Cardiothoracic Surgery Residents Research Articles

Where are they now? An analysis of integrated cardiothoracic surgery residency applicants

Changes in cardiothoracic surgery (CTS) workforce trends have affected training paradigms to include the establishment of integrated six-year CTS residency (I6) programs. This study aimed to determine commitment of selected I6 program applicants to the specialty.Internal archives at a single institution were accessed to identify applicants interviewed for an I6 position from 2014 to 2016. A systematic internet search of publicly available information was performed to identify the trainee's current specialty. Descriptive analysis was performed.Forty-seven applicants were identified. Successful search results were achieved for 97.9 % of the applicants. One applicant was excluded, resulting in a cohort of 45. 48.9 % of the applicants successfully matched into I6 programs. Of the 23 who did not match into an I6 program, 91.3 % began a General Surgery (GS) residency. When looking solely at the GS trainees, 71.4 % sought and matched into a traditional or 4/3 CTS residency. In total, 77.8 % of the cohort are currently pursuing careers in cardiothoracic surgery.The study identified a strong continued interest in the field of CT Surgery among those interviewed for integrated residency. The methodology used in this study provided an effective way to follow career choice of applicants interviewed and could be applied by additional programs to further elucidate career choice and levels of commitment.

Analyzing the Impact of Cardiothoracic Surgery Rotation in Africa on The Interest and Perception of Medical Students Towards a Career in Cardiothoracic Surgery - A Continental Cross Sectional Study

Objective: Globally, there have been a gradual decline in medical students’ interest to consider cardiothoracic surgery as a future career. Recruiting African medical students to cardiothoracic surgery is important given projected cardiothoracic surgeon shortages in Africa and new training models. With little representation of cardiothoracic surgery in medi¬cal school curriculum, we assessed the impact of cardiothoracic surgery rotation in Africa on the interest and perception of medical students towards a career in cardiothoracic surgery. Method: A cross-sectional study was carried out in which a Google form e-survey was disseminated to African clinical medical students between September 5th and October 5th, 2022. The questionnaire included a five-point Likert scale, Yes/No questions, free-text questions and multiple-choice questions. Data on exposure and length of cardiothoracic surgery rotation and perception of, and interest in, cardiothoracic surgery were collected. Data was analyzed using Result: A total of 527 participants take our questionnaire with the majority being males 305 (57.9%). Most participated age group was 21-25 with 360 (68.3%) participants. The countries with highest participations rates were Kenya, Africa, Ivory Coast, and Ghana with 71 (13.5), 64 (12.1), 53 (10.1), and 44 (8.3), respectively. Most of our responders were medical students at either 5th year 154 (29.2%) or 6th year 129 (24.5%) of medical school. 247 (46.9%) stated that they don’t have a cardiothoracic surgery (CTS) rotation as an option in their surgical training while 230 (43.6%) stated to have a CTS rotation in their hospital of whom only 182 (34.5%) have been exposed to CTS rotation. Of whom exposed to CTS sortation the duration was either one to two weeks or less than a week with 64 (12.1%) and 50 (9.5%). Conclusion: This study shows the importance of quality cardiothoracic surgery exposure and its impact on medical students’ interests in pursuing a career in CTS. The negative relationship between exposure and interest in CTS can be linked with the realization of the barriers that come with pursuing CTS. Mentorship is essential in closing the gap between male and female medical students regarding their interest in pursuing a CTS residency slot

Factors in turnover intention of cardiothoracic surgery residents

Increasing numbers of cardiothoracic surgery residents are resigning, without completing their training. This study analyzes how their turnover intention is related to the training environment, and individual psychological factors. Responses by 57 Korean cardiothoracic surgery residents were analyzed. Their levels of depression, anxiety, grit, and empathy, working conditions, the effect of someone’s presence to discuss their concerns with, burnout, and turnover intention were identified as the research variables. Descriptive statistical analysis, correlation analysis, and structural equation modeling were used for data analysis. Burnout has the most significant relationship with turnover intention. It has a mediating effect on the influence of depression, grit (sustained interest), and working conditions, over turnover intention. Empathy, and the presence of someone to discuss concerns with, also affect turnover intention directly. The study also confirmed that grit and work satisfaction affect turnover intention indirectly, through burnout. The study identified both individual- and systemic-level factors for an effective training environment, to reduce cardiothoracic surgery residents’ tendencies of leaving the residency program, and supporting them for greater satisfaction with their career choice. In order to resolve negative emotions such as burnout and depression, and foster empathy, a human resource development program for the residents’ psychological support must be prepared. The program director should be adequately educated to take charge of the training program, oversee the residents’ education and welfare, and perform the roles of role-model and mentor.

Diversifying cardiac intensive care unit models: Successful example of an operating surgeon-led unit

ObjectiveThe intensivist-led cardiovascular intensive care unit model is the standard of care in cardiac surgery. This study examines whether a cardiovascular intensive care unit model that uses operating cardiac surgeons, cardiothoracic surgery residents, and advanced practice providers is associated with comparable outcomes. MethodsThis is a single-institution review of the first 400 cardiac surgery patients admitted to an operating surgeon-led cardiovascular intensive care unit from 2020 to 2022. Inclusion criteria are elective status and operations managed by both cardiovascular intensive care unit models (aortic operations, valve operations, coronary operations, septal myectomy). Patients from the surgeon-led cardiovascular intensive care unit were exact matched by operation type and 1:1 propensity score matched with controls from the traditional cardiovascular intensive care unit using a logistic regression model that included age, sex, preoperative mortality risk, incision type, and use of cardiopulmonary bypass and circulatory arrest. Primary outcome was total postoperative length of stay. Secondary outcomes included postoperative intensive care unit length of stay, 30-day mortality, 30-day Society of Thoracic Surgeons–defined morbidity (permanent stroke, renal failure, cardiac reoperation, prolonged intubation, deep sternal infection), packed red cell transfusions, and vasopressor use. Outcomes between the 2 groups were compared using chi-square, Fisher exact test, or 2-sample t test as appropriate. ResultsA total of 400 patients from the surgeon-led cardiovascular intensive care unit (mean age 61.2 ± 12.8 years, 131 female patients [33%], 346 patients [86.5%] with European System for Cardiac Operative Risk Evaluation II <2%) and their matched controls were included. The most common operations across both units were coronary artery bypass grafting (n = 318, 39.8%) and mitral valve repair or replacement (n = 238, 29.8%). Approximately half of the operations were performed via sternotomy (n = 462, 57.8%). There were 3 (0.2%) in-hospital deaths, and 47 patients (5.9%) had a 30-day complication. The total length of stay was significantly shorter for the surgeon-led cardiovascular intensive care unit patients (6.3 vs 7.0 days, P = .028), and intensive care unit length of stay trended in the same direction (2.5 vs 2.9 days, P = .16). Intensive care unit readmission rates, 30-day mortality, and 30-day morbidity were not significantly different between cardiovascular intensive care unit models. The surgeon-led cardiovascular intensive care unit was associated with fewer postoperative red blood cell transfusions in the cardiovascular intensive care unit (P = .002) and decreased vasopressor use (P = .001). ConclusionsIn its first 2 years, the surgeon-led cardiovascular intensive care unit demonstrated comparable outcomes to the traditional cardiovascular intensive care unit with significant improvements in total length of stay, postoperative transfusions in the cardiovascular intensive care unit, and vasopressor use. This early success exemplifies how an operating surgeon-led cardiovascular intensive care unit can provide similar outcomes to the standard-of-care model for patients undergoing elective cardiac surgery.

A Nationwide Evaluation of Cardiothoracic Resident Research Productivity

BackgroundEvaluating the research productivity of cardiothoracic surgery residents during their training and early career is crucial for tracking their academic development. To this end, the training pathway of residents and the characteristics of their program in relation to their productivity were evaluated. MethodsAlumni lists from integrated 6-year thoracic surgery (I-6) and traditional thoracic surgery residency programs were collected. A Python script was used to search PubMed for publications and the iCite database for citations from each trainee. Publications during a 20-year time span were stratified by the year of publication in relation to the trainee’s graduation from thoracic surgery residency. Trainees were analyzed by training program type, institutional availability of a cardiothoracic surgery T32 training grant, and protected academic development time. ResultsA total of 741 cardiothoracic surgery graduates (I-6, 70; traditional, 671) spanning 1971 to 2021 from 57 programs published >23,000 manuscripts. I-6 trainees published significantly more manuscripts during medical school and residency compared with traditional trainees. Trainees at institutions with cardiothoracic surgery T32 training grants published significantly more manuscripts than those at non-T32 institutions (13 vs 9; P = .0048). I-6 trainees published more manuscripts at programs with dedicated academic development time compared with trainees at programs without protected time (22 vs 9; P = .004). ConclusionsI-6 trainees publish significantly more manuscripts during medical school and residency compared with their traditional colleagues. Trainees at institutions with T32 training grants and dedicated academic development time publish a higher number of manuscripts than trainees without those opportunities.

Workforce diversity in cardiothoracic surgery: An examination of recent demographic changes and the training pathway

IntroductionThe purpose of our study was to examine changes in the demographic makeup of resident physicians in integrated 6-year cardiothoracic surgery and traditional thoracic surgery residency programs from 2013 to 2022 compared with other surgical subspecialties and determine potential leaks in the training pathway. MethodsData from US Graduate Medical Education reports from 2013 to 2022 and medical student enrollment data from the Association of American Medical Colleges were obtained. Average percentages of women and underrepresented minorities were calculated in 2 5-year intervals: 2013 to 2017 and 2018 to 2022. Average percentages of women, Black, and Hispanic medical students and residents were calculated for the 2019 to 2022 period. Pearson χ2 tests were conducted to determine significant differences in proportions of women, Black/African American, and Hispanic trainees across time (α = 0.05). ResultsThoracic surgery and I6 residents saw a significant increase in the proportion of women trainees across the 2 time periods (19.9% (210 out of 1055) to 24.6% (287 out of 1169) (P < .01) and 24.1% (143 out of 592) to 28.9% (330 out of 1142) (P < .05)), respectively. There was no significant change in the proportion of Black and Hispanic trainees in thoracic surgery fellowship or integrated 6-year cardiothoracic residency programs. Hispanic trainees were the only group whose proportion of cardiothoracic surgery trainees was not significantly lower than their medical school proportion. Women and Black trainees had significantly lower proportions of thoracic surgery residents and integrated 6-year cardiothoracic residency program residents than their proportions in medical school (P < .01). ConclusionsCardiothoracic surgery has not significantly increased the number of Black and Hispanic trainees during the past decade. The lower proportion of Blacks and women in thoracic surgery residency and fellowship programs compared with their proportion in medical schools is concerning and is an opportunity for intervention.

Virtual Reality Simulator versus Conventional Advanced Life Support Training for Cardiopulmonary Resuscitation Post-Cardiac Surgery: A Randomized Controlled Trial.

External chest compressions are often ineffective for patients arresting after cardiac surgery, for whom emergency resternotomy may be required. A single-blinded randomized controlled trial (RCT) was performed, with participants being randomized to a virtual reality (VR) Cardiac Surgical Unit Advanced Life Support (CSU-ALS) simulator training arm or a conventional classroom CSU-ALS training arm. Twenty-eight cardiothoracic surgery (CTS) residents were included and subsequently assessed in a moulage scenario in groups of two, either participating as a leader or surgeon. The primary binary outcomes were two time targets: (1) delivering three stacked shocks within 1 min and (2) resternotomy within 5 min. Secondary outcomes were the number of protocol mistakes made and a questionnaire after the VR simulator. The conventional training group administered stacked shocks within 1 min in 43% (n = 6) of cases, and none in the VR group reached this target, missing it by an average of 25 s. The resternotomy time target was reached in 100% of the cases (n = 14) in the conventional training group and in 83% of the cases (n = 10) in the VR group. The VR group made 11 mistakes in total versus 15 for those who underwent conventional training. Participants reported that the VR simulator was useful and easy to use. The results show that the VR simulator can provide adequate CSU-ALS training. Moreover, VR training results in fewer mistakes suggesting that repetitive practice in an immersive environment improves skills.

Collaborative simulation rotation with integrated cardiothoracic and vascular surgery junior residents accelerates technical skill progression

ObjectiveIntegrated cardiothoracic surgery (CTS) and vascular surgery (VS) residents must achieve operative independence in fewer years compared with residents in traditional training paradigms. Developing a strong foundation early in training from which to build technical skills is of paramount importance. We hypothesized that intensive simulation performed by CTS and VS junior residents would accelerate technical skill progression and improve confidence. MethodsIn July 2021, 7 post-graduate year (PGY)-1 and 5 PGY-2 residents from integrated CTS and VS programs at a single institution participated in a collaborative simulation rotation. Training included low-fidelity vascular anastomoses, high-fidelity cadaver operative simulation, and core surgical tasks. Residents rated confidence levels before and after training. Performance during end-to-end and end-to-side vascular anastomoses (pre- and post-simulation) were evaluated for: respect for tissue, time and motion, needle handling, needle angles, and knot tying. ResultsEnd-to-end anastomosis scores increased from 10.4 to 19 (p < .001); completion times reduced from 10.8 to 8.7 min (p = .02). End-to-side anastomosis scores increased from 11.4 to 14.6 (p < .001); completion time was unchanged at 8.8 vs. 8.9 min. Trainee confidence level increased for these core tasks: knot tying (3.4 vs 4.1, p = .03), end-to-end anastomosis (2.1 vs 3.6, p < .01), end-to-side anastomosis (1.9 vs 3.3, p < .01), Castroviejo needle driver handling (2.7 vs 3.8, p < .01), ultrasound guided vascular access (2.4 vs 3.5, p = .01), bronchoscopy (1.8 vs 3.1, p = .01), and chest tube placement (1.9 vs 3.1, p < .01). ConclusionsDedicated collaborative simulation focusing on technical skills relevant to both CTS and VS trainees accelerates skills progression and increases resident confidence.

Annual Structured Communication Skills Training for Surgery Residents

IntroductionThere is no formalized communication curriculum for surgical training. The aim of this study is to determine the benefit of annual communication skill-building workshops for surgical residents over several years. MethodsThe general surgery and the integrated cardiothoracic surgery residents in a tertiary care, urban academic center participated in a 2-hour communication skill-building workshop each year from July 2017 to June 2021. Each participant was administered an anonymous pre-session and post-session survey with a 5-point Likert scale to assess their self-reported preparedness and their evaluation of the workshop. Survey responses were divided into three groups based on their experience in this workshop; no experience (Experience 0), 1 y of experience (Experience 1), and two or more years of experience (Experience 2+). They were compared among groups. ResultsSeventy-one surgical residents participated in the workshop generating 124 survey results (Experience 0, 71 [57.3%], Experience 1, 41 [33.1%], and Experience 2+, 12 [9.7%]). Self-reported preparedness scores improved for the overall group as well as for each experience group. While scores decreased significantly in the following years, they improved after each workshop. Scores were significantly better with more experience (4, interquartile range [IQR] 3-4 in Experience 0, 4, IQR 3-5 in Experience 1, 4, IQR 4-5 in Experience 2+, P < 0.001 between Experience 0 and Experience 1, P = 0.041 between Experience 1 and Experience 2+). All residents reported an overwhelmingly positive review of the curriculum. ConclusionsYearly 2-hour communication skills practice increased surgical residents’ self-reported preparedness, and the repetition helped the improvement. Annual workshops are important for residents to be more prepared for serious illness communication.

Experience, exposure, and attitudes regarding off-pump coronary artery bypass grafting techniques in US cardiothoracic surgical residents: Results of a survey

BackgroundWe sought to determine the current level of exposure to and interest in off-pump coronary artery bypass and beating heart surgery techniques regarding cardiothoracic surgical residents in the United States. MethodsAn email survey consisting of 6 questions was sent to all cardiothoracic surgery residents of approved cardiothoracic training programs in the United States. The survey was emailed using the Qualtrics XM cloud-based survey platform. When the email responses were received, the answers to the survey questions were tabulated by the Qualtrics software and the resident's institution and year of graduation from their residency was noted. ResultsOf 400 surveys sent, we received 99 responses for a response rate of 25%. A total of 78% of cardiothoracic surgery residents reported that they are at programs that do off-pump coronary artery bypass or beating heart surgery infrequently, noting that these cases are done in less than 5% of the coronary artery bypass graftings to which they are exposed. A total of 51% responded that they do not feel comfortable with off-pump coronary artery bypass grafting under any circumstances. A total of 49% reported some comfort with the technique with most of these respondents noting that they would do off-pump coronary artery bypass or beating heart surgery on a selective basis if the clinical situation arose and 4% plan to do off-pump coronary artery bypass routinely. Exposure to off-pump coronary artery bypass and beating heart surgery significantly correlated with future adoption of the technique by the cardiothoracic surgery residents. Cardiothoracic surgery residents in the lowest, middle, and highest terciles of exposure to off-pump coronary artery bypass and beating heart surgery plan to use these techniques 31%, 86%, and 75%, respectively, in selective cases when they are in independent practice. ConclusionsOver half of graduating cardiothoracic surgery residents do not feel comfortable with off-pump coronary artery bypass or beating heart surgery techniques. Exposure to these techniques in training correlates with comfort level and plans to use them in independent practice.

Increased social media utilization and content creation by cardiothoracic surgery programs during the coronavirus disease 2019 pandemic

ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic has changed the landscape of professional activities, emphasizing virtual meetings and social media (SoMe) presence. Whether cardiothoracic programs increased their SoMe presence is unknown. We examined SoMe use and content creation by cardiothoracic surgery programs during the COVID-19 pandemic. MethodsWe searched the Accreditation Council for Graduate Medical Education to identify all cardiothoracic surgery residency programs (n = 122), including independent (n = 74), integrated (n = 33), and congenital (n = 15) training programs at 78 US cardiothoracic surgery teaching institutions. We then manually searched Google, Facebook, Instagram, LinkedIn, and Twitter to identify the associated residency and departmental accounts. The timeline for our search was between 10/2021 and 4/2022. March 2020 was used as the starting point for the COVID-19 pandemic. We also contacted the account managers to identify account content creators. The data are descriptively reported and analyzed. ResultsOf 137 SoMe accounts from 78 US cardiothoracic surgery teaching institutions, 72 of 137 (52.6%) were on Twitter, 34 of 137 (24.8%) on Facebook, and 31 of 137 (22.6%) on Instagram. Most accounts were departmental accounts (105/137 = 76.6%) versus 32 of 137 (23.4%) training program accounts. Most training program-specific SoMe accounts across all platforms were created after the COVID-19 pandemic, whereas departmental accounts were pre-existing (P < .001). The most pronounced SoMe growth was on Instagram at the training program level, with 91.7% of Instagram accounts created after the pandemic. Trainees are the content creators for 94.4% of residency accounts and 33.3% of departmental accounts. Facebook's presence was stagnant. Congenital training programs did not have a specific SoMe presence. ConclusionsSoMe presence by cardiothoracic surgery training programs and departments has increased during the pandemic. Twitter is the most common platform, with a recent increased trend on Instagram. Trainees largely create content. SoMe education and training pathways may be needed for involved trainees to maximize their benefits.

Basic principles of cardiothoracic surgery training: a position paper by the European Association for Cardiothoracic Surgery Residents Committee.

OBJECTIVESAcross Europe there are significant variations in the fundamental structure and content of cardiothoracic surgery (CTS) training programmes. Previous efforts have been made to introduce a Unified European Training System, which outlined the fundamentals of the ideal programme and supported a paradigm shift from an apprenticeship to a competency-based model. This article’s goal was to define key structural, administrative and executive details of such a programme to lay the foundations for the standardization of cardiothoracic surgical training across Europe.METHODSThe European Association for Cardiothoracic Surgery Residents Committee had previously conducted a residents’ training survey across Europe in 2020. Training curricula from the twelve most represented countries across Europe were either searched online or obtained from the countries’ national trainee representative and reviewed by the committee. Information was collated and placed into one of the following categories to develop the position paper: (i) selection of eligible candidates, (ii) guidance for an outcome-based syllabus, (iii) documentation and evaluation of training progress, (iv) mandatory rotations and training courses, (v) number of independent or assisted cases and (vi) requirements and quality assurance of teachers.RESULTSAn independent professional body should promote an outcome-based syllabus and take responsibility for the training programme’s quality assurance. Trainees should be selected on merit by an open and transparent process. Training should be delivered within a defined period and supervised by an appointed training committee to ensure its implementation. This committee should review the trainees progression regularly, provide feedback and offer trainees the opportunity to experience various training environments and trainers. A common electronic portal be used by trainees to record their agreed objectives and to evidence their completion. Trainees should regularly attend specialty-relevant courses and conferences to promote professional and academic development. The end of training is reached when the formal requirements of the training programme are met and the trainee is able to perform at the level expected of a day-1 independent surgeon.CONCLUSIONSThis article defines the key structural, administrative, and executive principles for CTS training. Programmes are encouraged to review and modify their training curricula, if necessary, to ensure the delivery of high-quality, standardized, outcome-orientated CTS training across Europe.

The Thoracic Surgery Medical Student Association: Understanding the needs of medical students pursuing cardiothoracic surgery in the United States

ObjectiveFounded in 2020, the Thoracic Surgery Medical Student Association is the first national organization dedicated to supporting medical students interested in pursuing cardiothoracic surgery. Our inaugural survey aimed to describe their basic characteristics and needs. MethodsAn Institutional Review Board–approved, nonincentivized, anonymous electronic survey was distributed to any medical students enrolled in Liaison Committee on Medical Education–accredited medical schools through social media such as Twitter, national organizations (Association of Women Surgeons, Thoracic Surgery Resident Association), and medical school cardiothoracic surgery interest groups. Their basic characteristics, attitudes, and preferences regarding cardiothoracic surgery were recorded. ResultsOf the 167 students from 117 unique schools who completed the survey, 53% identified as White and 57% identified as female. Stages of training were well distributed: 16% first-year medical students, 33% second-year medical students, 16% third-year medical students, 21% fourth-year medical students, and 14% dual degree/research students. Most participants (57%) did not have (32%) or were not aware of having (25%) a thoracic surgery training program at their home institution. The majority (72%) of students reported not having a cardiothoracic surgery interest group at their home institution. The most desired areas of cardiothoracic were networking (31%) and mentorship (28%). ConclusionsThere is a significant need to directly engage medical students who are interested in cardiothoracic surgery considering limited exposure at home institutions through a lack of cardiothoracic surgery interest groups and cardiothoracic residency programs. The Thoracic Surgery Medical Student Association is poised to address these areas with directed networking by connecting cardiothoracic surgery faculty and residents from other institutions with medical students interested in pursuing cardiothoracic surgery.

Congenital Heart Surgery Training Experiences and Perceptions Among Cardiothoracic Surgery Residents

Interest and core training in congenital heart surgery (CHS) has not been characterized among current cardiothoracic surgical trainees. This study aimed to evaluate perceptions, interest, exposure, and experience among current trainees. A 22 question survey was distributed to all cardiothoracic surgical trainees in ACGME-accredited thoracic surgery residencies. Questions included demographics, exposure to CHS during, perceptions of, participation in and quality assessment of CHS training. There were 106 responses (20.1% response rate) of which 31 (29.0%) were female and 87 (81.3%) were cardiothoracic track. While 69 (64.5%) reported having an interest in CHS at some point during training, only 24 (22.4%) were actively pursuing CHS. All but 7 (6.5%) residents reported having easy access to congenital mentorship, with 35 (32.7%) actively participating in CHS research. Three months was the median duration of congenital rotations. Residents reported less operative participation on CHS compared to adult cardiac surgery. Several residents noted the need for earlier exposure and increased technical/operative experience as areas in need of improvement. The most cited primary influences to pursue CHS included: mentorship, breadth of pathology, and technical nature of the specialty. Lack of consistent job availability and length of additional training were reported as negative influences. Cardiothoracic residents report adequate exposure to obtain case requirements and knowledge for board examinations in CHS but highly variable operative involvement. Mentorship and early exposure remain important for those interested in CHS, while additional training time and limited job availability remain hurdles to CHS.

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

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

A Simplified Approach Step-by-Step with Pearls and Pitfalls for Minimally Invasive Mitral Valve Surgery (Non-redo)

Minimally invasive mitral valve surgery was introduced in Europe and the United States in the late 1990's. There has been a low, but increasing adoption rate in the United States. The low adoption rate is likely secondary to the lack of formalized training during cardiothoracic surgery residency and a culture that has failed to accept the procedure. In this manuscript, we provide a detailed, step-by-step guide to minimally invasive mitral valve surgery via a limited right thoracotomy.

Robotic-assisted left lower-lobe pulmonary lobectomy: Eleven steps.

Robotic-assisted left lower-lobe pulmonary lobectomy: Eleven steps.

Perceptions of Training Pathways from Recent Cardiothoracic Surgery Graduates.

There are three cardiothoracic surgery (CTS) training pathways-general surgery residency followed by a CTS residency of 2-3 years (traditional), 4 years of general surgery and 3 years of CTS residency (4+3), and an integrated 6-year pathway (I-6). The goal of this study was to survey early career cardiothoracic surgeons regarding their training experiences. An email-based survey was sent to cardiothoracic surgeons, who graduated between 2012-2017. Data on training pathway specific variables and overall satisfaction were collected. The primary endpoints were career preparation and satisfaction, scored on a scale from 1-100, 100 being the most positive. Four hundred seventy-seven emails were sent, with a response rate of 95/477 (20%). Seventy-six of the respondents (80%) were male; the mean age was 39. Seventy-seven (81.0%) completed a traditional training pathway, 7 (7.4%) completed a 4+3 pathway, and 11 (11.6%) completed an I-6 pathway. Participants felt prepared for practice with a mean response of 79.8 (range 31-100); mean career satisfaction was 87.6. When asked which pathway respondents would choose in the current era, 52 (54.7%) would choose a traditional pathway, 17 (17.9%) a 4+3 pathway, and 19 (20.0%) an I-6 program; 7 (7.4%) did not respond. Twenty of 72 (27.8%) traditional pathway trained and 18/18(100%) integrated pathway trained surgeons would choose an integrated pathway. This is the first survey addressing perceptions of training from early-career cardiothoracic surgeons across all training pathways. Data from this study provides insights to better understand how to improve CTS training for the next generation of surgeons.

Ausprägung der Beanspruchungsreaktionen während operativer Lehreingriffe und Erfassung des arbeitsbezogenen Stressempfindens bei Assistenzärzten

Characteristics of stress reactions during surgical teaching procedures and recording of workrelated stress perception among resident physicians Background: Junior surgeons are exposed to high workloads inside and outside the operating theatre early in their careers. By using different measurement tools, it is possible to gain insight into the physiological and subjective stress levels of surgical residents. Aim and Methods: The aim of this study was to investigate differences in time-based stress parameters in two cardiothoracic surgery residents during surgical teaching procedures (n = 24) for aortocoronary bypasses with and without senior physician supervision by means of heart rate variability (HRV). In addition, subjective stress perception was recorded in relation to work-related behaviour and experience patterns (AVEM). Results: The time-related HRV parameters indicate higher psychological stress during the intraoperative phases without a senior physician (Mean HR: 96.1 vs. 89.4; Mean RR: 628.7 ms vs. 675.0 ms; RMSSD: 16.9 ms vs. 20.6 ms; NN50: 120.0 vs. 189.5). The stress index (14.37 vs. 12.27), PNS (–2.17 vs. –1.81), and SNS (2.90 vs. 2.08) values based on these data confirm this. Based on the results from the AVEM, the residents studied can be classified as risk types for a health-risk behaviour and experience pattern. Conclusions: The results illustrate the high psychological stress of assistant physicians and are further evidence of the high risk of burnout in the medical profession. The presence of senior physicians during operative activities seems to have a positive effect on the stress level of junior physicians. Keywords: residents – workloads – psychological stresses – heart rate variability – stress perception

Introduction of robotic surgery does not negatively affect cardiothoracic surgery resident experience.

The objective of this study was to evaluate the educational impact following the implementation of a robotic thoracic surgery program on cardiothoracic (CT) surgery trainees. We hypothesized that the introduction of a robotic thoracic surgery program would adversely affect the CT surgery resident experience, decreasing operative involvement and subsequent competency of surgical procedures. CT surgery residents and thoracic surgery attendings from a single academic institution were administered a recurring, electronic survey from September 2019 to September 2020 following each robotic thoracic surgery case. Surveys evaluated resident involvement and operative performance. This study was exempt from review by our Institutional Review Board. Attendings and residents completed surveys for 86 and 75 cases, respectively. Residents performed > 50% of the operation independently at the surgeon console in 66.2 and 73.3% of cases according to attending and resident responses, respectively. The proportion of trainees able to perform > 75% of the operation increased with each increasing year in training (p = 0.002). Based on the Global Evaluative Assessment of Robotic Skills grading tool, third-year residents averaged higher scores compared to first-year residents (22.9 versus 17.4 out of 30 possible points, p < 0.001), indicating that more extensive prior operative experience could shorten the learning curve of robotic thoracic surgery. CT surgery residents remain actively involved in an operative role during the establishment of a robotic thoracic surgery program. The transition to a robotic thoracic surgery platform appears feasible in a large academic setting without jeopardizing the educational experience of resident trainees.