

COVID-19: Crisis management in congenital heart surgery

Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases.

Ray C. Fish (1902–1962) was a leading figure in Houston's natural gas industry and a philanthropist. He believed in the American dream of “opportunity for success.” The Ray C. Fish Foundation was established so that others might be encouraged to broaden man's self-knowledge and to keep the American dream alive. After its founder's death from heart disease, the Fish Foundation granted $5 million to make the Texas Heart Institute a reality. For this reason, the Institute's highest professional award is given in honor of this extraordinary man. The award recognizes those whose innovations have made significant contributions to cardiovascular medicine and surgery. The 1st Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases were presented in 1972 to Dr. Norman Shumway. Since 1972, 25 other highly deserving recipients have been so honored by the Institute. The complete Roll of Recipients appears at the end of this article. In 2004, the faculty and staff of the Institute were extremely pleased to honor James L. Cox, MD. Dr. Cox received his award at a dinner held in conjunction with the Fifth Symposium on Cardiac Arrhythmias (New Pharmacologic and Interventional Strategies), on 14 February 2004, at the Houstonian Hotel, Club and Spa. James L. Cox, MD Dr. James L. Cox was honored for his seminal work in atrial fibrillation, a condition that affects up to 2 million people in the United States and is responsible for about 300,000 strokes every year. This disorder is characterized by spiraling electric signals that cause the heart to beat out of control. Dr. Cox has spent his career unraveling the mechanism behind this disorder and devising surgical techniques to cure it. In 1987, Dr. Cox performed his first Maze procedure. The Maze procedure definitively curbs the electrical, atrial chaos with a maze of incisions on the surface of the atria. The incisions block the signals, stopping the atrium from fibrillating. The Cox-Maze procedure has proved highly successful in long-term follow-up of patients. In 1967, Dr. Cox received his medical degree from the University of Tennessee, where he earned the Alpha Omega Alpha Distinguished Graduate Award as the outstanding student in his graduating class. He spent the next 11 years in surgical training under Dr. David Sabiston, Jr., at Duke University, except for a 2-year stint on active duty in the U.S. Army, which earned him a personal commendation from Brigadier General George S. Patton III. Dr. Cox was appointed an NIH Scholar in Academic Surgery for the remainder of his surgical training. After completing his residency, he remained at Duke for 5 years before leaving to become chief of the Division of Cardiothoracic Surgery at Washington University School of Medicine in St. Louis. In 1997, he left St. Louis for Washington, D.C., and the chairmanship of the Department of Cardiothoracic Surgery at Georgetown University. Not long thereafter, simultaneous bilateral knee replacements forced him to give up the clinical practice of surgery, but he has remained very active in the field. Currently, he is chairman and chief executive officer of The World Heart Foundation and a member of the board of directors of The Cardiothoracic Surgery Network (CTSNet). In addition, Dr. Cox was editor-in-chief of 2 of the 3 official journals of the American Association for Thoracic Surgery. Dr. Cox has trained more than 100 residents and fellows, delivered over 150 peer-reviewed scientific presentations, given over 180 invited lectures, and served as visiting professor at 79 institutions nationally and internationally and as invited operating surgeon at 40 international institutions. Dr. Cox has been a director of the American Board of Thoracic Surgery, a board member of the Thoracic Foundation for Research and Education, a member of the NIH Study Section on Surgery and Bioengineering, and chairman of the Residency Review Committee for Thoracic Surgery; in 2001, he was president of the American Association for Thoracic Surgery.

American Board of Thoracic Surgery 10-Year Maintenance of Certification Exam Improves and Validates Knowledge Acquisition

Previous "high-stakes" examinations by the American Board of Thoracic Surgery (ABTS) required remote testing, were noneducational, and were not tailored to individual practices. Given the ABTS mission of public safety and diplomate education, the ABTS Maintenance of Certification (MOC) examination was revised in 2015 to improve the educational experience and validate knowledge acquired. The ABTS-MOC Committee developed a web-based, secure examination tailored to the specialty-specific practice profile (cardiac, general thoracic, cardiothoracic, congenital) of the individual surgeon. After an initial answer to each question, an educational critique was reviewed before returning to the initial question and logging a second (final) response. Intraexam learning was assessed by comparing scores before and after reading the critique. Diplomate feedback was obtained. A total of 988 diplomates completed the 10-year MOC examination between 2015 and 2017. Substantive learning was demonstrated with an 18%, 17%, 20%, and 9% improvement in cardiac, general thoracic, cardiothoracic, and congenital final scores, respectively. This improvement was most notable among diplomates with the lowest initial scores. Fewer diplomates failed the new exam (<1% vs 2.3%). Diplomate postexam survey highlighted marked improvements in clinical relevance (35% vs 78%), convenience (37% vs 78%), and learning (15% vs 45%). Over 80% acknowledged educational value, and 97% preferred the new format. The new MOC process demonstrates increased knowledge acquisition through a convenient, secure, web-based practice-focused examination. This approach provides feedback, identifies baseline knowledge gaps for individual diplomates, and validates new knowledge attained.

Cardiothoracic surgery mock oral examinations: A single institution's 5-year experience

ObjectivesAlthough in-training examinations provide surrogate data on qualifying exam readiness, use of mock oral examinations (MOEs) in cardiothoracic surgery training before the American Board of Thoracic Surgery certifying oral exam is not uniform. Although MOEs are prioritized by some institutions, development and execution of these labor-intensive, time-consuming exams may be a barrier to others. Therefore, we aimed to develop an MOE program and to assess its educational value. MethodsWe developed an institutional MOE program that mimicked the certification examination and was serially administered to 10 cardiothoracic surgery trainees from 2014 to 2018. Biannual MOE scores were reviewed, along with certifying examination pass rates. MOE data were available for curriculum development and trainee performance evaluations. ResultsMOEs were conducted twice each academic year, with 4 exams administered during each individual's training. MOE program development required significant up-front time commitment, and thereafter each MOE required approximately 24 total faculty hours and 4 administrator hours. The pass rates for sequential MOEs demonstrated gradual improvement, and the corresponding certifying exam pass rate was 100% for these same individuals. MOE data were routinely used for curriculum refinement, as well as individual trainee feedback. ConclusionsStandardized MOEs are useful educational adjuncts to assess trainees' knowledge and readiness for certification exams, but require significant coordination and time to develop an accurate, rigorous simulation mechanism. Although we recognize that improvement in serial MOEs is likely related to exposure as well as expanding funds of knowledge, we believe these results justify use of this assessment tool in training.

Gordon F. Murray, MD, January 8, 1939 to May 21, 2018

Dr Gordon F. Murray was the 44th president of The Society of Thoracic Surgeons and a distinguished member of this profession. He had a major influence on surgery as both Chief of Division of Cardiothoracic Surgery and Chairman of the Department of Surgery at West Virginia University. An advocate of resident education, he served on the American Board of Thoracic Surgery and the Residency Review Committee, and was President of the Thoracic Surgery Directors Association. He was a tireless worker and leader in our specialty.

W. Gerald Rainer, MD, November 13, 1927 to November 14, 2017

W. Gerald Rainer, the 25th president of The Society of Thoracic Surgeons and a founding member of The Society of Thoracic Surgeons, died suddenly on November 14, 2017, the day after celebrating his 90th birthday with his family. He will be remembered as a superb private practice cardiothoracic surgeon who also participated in research, had a strong commitment to the community and the University of Colorado, and a superb record of service to The Society of Thoracic Surgeons and other professional societies.

Lessons Learned: A Roundtable Discussion on Succeeding in Cardiothoracic Surgical Residency and Practice

Lessons Learned: A Roundtable Discussion on Succeeding in Cardiothoracic Surgical Residency and Practice

Hassan Najafi, May 22, 1930–May 20, 2017

Dr Hassan Najafi, an immigrant from Iran who became the 18th president of The Society of Thoracic Surgeons, died on May 20, 2017. He had also served as chair of the American Board of Thoracic Surgery and the Residency Review Committee for Thoracic Surgery, and was afounding member and first president of the Thoracic Surgery Directors Association. A superb technical surgeon, educator, and investigator, Dr Najafi led theDepartment of Cardiovascular and Thoracic Surgery at Rush University Medical Center for 25 years. Refined and charismatic, he was wholly devoted to hispatients, family, trainees, colleagues, and our profession.

Providing cardiothoracic services in 2035: Signs of trouble ahead

ObjectiveAs the population ages, we will present the reality around being able to meet the health care needs of our population. In particular, we will present that providing cardiothoracic services in 2035 with a shortage of surgeons and an unknown caseload may be an impossibility. MethodsBy using data from the American Board of Thoracic Surgery, we estimate that in 2010, 4000 cardiothoracic surgeons performed more than 530,000 cases. Additionally, cardiothoracic residency programs train and certify on average 90 new surgeons every year. To estimate the number of cases for 2035, we consulted the Census Bureau figures for 2010 and population projections for 2035. We then estimated the expected caseload for cardiothoracic surgeons relative to heart surgery, as well as lung and esophageal surgery. We found that among 2010 cardiothoracic surgeons in the United States, they completed more than 530,000 cases. ResultsWe project that by 2035 there will be 853,912 cases to perform, representing an increase from 2010 to 2035 of approximately 61% nationally. The cases per surgeon, per year, in 2010 averaged 135 for almost each of the 4000 surgeons. In 2035, the average caseload per surgeon will be 299 cases, representing an increase of 121% for the individual surgeon. ConclusionsWe conclude that by 2035, cardiothoracic surgeons will be responsible for more than 850,000 patients requiring surgery. This represents a 61% increase in the national case load and a potential for a 121% increase for each cardiothoracic surgeon. We believe this is not feasible and a sign of trouble ahead.

Congenital Heart Surgery Subspecialty Certification: How Is It Working? The American Board of Thoracic Surgery Perspective.

Congenital heart surgery is among the most challenging fields in all of medicine. The unique skills and knowledge base required prompted the American Board of Thoracic Surgery (ABTS) to establish the Subspecialty Certificate in Congenital Heart Surgery (CHS). Standards for operative experience and fellowship training programs were established by the ABTS and the Accreditation Council for Graduate Medical Education. Since 2009, 188 Subspecialty Certificates in CHS have been granted, including 38 earned through the fellowship training pathway. Today, the overwhelming majority of congenital heart surgeons in the United States hold a Subspecialty Certificate in CHS. Recent survey data suggests those individuals who have completed Accreditation Council for Graduate Medical Education fellowship training in CHS were satisfied with the operative experience they received during training and the vast majority are practicing CHS. While surgical training and education will always be a work in progress, in the 7 years since its inception, the ABTS Subspecialty Certificate in CHS has achieved the goal of quality control and standardization of CHS training.