Cardiothoracic Surgery Training Research Articles

PL05.02: Surgery

The speaker began his training in Cardiothoracic surgery in 1973 and was appointed as a Consultant in 1979. He will introduce this topic by describing a typical case undergoing surgical treatment for lung cancer in the 1970s, the patient journey and outcomes at that time. From that basis he will detail the changes in the surgical treatment of lung cancer in the last 40 years. This will include: Changes in the epidemiology of lung cancer. Improvements in pre-operative selection. Improvements in the staging process prior to surgery, during surgery and post-surgery. Differences in surgical approach and the anatomical extent of resection. Changes in the stage classification over that period. The establishment of effective adjuvant therapy. Improved outcomes in morbidity, mortality and survivorship. None of these improvements has been of itself a game changer but collectively they amount to a fundamental change in the surgical management of this disease. A brief mention will be made of advances in the surgical treatment of other thoracic malignancies. lung cancer, surgery, staging, results

A Structured, Debate-Style Cardiothoracic Surgery Journal Club for Trainee Acquisition and Application of Seminal Literature.

The acquisition of specialty-specific seminal literature and its application to daily, clinical patient-care decisions are critical components of clinical training. This structured, debate-style cardiothoracic surgery journal club module engages trainees in discussion of realistic patient scenarios, incorporating an extensive body of literature identified as the best evidence for the practice of cardiothoracic surgery. We designed the structured, debate-style cardiothoracic surgery journal club and delivered it to University of Texas MD Anderson Cancer Center cardiothoracic surgery trainees. Overall assessment of knowledge acquisition consisted of both direct judging of debates by faculty facilitators and a year-end written test of trainee knowledge. Associated materials include guidelines and resources for faculty facilitators and trainees to prepare them for the journal club debate. Also included are cardiothoracic surgery patient cases, PowerPoint presentation slides, a debate score sheet, and multiple-choice knowledge tests with answer keys. Our structured, debate-style cardiothoracic surgery journal club is an effective educational intervention for cardiothoracic surgical trainees to gain practice in applying specialty-specific, literature-based evidence to particular patient problems. This resource may be used by course directors for surgery, for independent study by individuals planning to matriculate into surgical residencies, or as a review for those already in surgical training. Moreover, this curriculum can be delivered at other clinical training programs.

In Memoriam: Robert L. Replogle, MD (1931–2016)

The cardiothoracic surgery community is saddened by the loss of Robert L. Replogle, MD, of Chicago, who died on 9 May 2016, at age 84. Dr. Replogle was an outstanding surgeon, researcher, and educator who will be remembered especially for his remarkable leadership abilities.Born in 1931, Bob Replogle grew up in Clear Lake, Iowa, and graduated from high school there. In 1949, he entered Cornell College, in Mount Vernon, Iowa. Before he could complete his studies, the Korean War broke out, and he was called to serve in the Navy (1951–1954). While working at the Naval Research Institute in Bethesda, Maryland, he developed an interest in medicine.After being discharged from the Navy, Dr. Replogle entered Harvard Medical School, where he became the last trainee of Robert E. Gross, MD, a pioneering pediatric surgeon. During Dr. Replogle's first year at Harvard, he met his future wife, Carol, whom he married a year later. After graduating from medical school, he served as an intern at the University of Minnesota, where he was introduced to heart surgery by Drs. Owen Wangensteen and C. Walton Lillehei. Later, he did a 2nd internship at the Peter Bent Brigham Hospital in Boston, and he completed residencies at Massachusetts General Hospital and Boston Children's Hospital. During this period, he created the Replogle tube, a double-lumen drainage catheter that is still used today in infants who have esophageal atresia. After completing his training in general and cardiothoracic pediatric surgery, he joined the faculty of Boston Children's Hospital.In 1967, Dr. Replogle became a pediatric surgeon and faculty member at the University of Chicago. He began as head of the congenital heart surgery program and subsequently became division chief. To expand his surgical skills and knowledge, he sought additional training in adult cardiac surgery at the Cleveland Clinic. Thereafter, he devoted his career to performing open-heart surgery in both adult and pediatric patients. During the course of his career, he directed the cardiac surgery programs at Michael Reese Hospital, Ingalls Memorial Hospital, and Columbus Hospital, in Chicago. He was also interested in medical research, particularly involving the microcirculation, and in educating the next generation of clinical investigators. Over the years, he mentored a number of younger surgeons and contributed to more than 100 scientific publications.One of Dr. Replogle's defining qualities was his remarkable leadership ability, which was evident in both his professional and his personal endeavors. His involvement with the Society of Thoracic Surgeons (STS) began with the organization's inaugural meeting, in 1964. Over the years, he used his creativity and foresight to advance the specialty of cardiac surgery and ensure the best care for heart patients. His many contributions included helping to establish the STS Education and Research Foundation (now known as the Thoracic Surgery Foundation), the STS National Database, the STS-PAC, and CTSnet. He also promoted the global standardization of training and certification programs for cardiothoracic surgery. In 1996–1997, he served as president of the STS.On a more personal level, Dr. Replogle used his leadership skills to resolve an issue close to his heart. His brother, Ralph, had cerebral palsy and needed specialized care, which was difficult to obtain in rural Iowa. Robert sought to improve the support system for families facing similar circumstances. In the early 1960s, he worked with members of his hometown community to found an organization to provide housing and assistance for adults with disabilities. Now known as Opportunity Village, this organization provides services to more than 600 people from over 30 communities.I first met “Rep” when we were both young. He had a genius for enjoying life through close friendships, witty conversation, and a range of interests that included computers, photography, travel, scuba diving, fast cars, and fine wines. At the risk of seeming irreverent, I hope that his heavenly estate includes at least as fine an offering of superb wines as the ones he collected while on earth.Most of all, Robert was devoted to his family. Survivors include his wife, Carol, as well as his children—Robert Jr., Jennifer, and Edith—and 9 grandchildren. My deepest sympathy is extended to his family, colleagues, and friends.

Invited Commentary

The article by Ikonomidis and colleagues [1Ikonomidis J.S. Ad N. Aldea G.S. et al.Vascular operations performed by cardiothoracic surgeons: The Society of Thoracic Surgeons survey.Ann Thorac Surg. 2016; 102: 589-592Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar] is a contemporary snapshot of thoracic surgeons performing peripheral vascular surgery and their perceived need for vascular surgery to be part of the formal cardiothoracic surgery training. This is an important and timely survey as our specialty continues to adapt and evolve to the growing number of minimally invasive approaches, catheter-based therapies, and endovascular procedures for cardiovascular diseases. In addition, the roots of cardiothoracic and vascular surgery have largely been intertwined. Historically, because of pioneering cardiovascular surgeons such as Drs DeBakey, Cooley, Crawford, and Spencer, who were major contributors to peripheral vascular surgery, vascular operations were commonly taught in thoracic training programs well into the late 1980s. Importantly, the American Board of Thoracic Surgery decided in the late 1970s not to examine candidates in vascular surgery primarily because of the growth of coronary bypass procedures. In 1982, a Certificate for Special Competence in Vascular Surgery was administered by the American Board of Surgery (ABS) to thoracic surgeons performing vascular surgery. In 1986, the vascular certificate was replaced with an ABS written and oral exam. Thoracic surgeons with at least150 peripheral cases per year were able to sit for the exam. By 1998, board certification was limited to residents formally finishing vascular surgery training programs. Thereafter, thoracic surgeons performing vascular surgery declined. Although this survey is limited by the number of respondents, 395 of 5,271 members responding (7.5%), and may have a bias toward those who practice vascular surgery, it does provide the best assessment of our member’s current involvement in vascular surgery. The survey found that 44% of thoracic surgeons are taking routine vascular call and performing a wide breadth of vascular procedures, both open and endovascular, including thoracoabdominal aneurysms, abdominal aneurysms, aortoiliac disease, peripheral vascular disease, dialysis access, and vascular trauma. Interestingly, only 11% of respondents are board certified in vascular surgery, but 43% would like to have vascular surgery boards. In addition, 81% of respondents would like to see vascular surgery as a part of the formal cardiothoracic curriculum and 90% believe that a cardiovascular track should be offered as a part of the cardiothoracic surgery education. To answer this growing need for vascular training within our specialty, the Allegheny General program has an integrated curriculum with our 0-5 vascular residency and with our thoracic surgery residency program, providing 6 months of cardiac surgery in the fourth year. Residents are also encouraged to finish the 2-year thoracic surgery residency 0-5-2. With dual certification in both vascular surgery and cardiothoracic surgery, residents have both a strong open and endovascular skill set. Thought leaders in both fields should study the Allegheny model. [2Magovern G. Simpson K. Curriculum innovation: the key to recruiting the best and brightest.J Thorac Cardiovasc Surg. 2011; 141: 1114-1115Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] Because the 2 fields are highly differentiated, it is unrealistic to consider a fully integrated 7-year curriculum. Efforts to integrate both fields make sense to primary care physicians, the general public, and to hospital-based cardiovascular institutes, all of whom are looking for multidisciplinary teams to augment quality, safety, and value. Vascular Operations Performed by Cardiothoracic Surgeons: The Society of Thoracic Surgeons SurveyThe Annals of Thoracic SurgeryVol. 102Issue 2PreviewMany cardiothoracic surgeons supplement their case volume through the performance of vascular surgical procedures. Information regarding this practice is not well defined. Full-Text PDF

Gender and Cardiothoracic Surgery Training: Specialty Interests, Satisfaction, and Career Pathways

The cardiothoracic surgical workforce is changing. Although 5% of practicing surgeons are women, 20% of current cardiothoracic surgery residents are women. The purpose of this study was to evaluate the influence of gender on specialty interest, satisfaction, and career pathways of current residents. Responses to the mandatory 2015 Thoracic Surgery Residents Association/Thoracic Surgery Directors Association in-training examination survey taken by 354 residents (100% response rate) were evaluated. The influence of gender was assessed with the use of standard univariate analyses. Women accounted for 20% of residents, and the percentage did not vary with postgraduate year or program type (traditional versus integrated). Although no differences were found between the genders related to specialty interest, academic versus private practice career, or pursuit of additional training, women were more likely to pursue additional training in minimally invasive thoracic surgery (10% versus 2.5%, p= 0.001) and less likely to perform research in their careers (65% versus 88%, p=0.043). Although women were equally satisfied with their career choice, had similar numbers of interviews and job offers, and felt equally prepared for their boards,graduating women felt less prepared technically (77% versus 90%, p= 0.01) and for practicing independently (71% versus 87%, p= 0.01). Women were less likely to be married (26% versus 62%, p < 0.001) and have children (19% versus 49%, p < 0.001). Although career satisfaction and specialty interest were similar between the genders, women were less likely to intend to perform research during their careers despite similar previous research experience. Women also demonstrated lower rates of marriage and childbearing compared with their male counterparts.

Cardiothoracic surgery training in Israel: A critical look at the past, aiming for a better future

Training the next generation of cardiothoracic surgeons is a global persistent challenge. Major issues, including length of training, decreasing volume of cases, shift toward high-risk, complex, and less-invasive procedures, increased specialization, and uncertainty with regard to future employment, are relevant and affect residency training programs in the United States, Europe, and other parts of the world. To produce high-quality, mature, and qualified surgeons, these challenges mandate an ongoing effort by our specialty leadership aimed at identifying creative solutions and adapting the current residency training curricula and methodology to the dynamic changes in our field. The current situation in Israel is discussed with the hope that sharing our experience might be useful and lead to adoption of some of our solutions by other countries.

Predictors of Career Choice Among Cardiothoracic Surgery Trainees

The impact of factors influencing career choice by cardiothoracic surgery (CTS) trainees remains poorly defined in the modern era. We sought to examine the associations between CTS trainee characteristics and future career aspirations. The 2012 Thoracic Surgery In-Training Examination survey results were used to categorize responders according to career interest: congenital, adult cardiac, mixed cardiac/thoracic, and general thoracic surgery. Univariate and multivariable analyses were used to identify and analyze characteristics associated with career interest categories. With a 100% response rate, 300 responses from trainees in programs accredited by the Accreditation Council for Graduate Medical Education were included in the analysis. Multinomial logistic regression identified three factors associated with career choice in CTS: level of training (p < 0.001), type of training pathway (p < 0.001), and primary motivating factor to pursue CTS (p = 0.002). Trainees interested in general thoracic surgery were more likely to commit to CTS during their senior years of general surgery training and were more likely to enroll in 2-year or 3-year traditional fellowships, whereas individuals pursuing adult or congenital cardiac surgery were more likely to commit earlier during training and were more commonly interested in 6-year integrated or joint training pathways. Moreover, trainees interested in general thoracic surgery were predominantly influenced by early mentorship (p = 0.025 vs adult cardiac), and trainees interested in adult cardiac surgery were more likely to be influenced by types of operations (p = 0.047 vs general thoracic). Career choice in CTS appears strongly associated with level of training, exposure to mentors, and training paradigm. These results demonstrate the importance of maintaining all four currently approved training pathways to retain balance and diversity in future CTS practices.

“Top Gun” Competition: Motivation and Practice Narrows the Technical Skill Gap Among New Cardiothoracic Surgery Residents

Adoption of simulation skills training in cardiothoracic (CT) surgery remains a challenge. This study sought to determine whether a "Top Gun" competition would encourage simulator use and improve technical skills among first-year CT residents. A coronary anastomosis simulation module with instructional video was sent to 96 first-year CT residents in traditional programs who were then invited to participate in a Top Gun competition. Residents uploaded a video recording of their baseline anastomosis using the simulator. After 6 weeks of practice under faculty supervision, each trainee uploaded a final video. All submissions were rated in blinded fashion by three CT surgeons. Twelve components were scored on a 5-point Likert scale (1= poor; 5= excellent); also, an overall pass-fail grade was given. Five trainees with the highest final scores were invited to compete at a live Top Gun competition. Seventeen trainees submitted a baseline anastomosis video for evaluation; 15 submitted a final video. Overall average scores improved from 3.24 ± 0.61 to 4.01 ± 0.33 (p < 0.001). Performance of the bottom 50% increased (1.11 ± 0.57) relative to the top 50% (0.43 ± 0.31), resulting in no detectable score difference after training (p= 0.14). Overall average time (minutes:seconds) decreased from 11:10 (range, 5:56 to 18:58) to 9:04 (range, 5:52 to 16:23; p < 0.01). Residents achieving a pass from all three raters increased from 13% (2 of 15) to 73% (11 of 15; p < 0.002). Thirteen of 15 residents completed a survey. Residents performed an average of 23 anastomoses (range, 10 to 40). The majority (10 of 13) agreed or strongly agreed that practicing on simulators will improve a trainee's technical skill acquisition. Focused training results in improved technical skills in vessel anastomosis, especially for residents with lower baseline skills. Simulation, as with anyeducational endeavor, requires the motivation of thetrainee, commitment of the faculty educator, and a defined training curriculum.

Practice improves performance on a coronary anastomosis simulator, attending surgeon supervision does not

Enthusiasm for simulation early in cardiothoracic surgery training is growing, yet evidence demonstrating its utility is limited. We examined the effect of supervised and unsupervised training on coronary anastomosis performance in a randomized trial among medical students. Forty-five medical students were recruited for this single-blinded, randomized controlled trial using a low-fidelity simulator. After viewing an instructional video, all participants attempted an anastomosis. Subsequently, the participants were randomized to 1 of 3 groups: control (n=15), unsupervised training (n=15), or supervised training with a cardiothoracic surgeon or fellow (n=15). Both the supervised and unsupervised groups practiced for 1 hour per week. After 4 weeks, the participants repeated the anastomosis. All pre- and posttraining performances were videotaped and rated independently by 3 cardiothoracic surgeons blinded to the randomization. All raters scored 13 assessment items on a 1 to 5 (low-high) scale along with an overall pass/fail rating. After the training period, all 3 groups showed significant improvements in composite scores (control: +0.52 ± 0.69 [P=.014], unsupervised: +1.05 ± 0.48 [P<.001], and supervised: +1.10 ± 0.84 [P<.001]). Compared with control group, both supervised (P=.005) and unsupervised trainees (P=.005) demonstrated a significant improvement. Between the supervised and unsupervised groups there were no statistically significant differences in composite scores. Practice on low-fidelity simulators enabled trainees to improve on a broad range of skills; however, the additional effect of attending-level supervision is limited. In an era of increasing staff surgeon responsibilities, unsupervised practice may be sufficient for inexperienced trainees.

An Extracorporeal Membrane Oxygenation Cannulation Curriculum Featuring a Novel Integrated Skills Trainer Leads to Improved Performance Among Pediatric Cardiac Surgery Trainees

American Heart Association guidelines recommend timely extracorporeal membrane oxygenation (ECMO) cannulation during cardiopulmonary resuscitation for pediatric cardiac arrest refractory to conventional resuscitation. Traditional cannulation training relies on the apprenticeship model. We hypothesized that a simulation-based ECMO cannulation curriculum featuring a novel integrated skills trainer would improve ECMO cannulation during cardiopulmonary resuscitation performance by cardiothoracic surgery trainees. An embedded surgical neck cannulation trainer, designed in collaboration with expert surgeons, formed the focus for a simulation-based cannulation curriculum. The course included a didactic presentation and 2 neck cannulations during cardiopulmonary resuscitation with video-assisted expert feedback with a further cannulation at 3 months. Primary outcome was time to cannulation on the trainer. Secondary outcomes were performance on a validated Global Rating Scale (GRS) of surgical technique and a novel Composite ECMO Cannulation Score (CECS). Ten cardiothoracic surgery trainees participated. The trainer was rated as authentic, and sessions was rated as highly useful. Median time to cannulation decreased between cannulation 1 and 2 (15 minutes 24 seconds vs. 12 minutes 15 seconds, P = 0.002). Improvement was sustained at 3 months (13 minutes 36 seconds, P = 0.157 vs. attempt 2). Likewise, GRS increased significantly at attempt 2 versus 1 (77% vs. 62%, P = 0.003) as did CECS (88% vs. 52%, P = 0.002). No deterioration in GRS or CECS was measured at 3 months. Cardiothoracic surgery trainees found a contextualized ECMO cannulation during cardiopulmonary resuscitation cannulation curriculum to be highly useful and demonstrated sustained improvement in time to cannulation, CECS, and GRS. Further work will focus on determining the clinical impact of this training and defining the optimal interval and number of training sessions.

The Joint Council on Thoracic Surgery Education Coronary Artery Assessment Tool Has High Interrater Reliability

Barriers to incorporation of simulation in cardiothoracic surgery training include lack of standardized, validated objective assessment tools. Our aim was to measure interrater reliability and internal consistency reliability of a coronary anastomosis assessment tool created by the Joint Council on Thoracic Surgery Education. Ten attending surgeons from different cardiothoracic residency programs evaluated nine video recordings of 5 individuals (1 medical student, 1 resident, 1 fellow, 2 attendings) performing coronary anastomoses on two simulation models, including synthetic graft task station (low fidelity) and porcine explant (high fidelity), as well as in the operative setting. All raters, blinded to operator identity, scored 13 assessment items on a 1 to 5 (low to high) scale. Each performance also received an overall pass/fail determination. Interrater reliability and internal consistency were assessed as intraclass correlation coefficients and Cronbach's α, respectively. Both interrater reliability and internal consistency were high for all three models (intraclass correlation coefficients = 0.98, 0.99, and 0.94, and Cronbach's α = 0.99, 0.98, and 0.97 for low fidelity, high fidelity, and operative setting, respectively). Interrater reliability for overall pass/fail determination using κ were 0.54, 0.86, 0.15 for low fidelity, high fidelity, and operative setting, respectively. Even without instruction on the assessment tool, experienced surgeons achieved high interrater reliability. Future resident training and evaluation may benefit from utilization of this tool for formative feedback in the simulated and operative environments. However, summative assessment in the operative setting will require further standardization and anchoring.

The Effects of Increased Provision of Thoracic Surgical Specialists on the Variation in Lung Cancer Resection Rate in England

There is a wide variation in the lung cancer resection rate in England. We assessed the effect of the regional provision of thoracic surgery service on the variation in lung cancer resection rate. A retrospective observational study correlating National Lung Cancer Audit data with thoracic surgery workforce data was performed to review the lung cancer resection rate in England in 2008 and 2009. In 2008, there was a sixfold variation in resection rate, with a higher resection rate in hospitals where surgeons were based (base hospitals) than in peripheral hospitals (20.0% versus 11.6%, p < 0.001). The resection rate was also higher in cancer networks, which were served by two or more specialist thoracic surgeons (14.6% versus 12.7%, p = 0.028), and where surgeons were present in more than two-thirds of the lung cancer multidisciplinary team meetings (14.4% versus 12.0%, p = 0.046). In 2009, the overall resection rate increased from 14.5% to 18.4%. Four units increased their number of specialist thoracic surgeons and had a significantly higher increase in resection rate than units without expansion (relative rise 66.3% versus 19.2%; p = 0.022). The large variation in the resection rate seems, in part, to be related to the local availability of specialist thoracic surgeons. The greatest improvement in the resection rate was in units with expansion of specialist thoracic surgeons. We suggest the expansion of specialist thoracic surgeons will improve the resection rate and thereby the overall survival of lung cancer in England. This has significant implications for the future of training in cardiothoracic surgery and organization of cancer services.

Emerging alternative model for cardiothoracic surgery training in India

BackgroundIn India, cardiothoracic (CT) surgery training follows a 3+3-year model, where 3 years of general surgery residency with certification (MS/DNB) is required for entering 3 years of thoracic surgery residency (MCh/DNB). There are two certifying boards at the national level. One being the Medical Council of India (MCI), which oversees the major accreditation process involving the undergraduate and postgraduate medical education in India, and the other being the National Board of Examinations (NBE), which was formed for the purpose of establishing a uniform standard of postgraduate medical education. Recently, the latter body has come up with an alternative model for thoracic surgery residency in India. This model includes an integrated 6-year residency, with lesser emphasis on general surgical skills and greater exposure to CT surgery.ConclusionsChanges to the current model of training for CT surgery is the need of the hour and should be initiated very soon by the MCI to meet the future demand for CT surgeons in India. An integrated training program is essential to create a new generation of cardiovascular specialists. Future directions to achieve this goal must include modifications to the undergraduate programs so as to infuse interest for CT surgery in the young minds of medical students.

An Analysis of Preclinical Students' Perceptions of Cardiothoracic Surgical Procedures

Interest in cardiothoracic surgery training has decreased, and there is a predicted shortage of 1,500 cardiothoracic surgeons by 2020. This study aims to analyze the attitudes toward cardiothoracic surgery of premedical and medical students in the preclinical years. An anonymous electronic survey assessing interest in the cardiothoracic surgery field was sent to preclinical medical students and interviewees at the University of Michigan Medical School in 2010. Respondents were analyzed as a single population (N=566) and then compared in premedical (n=460) and medical student (n=106) groups. Responses were compared using independent-sample t tests. Forty-six percent of respondents were women. Surgical specialty was ranked the top field of interest. Ninety-four percent reported intellectual interest, and 70% listed lifestyle as important factors when considering a specialty. Ninety-two percent of respondents were unaware of the new integrated training programs. Just 4% had had previous mentorship from a cardiothoracic surgeon. In group comparison, salary and lifestyle were of greater concern to the medical group than the premedical group (salary, 47% vs 33%; p<0.01; lifestyle, 78% vs 68%; p<0.05, respectively). Given the ability to achieve one's personal goals, the premedical group was more interested in cardiothoracic surgery than was the medical group (88% vs 76%; p<0.05). Cardiothoracic surgeons may be better served by aiming their recruiting and mentoring efforts toward premedical students, who are more open to longer training, less concerned about lifestyle and salary, and are generally more interested in pursuing thoracic surgery than are medical students.

Factors Affecting Selection of Operative Approach and Subsequent Short-Term Outcomes after Anatomic Resection for Lung Cancer

Previous studies evaluating video-assisted thoracoscopic surgery (VATS) for lung cancer are single-institution series, suffer from small sample size, or use administrative or self-reported databases. Using a multi-institutional, standardized, and audited surgical outcomes database, our objectives were to examine preoperative factors associated with undergoing VATS vs open resection and assess subsequent perioperative outcomes. The American College of Surgeons National Surgical Quality Improvement Program Participant Use File was used to identify patients who underwent anatomic resection (eg, segmentectomy, lobectomy, and bi-lobectomy) for primary lung cancer (2005 to 2010). Multiple logistic regression models, including propensity scores, were developed to assess preoperative factors associated with undergoing VATS and the risk-adjusted association between operative approach and 30-day outcomes. Of 2,353 patients undergoing resection, 74% underwent open thoracotomy (OT) and 26% underwent VATS. After regression for confounders, factors associated with undergoing a VATS were patient age older than 75 years (odds ratio [OR] = 1.41; 95% CI, 1.05-1.90), Hispanic ethnicity (OR = 2.52; 95% CI, 1.69-3.77), and cardiothoracic surgery training (OR = 1.68; 95% CI, 1.37-2.07). Patients undergoing OT had a higher likelihood of any adverse event developing (24% vs 14%; OR = 1.76; 95% CI, 1.35-2.29), specifically pneumonia and sepsis/septic shock. Median length of stay was significantly longer in the OT group (7 vs 4 days; p < 0.001). Mortality was not significantly different for VATS vs OT after regression for confounders. In addition to patient factors, surgeon training can play a role in determining the operative approach offered to patients. Patients selected for VATS had a lower 30-day morbidity and shorter length of stay compared with OT anatomic resection for primary lung cancer.

A European training system in cardiothoracic surgery: is it time?

Training in cardiothoracic surgery across Europe remains diverse and variable despite the ever closer integration of European countries at all levels and in all areas of life. Coupled with the increasing ease of movement across Europe, the need for uniform training programmes has arisen to allow for equivalent accreditation and certification. We review the current training paradigms within the specialty across the world and in Europe and also explore the concept of competence. There are diverse training systems across the world and in Europe in particular. Competence-based training is the new model of training; however, competence remains difficult to define and measure. We propose a European Training Programme in Cardiothoracic Surgery that aims to standardize training across the European countries. The difficulties in unifying training across Europe are numerous, but it is time to implement a European Training System in Cardiothoracic Surgery that will deliver a competence-based curriculum.

Evaluation of simulation training in cardiothoracic surgery: The Senior Tour perspective

Evaluation of simulation training in cardiothoracic surgery: The Senior Tour perspective

Evaluation of simulation training in cardiothoracic surgery: The Senior Tour perspective

The study objective was to introduce senior surgeons, referred to as members of the "Senior Tour," to simulation-based learning and evaluate ongoing simulation efforts in cardiothoracic surgery. Thirteen senior cardiothoracic surgeons participated in a 2½-day Senior Tour Meeting. Of 12 simulators, each participant focused on 6 cardiac (small vessel anastomosis, aortic cannulation, cardiopulmonary bypass, aortic valve replacement, mitral valve repair, and aortic root replacement) or 6 thoracic surgical simulators (hilar dissection, esophageal anastomosis, rigid bronchoscopy, video-assisted thoracoscopic surgery lobectomy, tracheal resection, and sleeve resection). The participants provided critical feedback regarding the realism and utility of the simulators, which served as the basis for a composite assessment of the simulators. All participants acknowledged that simulation may not provide a wholly immersive experience. For small vessel anastomosis, the portable chest model is less realistic compared with the porcine model, but is valuable in teaching anastomosis mechanics. The aortic cannulation model allows multiple cannulations and can serve as a thoracic aortic surgery model. The cardiopulmonary bypass simulator provides crisis management experience. The porcine aortic valve replacement, mitral valve annuloplasty, and aortic root models are realistic and permit standardized training. The hilar dissection model is subject to variability of porcine anatomy and fragility of the vascular structures. The realistic esophageal anastomosis simulator presents various approaches to esophageal anastomosis. The exercise associated with the rigid bronchoscopy model is brief, and adding additional procedures should be considered. The tracheal resection, sleeve resection, and video-assisted thoracoscopic surgery lobectomy models are highly realistic and simulate advanced maneuvers. By providing the necessary tools, such as task trainers and assessment instruments, the Senior Tour may be one means to enhance simulation-based learning in cardiothoracic surgery. The Senior Tour members can provide regular programmatic evaluation and critical analyses to ensure that proposed simulators are of educational value.

Procedural Simulation

The provision of high-quality cardiothoracic surgical training faces many challenges. This has generated an increased interest in simulation-based learning, which can provide a less stressful environment for deliberate practice. We developed a comprehensive, structured program of knowledge and simulation-based learning aligned to the official cardiothoracic surgery curriculum.A portfolio of 10 curriculum-aligned training courses was designed for cardiothoracic surgical trainees during their 6-year training program. The courses were delivered through a multitude of education methods, including live porcine operating simulation models, and were evaluated through a series of quantitative (5-point Likert-scale) and qualitative assessments. The trainees (n = 15-21 per course) also completed pre- and postsession self-confidence and competency levels for each training episode of knowledge and skill, respectively. In addition, board examination pass rates were assessed in the 3-year periods before and after implementation of the courses.Quantitative analysis of the trainees' feedback demonstrated an extremely positive view of the portfolio of the simulation-based training courses with excellent satisfaction scores (out of 5) for teaching sessions (4.44 ± 0.07), faculty (4.64 ± 0.07), content and materials (4.63 ± 0.07), and facilities (4.73 ± 0.05). The courses have shown a significant improvement in the post–self-confidence (7.98 ± 0.13 vs 5.62 ± 0.20, P < .01) and perceived self-competency (8.10 ± 0.10 vs 5.67 ± 0.11, P < .01) scores for all courses. Examination pass rates significantly improved in the 3-year period after attendance at the courses (94.82% ± 2.34% vs 76.26% ± 3.23%, P < .005).This study has described the implementation of the only extensive program of structured simulation-based courses that has been developed to complement clinical training in cardiothoracic surgery.

Comparison of cardiothoracic surgery training in usa and germany

BackgroundTraining of cardiothoracic surgeons in Europe and the United States has expanded to incorporate new operative techniques and requirements. The purpose of this study was to compare the current structure of training programs in the United States and Germany.MethodsWe thoroughly reviewed the existing literature with particular focus on the curriculum, salary, board certification and quality of life for cardiothoracic trainees.ResultsThe United States of America and the Federal Republic of Germany each have different cardiothoracic surgery training programs with specific strengths and weaknesses which are compared and presented in this publication.ConclusionsThe future of cardiothoracic surgery training will become affected by technological, demographic, economic and supply factors. Given current trends in training programs, creating an efficient training system would allow trainees to compete and grow in this constantly changing environment.