Cardiothoracic Surgery Training Research Articles

Cardiac surgery simulation: a low-cost feasible option in an Australasian setting.

Simulation training is a useful adjunct to surgical training and education (SET) in Cardiothoracic Surgery yet training opportunities outside the Royal Australasian College of Surgery or industry-sponsored workshops are rare due to high cost and limited training faculty, time, assessment tools or structured curricula. We describe our experience in establishing a low-cost cardiac simulation programme. We created low-cost models using hospital facilities, hardware stores, abattoirs and donations from industry. Three workshops were conducted on coronary anastomoses, aortic and mitral valve replacement. Whole porcine hearts were sourced from local farms. Industry donations of obsolete stock were used for suture and valve material-stations constructed using ironing-board, 2-L buckets and kebab-skewers. Suture ring holders were fashioned from recycled cardboard or donated. All participants were asked to complete pre and post simulation self-assessment forms. Across three workshops, 45 participants (57.8% female) with a median age 27 (interquartile range 24-31) attended. Training level consisted of nurses (8, 17.8%), medical students (17, 37.8%), residents/house officers (6, 13.3%) and registrars (14, 31.1%). There were improvements in knowledge of anatomy (mean difference 18%; 95% confidence interval 12%-24%), imaging (16%; 10%-22%) and procedural components (34%; 28%-42%); and practical ability to describe steps (30%; 24%-38%), partially (32%; 26%-38%) or fully complete (32%; 28%-38%) the procedure. Simulation-based training in cardiac surgery is feasible in a hospital setting with low overhead costs. It can benefit participants at all training levels and has the potential to be implemented in training hospitals as an adjunct to the SET programme.

Characterization of academic cardiothoracic surgeons who started as attendings in private or community practice

BackgroundSurgeons are traditionally categorized as working either in academic or private/community practice, but some transition between the two environments. Here, we profile current academic cardiothoracic surgeons who began their attending careers in private or community practice. We hypothesized that research activity may distinguish cardiothoracic surgeons who started in non-academic versus academic practice. MethodsPublicly available data regarding professional history and research productivity were collected for 992 academic cardiothoracic surgeons on faculty at the 77 cardiothoracic surgery training programs in the United States in 2018. Data are presented as medians analyzed with the Mann-Whitney test or proportions analyzed with Fisher exact test or the χ2 test. ResultsA total of 80 (8.1%) academic cardiothoracic surgery faculty started their careers in non-academic practice, and 912 (91.9%) started directly in academia. Those who started in non-academic practice spent a median 7.0 y in private/community practice and were more likely to be cardiac surgeons (68.8% vs 51.6%, P = .0132). They were equally likely to pursue a protected research fellowship (56.3% vs 57.0%, P = .9067) and publish research during training (92.5% vs 91.1%, P = .8374), but they published fewer total papers by the end of cardiothoracic surgery fellowship (3.0 vs 7.0, P = .0001) and fewer papers per year as an academic attending (0.8 vs 2.9, P < .0001). Nevertheless, the majority of cardiothoracic surgery faculty who started in non-academic practice are currently active in research (68.8%), and 2 such surgeons received National Institutes of Health R01 funding. ConclusionTransitioning from non-academic to academic practice is an uncommon but feasible pathway for interested cardiothoracic surgeons.

COVID-19 and cardiothoracic surgery: Effects on training and workforce utilization in a global pandemic.

BackgroundThe COVID‐19 pandemic has disrupted all aspects of healthcare, including cardiothoracic surgery (CTS). We sought to determine the pandemic's impact on CTS trainees' educational experiences.MethodsA survey was developed and distributed to members of the Thoracic Surgery Residents Association and other international CTS trainees. Trainees were asked to evaluate their cumulative experiences and share their overall perceptions of how CTS training had been impacted during the earliest months of the COVID‐19 pandemic (i.e., since March 01, 2020). Surveys were distributed and responses were recorded June 25–August 05, 2020. In total, 748 surveys were distributed and 166 responses were received (overall response rate 22.2%). Of these, 126 of 166 responses (75.9%) met inclusion criteria for final analysis.ResultsFinal responses analyzed included 45 of 126 (35.7%) United States (US) and 81 of 126 (64.3%) international trainees, including 101 of 126 (80.2%) senior and 25 of 126 (19.8%) junior trainees. Most respondents (76/126, 43.2%) lost over 1 week in the hospital due to the pandemic. Juniors (12/25, 48.0%) were more likely than seniors (20/101, 19.8%) to be reassigned to COVID‐19‐specific units (p < .01). Half of trainees (63/126) reported their case volumes were reduced by over 50%. US trainees (42/45, 93.3%) were more likely than international trainees (58/81, 71.6%) to report reduced operative case volumes (p < .01). Most trainees (104/126, 83%) believed their overall clinical acumen was not adversely impacted by the pandemic.ConclusionsCTS trainees in the United States and abroad have been significantly impacted by the COVID‐19 pandemic, with time lost in the hospital, decreased operative experiences, less time on CTS services, and frequent reassignment to COVID‐19‐specific care settings.

Training in cardiothoracic surgery: Another victim of COVID-19 pandemic.

Training in cardiothoracic surgery: Another victim of COVID-19 pandemic.

Training in cardiothoracic surgery: how far is the other side of the table?

This article discusses the history and process of national selection of trainees, future workforce planning and projections in cardiothoracic surgery. In addition (and perhaps most importantly), it describes the challenges of the new, shorter, seven-year specialty training curriculum.

Nontechnical skills training in cardiothoracic surgery: A pilot study

The importance of nontechnical skills in surgery is widely recognized. We demonstrate the feasibility of administering and assessing the results of a formal Non-Technical Skills in Surgery (NOTSS) curriculum to cardiothoracic surgery residents. Eight cardiothoracic surgery residents participated in the NOTSS curriculum. They were assessed on their cognitive (situation awareness, decision-making) and social (communication and teamwork, leadership) skills based on simulated vignettes. The residents underwent pretraining NOTSS assessments followed by self-administered confidence ratings regarding the 4 skills. Subsequently, a formal NOTSS lecture was delivered and additional readings from the NOTSS textbook was assigned. A month later, the residents returned for post-training NOTSS assessments and self-administered confidence ratings. Changes across days (or within-day before vs after curriculum) were assessed using Wilcoxon signed rank test. There was a significant improvement in the overall NOTSS assessment score (P=.01) as well as in the individual categories (situation awareness, P=.02; decision-making, P=.02; communication and teamwork, P=.01; leadership, P=.02). There was also an increase in resident self-perception of improvement on the post-training day (P=.01). We have developed a simulation-based NOTSS curriculum in cardiothoracic surgery that can be formally integrated into the current residency education. This pilot study indicates the feasibility of reproducible assessments by course educators and self-assessments by participating residents in nontechnical skills competencies.

Characteristics and Attitudes of Aspiring Cardiothoracic Surgeons: A Survey Study

BackgroundAlthough recruiting highly qualified, diverse applicants into cardiothoracic surgery remains a national priority, their characteristics remain unknown. This study aims to describe current and future applicants in cardiothoracic surgery. MethodsAspiring cardiothoracic surgeons (students interested in matriculating in a North American training program) were voluntarily enrolled in the study through Twitter and email outreach. A 33-question survey evaluated their backgrounds, research experiences, attitudes, and interests within cardiothoracic surgery. Standard descriptive statistics were used. ResultsThere were 111 participants, 40 of whom were female (36.0%) and 27 of whom identified as an underrepresented minority (24.3%). Of the total, 63 belonged to an institution with a cardiothoracic surgery training program (56.8%). A total of 91 students envisioned having a mostly operative career (82.0%) and 75 envisioned pursuing educational roles (67.6%). The most popular surgical specialties were heart transplantation (50.5%) and aortic surgery (47.8%). Participants selected having a high-intensity operative environment (81.2%) and an innovative academic environment (58.8%) as the most attractive qualities. Perceived lack of work–life balance (46%) and toxic training or work environment (28%) were the greatest deterrents. Finances during the application process were perceived as a potential barrier by 41 students (36.9%). Approximately 75% of students (83 of 111) had faculty as mentors; 46.8% (56 of 111) thought that cardiothoracic surgery faculty were approachable but had limited time for mentorship. ConclusionsThis survey study characterized a nationally selected pool of aspiring cardiothoracic surgeons using social media. Future studies involving larger and more diverse cohorts are warranted to find areas for improvement in recruitment, retention, and diversity.

Are Esophagectomy Board Requirements Achievable? A Multi-Institutional Analysis

Duty-hour restrictions have implications on trainee operative exposure necessary to meet minimum case-volume requirements. We utilized a previously validated simulation model to evaluate the effect of program volume, trainee numbers and complement, and rotation schedule on the probability of achieving adequate esophagectomy case numbers for cardiothoracic surgery trainees. A ProModel simulator centered on probabilistic distributions of operative cases was utilized. Historical data from five 2-year cardiothoracic surgery training programs were obtained from 2016-2018 and used as inputs to the simulator that generated 10,000 "trainee 2-year periods" per program. Programs varied in annual average esophagectomy volume (12-91 per year), with 2-4 trainees graduating over a 2-year training period. If esophagectomy cases were distributed solely based on scheduling and institutional volume, only 60% of evaluated programs could adequately expose all trainees in esophagectomy to meet case requirements. The 3 programs with adequate esophagectomy volumes had averaged 3.3 times (range 3.0-3.6) the minimum number of board-required cases for their programs' trainees. The ability of programs to provide trainees with adequate esophagectomy volume is challenging based on institutional volume and scheduling. Through simulation, we demonstrate that programs need >2 times the expected minimum number of esophagectomies to ensure that >90% of trainees meet case-volume requirements. Programs may consider strategies such as allowing trainees to select cases based on personal need, train fewer fellows, or enable trainees to seek subspecialty exposure externally to achieve minimum esophagectomy case-load requirements.

National Institutes of Health R01 Grant Funding Is Associated With Enhanced Research Productivity and Career Advancement Among Academic Cardiothoracic Surgeons

National Institutes of Health (NIH) funding has declined among cardiothoracic surgeons. R01 grants are a well-known mechanism to support high-impact research, and we sought to clarify the association between NIH funding and academic achievement. We hypothesized that cardiothoracic surgeons who acquired R01 funding exhibit greater research output and faster career advancement. All cardiothoracic surgeons (n = 992) working at accredited United States cardiothoracic surgery training hospitals in 2018 were included. Institutional webpages, Scopus, and Grantome were utilized to collect publicly-available data regarding each surgeon's training and career history, research publications, and NIH funding. Seventy-eight (7.9%) surgeons obtained R01 funding as a principal investigator while 914 (92.1%) did not. R01-funded surgeons started their attending careers earlier (1998 vs 2005, P < 0.0001) and were more likely to have pursued dedicated research training (P < 0.0001). R01-funded surgeons authored 5.3 publications/year before their first R01 grant, 9.3 during the grant period, and 8.6 after the grant expired, all of which were greater than the publication rate of non-R01-funded surgeons at comparable career timepoints (2.0-3.0 publications/year, P < 0.0001). Among time-matched surgeons who completed medical school in 1998 or earlier (n = 73 R01-funded vs n = 602 non-funded), R01-funded surgeons have published more total publications (178.0 vs 56.5 papers, P < 0.0001) and exhibit a greater H-index (41.0 vs 19.0, P < 0.0001). These R01-funded surgeons have also advanced to higher academic ranks (P < 0.0001) and are more likely to be chiefs of their departments or divisions (42.5% vs 25.7%, P = 0.0035). Cardiothoracic surgeons who obtain R01 funding exhibit greater research productivity and faster career advancement.

Mentorship Effectiveness: This Is Our Responsibility

Our residents are facing work environments that are changing daily, expectations that are evolving, and workforce challenges that are very real. In this issue of The Annals of Thoracic Surgery, Reich and colleagues1 describe challenges that are present relative to mentorship effectiveness in cardiothoracic surgery training. Through a rigorous process of survey data collection, the authors have identified that mentors cited as being “easy to work with and approachable” are the major criterion for mentor selection, whereas the inability to find someone who reflected the resident’s needs was the major reason for not having a mentor.

Challenges and satisfaction in Cardiothoracic Surgery Residency Programmes: insights from a Europe-wide survey.

The increasing complexity of surgical patients and working time constraints represent challenges for training. In this study, the European Association for Cardio-Thoracic Surgery Residents' Committee aimed to evaluate satisfaction with current training programmes across Europe. We conducted an online survey between October 2018 and April 2019, completed by a total of 219 participants from 24 countries. The average respondent was in the fourth or fifth year of training, mostly on a cardiac surgery pathway. Most trainees follow a 5-6-year programme, with a compulsory final certification exam, but no regular skills evaluation. Only a minority are expected to take the examination by the European Board of Cardiothoracic Surgery. Participants work on average 61.0 ± 13.1 h per week, including 27.1 ± 20.2 on-call. In total, only 19.7% confirmed the implementation of the European Working Time Directive, with 42.0% being unaware that European regulations existed. Having designated time for research was reported by 13.0%, despite 47.0% having a postgraduate degree. On average, respondents rated their satisfaction 7.9 out of 10, although 56.2% of participants were not satisfied with their training opportunities. We found an association between trainee satisfaction and regular skills evaluation, first operator experience and protected research time. On average, residents are satisfied with their training, despite significant disparities in the quality and structure of cardiothoracic surgery training across Europe. Areas for potential improvement include increasing structured feedback, research time integration and better working hours compliance. The development of European guidelines on training standards may support this.

Abstract 17052: Cardiothoracic Surgeons With a PhD Degree Exhibit Greater Research Productivity

Introduction: A PhD degree can offer significant research experience for academic surgeons. Here, we evaluated the impact of a PhD on research productivity and career advancement in cardiothoracic (CT) surgeons. Methods: All CT surgeons practicing at an accredited United States CT surgery training program in 2018 who earned a PhD or completed a research fellowship during training (RF) were included (n=583). To ensure a more consistent training pathway, we performed a sub-analysis of U.S. medical school graduates (n=456). Surgeon-specific data were obtained from publicly available sources (eg. institutional webpages, Scopus). Results: 92 (15.8%) surgeons obtained a PhD while 491 (84.2%) did not but did a RF (Table 1A). Importantly, attending start year was similar (2005 vs 2005, p=0.5202). As of 2018, PhD surgeons published greater first-author (17.0 vs 12.0, p=0.0079), last-author (12.0 vs 6.0, p=0.0462), and total papers (68.5 vs 52.0, p=0.0148), as well as total papers per year as an attending (4.6 vs 3.0, p=0.0148). However, PhD surgeons took a similar amount of time as non-PhD surgeons who did a RF to become a full professor from the start of their first job (12.0 vs 11.0, p=0.6620). No difference was observed in current academic rank neither (p=0.8047). For U.S. medical school graduates, there were 40 PhD surgeons and 416 non-PhD surgeons who did a RF (Table 1B). Both groups published a similar number of first-author (13.0 vs 13.0, p=0.5379), last-author (12.5 vs 6.0, p=0.0981), total papers (64.5 vs 54.0, p=0.3453), and total papers per year as an attending (3.2 vs 3.0, p=0.7546). Years to full professor were also similar between these two groups (12.0 vs 11.0, p=0.6007) as was current academic rank (p=0.3114). Conclusions: A PhD degree is not associated with faster career advancement but may be associated with enhanced research productivity for some surgeons due to the impact of their medical school training environment.

Abstract 15074: Impact of Conducting Basic Science versus Clinical Research During Training on Future Academic Productivity Among Cardiothoracic Surgeons

Introduction: There is growing concern regarding the attrition of surgeon-scientists in cardiothoracic (CT) surgery. The academic impact of conducting basic science research (BSR) during training, however, remains unknown. We hypothesized that CT surgeons who publish a first-author BSR paper during training exhibit enhanced future academic productivity. Methods: CT surgeons on faculty at accredited United States CT surgery training hospitals in 2018 who published a first-author BSR paper or a first-author clinical research (CR) paper during training were identified (n=762). To normalize for environmental differences in research exposure, we specifically studied the surgeons who pursued a research fellowship and who attended a top-50 NIH-funded institution at every stage of training (n=252). Data regarding each surgeon’s professional history and publication record were obtained from publicly-available online sources. Results: As shown in Table 1, surgeons who published a first-author paper in BSR during training and those who published a first-author paper only in CR share similar characteristics and have practiced as an attending surgeon for a similar duration (11.0 years each, p=0.486). However, surgeons who published a first-author BSR paper during training ultimately published more papers per year as an attending (4.3 vs 2.8, p=0.017), resulting in more total publications (73.5 vs 47.5, p=0.003) and a greater H-index (22.0 vs 18.0, p=0.004). The surgeons who published a first-author BSR paper during training were also more likely to have published a BSR paper in the past 2 years as an attending, both as a first or last author (12.0% vs 2.0%, p=0.004), or as a co-author (34.0% vs 15.7%, p=0.001). Conclusions: Academic CT surgeons who published a first-author BSR paper during training exhibit enhanced research productivity and scholarly impact. Funding and institutional support for aspiring CT surgeon-scientists may yield career-long academic benefits.

Early Engagement in Cardiothoracic Surgery Research Enhances Future Academic Productivity

Early engagement in cardiothoracic (CT) surgery research may help attract trainees to academic CT surgery, but whether this early exposure boosts career-long academic achievement remains unknown. A database of all CT surgery faculty at accredited, academic CT surgery training programs in the United States during the year 2018 was established. Excluding international medical graduates, surgeons who started general surgery residency in the United States before 2004 and who published at least 1 manuscript before traditional CT fellowship training were included (n= 472). Each surgeon's educational background, work history, and research publications were recorded from publicly available online sources. Before fellowship training, 370 surgeons (78.4%) coauthored a CT surgery manuscript, and 102 (21.6%) published only on subjects unrelated to CT surgery. Regardless of whether surgeons pursued dedicated research training or not, those who coauthored a CT surgery manuscript before fellowship training published more papers per year as an attending (P < .01), resulting in more total publications (P < .01) and a higher H-index (P < .01) over comparably long careers. Among CT surgeons who did not publish CT surgery research before fellowship training, those who coauthored a CT surgery manuscript during fellowship also exhibited enhanced future academic productivity. Academic CT surgeons who published CT surgery research before fellowship training ultimately exhibited more prolific and impactful research profiles compared with those who published only on subjects unrelated to CT surgery during training. Efforts to increase early engagement in CT surgery research among trainees should be fully endorsed.

New Attending Surgeons Hired by Their Training Institution Exhibit Greater Research Productivity

A first attending job often sets the tone for academic surgeons' future careers, and many graduating trainees are faced with the decision to begin their career at their training institution or another institution. We hypothesized that surgeons hired as first-time faculty at their cardiothoracic surgery fellowship institution exhibit greater research productivity and career advancement than those hired as first-time faculty at a different institution. Cardiothoracic surgeons who were listed as clinical faculty at all 77 accredited United States cardiothoracic surgery training programs in 2018 and who trained through the general surgery residency and cardiothoracic surgery fellowship pathway were included (n=904). Surgeon-specific data regarding professional history, publications, and grant funding were obtained from publicly available sources. Of the 904 surgeons, 294 (32.5%) were hired as first-time faculty at their cardiothoracic surgery fellowship institution whereas 610 (67.5%) were hired at a different institution (start year 2005 vs 2006; P= .342). Both groups exhibited similar research productivity upon starting their first job (total papers: 7.0 vs 7.0, P= .591). Followed to the present, surgeons hired at their cardiothoracic surgery fellowship institution produced more total papers (64.5 vs 39.0, P < .001) and exhibited a higher H-index (20.0 vs 14.0, P < .001). Surgeons in both groups required a similar amount of time to achieve associate (P= .208) and full professor (P= .593) ranks. Surgeons hired as first-time faculty at their cardiothoracic surgery fellowship institution may experience benefits to research productivity but not career advancement. Trainees may find it advantageous to begin their careers in a familiar environment where they have already formed a robust specialty-specific network.

Mentorship Effectiveness in Cardiothoracic Surgical Training

Mentoring is an essential component of cardiothoracic surgery training, yet trainees report varied experiences despite substantial efforts to enhance mentorship opportunities. This study aimed to evaluate mentorship effectiveness and identify gaps in mentorship education. A survey was distributed to cardiothoracic surgical trainees in Accreditation Council for Graduate Medical Education-accredited programs (n= 531). Responses to 16 questions concerning trainee experiences, expectations, and perspectives on mentorship were collected. An 11-component mentorship effectiveness tool generated a composite score (0 to 55), with a score of 44 or lower indicating less effective mentorship. Sixty-seven residents completed the survey (12.6%), with most (83.6%) reporting a current mentor. Trainees with mentors cited "easy to work with and approachable" (44 of 58; 75.9%) as the major criterion for mentor selection, whereas trainees without a mentor reported an inability to identify one who truly reflected the resident's needs (6 of 11; 45.5%). Resident age, gender, race or ethnicity, marital status, family status, postgraduate year, and training program type or size were not associated with having a mentor (P= .15 to .73). The median mentorship effectiveness score was 51 (interquartile range, 44, 55). More than one-third of residents (25 of 67) had either no mentor (n= 6) or less effective mentorship (n= 16), or both (n= 3). Resident and program characteristics were not associated with mentorship effectiveness (P= .39 to .99). Finally, 61.2% of residents had not received education on effective mentorship, and 53.8% did not currently serve as a mentor. Many resident respondents have either no mentor or less effective mentorship, and most reported not having received education on mentorship. Addressing these gaps in mentorship training and delivery should be prioritized.

Multimodal Cardiopulmonary Bypass Skills Assessment Within a High-Fidelity Simulation Environment

A high-fidelity simulator that uses a perfused porcine heart, cannulae, and tubing has been demonstrated to be a useful training adjunct. We hypothesized that multimodal assessment of cardiopulmonary bypass (CPB) skills within this high-fidelity simulated environment could discern expert from trainee performance. Three traditional fellows (postgraduate year 6-8) and 3 attending surgeons each performed 3 aortic cannulations. The third sequence included venous cannulation, commencement of CPB, and placement of a cardioplegia catheter and aortic cross-clamp. Performance across 20 cognitive and 21 technical domains was evaluated. Surgeon and assistant hand movements and economy of motion were assessed by electromagnetic motion sensors worn under sterile gloves. Analysis showed a significant difference in cognitive (6.7 ± 2.3 vs 4.6 ± 2.7, P= .03) but not technical (6.2 ± 2.5 vs 5.8 ± 2.2, P= .7) scores favoring the experts. In addition, experts showed higher efficiency by spending 64 ± 14 seconds to construct a nonpledgeted aortic purse-string suture and secure it with a Rummel, while trainees spent 82 ± 30 seconds to complete this task (P= .03). Motion analysis revealed similar path lengths between experts and trainees for cannulation and CPB but significantly shorter path lengths for experts in cross-clamp (47.5 ± 15.5 m vs 91.9 ± 20.3 m, P= .04). Multimodal assessment using cognitive, technical, and motion analysis of basic CPB tasks using a high-fidelity simulation environment is a valid system to measure performance and discriminate experts from trainees. This construct may allow for development of "competence thresholds" with important implications for training and certification in cardiothoracic surgery.

Recent Trends in Cardiothoracic Surgery Training: Data from the National Resident Matching Program

In 2008, integrated thoracic residency programs (IP) for cardiothoracic (CT) training were created in response to a decline in CT trainees. However, few studies have reported on trends in the CT training pathway since the inception of IPs. This manuscript examines the current trends related to the overall number of surgical trainees entering CT surgery training following the introduction of IPs into the National Resident Match Program (NRMP). Main and specialty match data were gathered from NRMP annual reports between 2008 and 2018. Descriptive statistics were used to analyze program size, applications, and filled and unfilled positions for IPs and traditional CT residency programs. Pearson's correlation coefficient was used to determine associations between program variables. NRMP main and specialty match in 2008 to 2018. Participants of the NRMP main and specialty match in 2008 to 2018. IPs increased from 2 programs offering 3 positions in 2008 to 28 programs offering 36 positions in 2018. However, during the same time period, the number of available traditional CT residency positions have decreased by 29% (130 to 92). As the number of IPs increased, there was a significant decrease in the number of traditional CT residency positions (ρ = -0.95, p < 0.001). Although, the overall number of CT residency programs (traditional and IP) remained largely unchanged, the proportion of filled CT residency positions increased from 67.7% in 2008 up to 97.7% in 2018. The IP training format has shown success in increasing the number of trainees entering into CT training programs. Consideration should be given to increasing the number of IP positions or increase interest in CT among general surgery residents to increase the number of CT surgery trainees with the goal of increasing the size of the future CT workforce.

The Thoracic Surgery Residents Association: Past contributions, current efforts, and future directions

ObjectiveThe Thoracic Surgery Residents Association (TSRA) is a resident-led organization established in 1997 under the guidance of the Thoracic Surgery Directors Association to represent the interests and educational needs of cardiothoracic surgery residents. We aim to describe the past contributions, current efforts, and future directions of the TSRA within a conceptual framework of the TSRA mission. MethodsPrimary review of educational resources was performed to report goals and content of past contributions. TSRA Executive Committee input was used to describe current resources and activities, as well as the future goals of the TSRA. Podcast analytics were performed to report national and global usage. ResultsSince 2011, the TSRA has published 3 review textbooks, 5 reference guides, 3 test-preparation textbooks, 1 supplementary publication, and 1 multiple-choice question bank and mobile application, all written and developed by cardiothoracic surgery trainees. In total 108 podcasts have been recorded by mentored trainees, with more than 175,000 unique listens. Most recently, the TSRA has begun facilitating trainee submissions to Young Surgeon's Notes, fostered a trainee mentorship program, developed the monthly TSRA Newsletter, and established a wide-reaching presence on Facebook, Twitter, and Instagram to help disseminate educational resources and opportunities for trainees. ConclusionsThe TSRA continues to be the leading cardiothoracic surgery resident organization in North America, providing educational resources and networking opportunities for all trainees. Future directions include development of an integrated disease-based resource and continued collaboration within and beyond our specialty to enhance the educational opportunities and career development of cardiothoracic trainees.

National Survey of Burnout and Distress Among Cardiothoracic Surgery Trainees

BackgroundBurnout has been linked to poor job satisfaction and increased medical errors, and is prevalent among health care professionals. We sought to characterize burnout and distress among US cardiothoracic surgery (CTS) trainees.MethodsA 19-question survey was sent to CTS trainees in collaboration with the Thoracic Surgery Residents Association. We queried sociodemographic variables, balance/quality of life, and indicators of depression and regret. We included questions along the emotional exhaustion, depersonalization, and personal accomplishment subscales of the Maslach Burnout Inventory.ResultsThe survey was sent to 531 CTS trainees across 76 institutions and there were 108 responses (20.3%). More than 50% of respondents expressed dissatisfaction with balance in their professional life and more than 40% screened positively for signs of depression. More than 25% of respondents (n = 28) would not complete CTS training again, given a choice. More than half met criteria for burnout on emotional exhaustion and depersonalization subscales. The CTS residents with children were more likely to express regret toward pursuing CTS training. A greater proportion of women than men reported poor levels of balance/quality of life during training as measured by missed health appointments, negative impact on relationships, and self-perception. Similarly, those in the final 3 years of training were more likely to report poor levels of balance/quality of life.ConclusionsHigh rates of burnout, regret, and depression are present among US CTS trainees. Efforts to promote trainee well-being and implement interventions that support those at high risk for burnout are warranted, to benefit trainees as well as the patients they serve.