Cardiothoracic Surgical Training Research Articles

Role of surgical simulation on self-reported confidence level on cardiothoracic surgical trainees.

Simulated self-practice using simulation models could improve fine motor skills and self confidence in surgical trainees. The purpose of this study is to evaluate on self-reported confidence level in cardiothoracic surgical trainees by using surgical simulation models. We conducted a cross-sectional study on all surgeons (n=10) involved in MIS simulation training. All surgeons are required to perform on three minimally invasive surgery (MIS) procedures (Mitral Valve Repair, Mitral Valve Replacement and Aortic Valve Replacement). A questionnaire was designed based on two existing scales related to self-confidence, the surgical self-efficacy scale [SSES] and the perceived competency scale [PCS]. We assessed their self-confidence (before and after training) in the use of simulation in MIS procedures using rating scales 1-5. The mean score was calculated for each domain and used as the predictor variable. We also developed six questions (PCS) using Objective Structured Assessment of Technical Skills (OSAT) related to each domain and asked participants how confident they were after performing each MICS procedure. The mean score was 4.7 for all assessed domains, except "knowledge" (3.8). Surgeons who had performed one or more MIS procedures had higher scores (P<0.05). There was no correlation between the number of MIS procedures performed and self-confidence scores. The results indicate that the cardiac surgery training based on MIS simulation improves trainees and consultants in terms of the level of self-confidence. Although surgeons generally have high levels of self-confidence after simulation training in MIS cardiac procedures, there is still room for improvement with respect to technical skills related to the procedure itself and its results.

Perception of congenital cardiac surgery as a career choice among cardiothoracic surgery trainees in the United Kingdom.

Our goal was to evaluate interest among trainees in pursuing congenital cardiac surgery (CCS) as a sub-specialty career and probe for reasons in decline in interest. An anonymized, voluntary survey of cardiothoracic surgical trainees across the United Kingdom and Ireland was conducted from October 2020 to December 2020. The questionnaire included demographics, congenital experience and career intentions. A total of 43 respondents from all training regions responded with a response rate of 36%. A total of 28% reported having no access to a congenital cardiac unit in their training region, reflecting that 4 out of the 14 regions do not have a congenital unit. Although only 18% of trainees have undertaken a placement, a large proportion (74%) have considered a career in CCS, predominantly (50%) before entering training or in the first half of the training programme (38%). Reasons for not pursuing included discouragement by colleagues (42%) and concerns regarding the training pathway, citing, among other reasons, length of training, limited exposure to operations and uncertainty about career progression. Respondents suggested improvements to the training programme, including increasing exposure and early mentoring and steps to dispel unduly negative perceptions about the specialty. A large proportion of cardiothoracic trainees have a negative perception of CCS in terms of career and training. Interest wanes substantially after entry into the United Kingdom cardiothoracic training programme for several reasons. As well as short-term measures to improve exposure to CCS and structure of training, there has to be long-term planning to improve perception about this sub-specialty at all levels.

CONNECTing nurses and allied professionals through specialised cardiothoracic surgical training

As part of the CONNECT series, Suzanne Fredericks and colleagues discuss the need for specialised cardiothoracic surgical training for nurses and allied health professionals, as well as the implications of this both across the UK and internationally.

Novel, intermediate-fidelity simulator for aortic arch surgery for the cardiothoracic surgical trainee.

Training cardiothoracic surgeons in open aortic surgery is challenging due to limited operator experience, low patient volume and technically demanding skills to be performed within a deep thoracic cavity. Surgical simulation has become a cornerstone of cardiothoracic surgical training and has been shown to improve skill acquisition and performance in the operating theatre. Due to the complexity of aortic surgery, there is a paucity of simulators that are concomitantly accessible and of sufficient fidelity. The purpose of this study was to develop a reproducible, intermediate-fidelity simulator for aortic surgery. This novel simulator was constructed from plastic storage containers to simulate the depth of a thoracic cavity. Head vessels and distal arch were reconstructed within the stimulator with synthetic Dacron polyester grafts to maximize model fidelity. A porcine or bovine heart was used for the simulation of aortic root replacement and anastomosis to the distal arch graft. The simulator was reproduced in a wet-lab skills session at an annual Australian cardiothoracic trainee meeting. Qualitative feedback was obtained from the current cardiothoracic trainees. It is a feasible model for the practice of aortic surgery. As the surgical education paradigm shifts towards simulation, this easily reproducible, intermediate-fidelity model provides an effective avenue to equip the trainee for the operating room and is a method of surgical training that can be considered by colleges.

Global cardiothoracic surgery: A survey of trainees’ interests and barriers

BackgroundMore than 5 billion people lack access to surgical care, disproportionately in low- and middle-income countries. The emerging literature demonstrates high interest in global surgery across specialties; however, participation in global cardiothoracic surgical care remains low. To date, there has been no research quantifying the attitudes of cardiothoracic surgeons about global surgery. Our study aimed to acquire a broader understanding of cardiothoracic surgical trainees’ interest in global surgery to address barriers and promote cardiac healthcare worldwide. MethodsAn online survey was sent to all North American cardiothoracic surgical residents via the Thoracic Surgery Residents Association email listserv. The survey was designed in the REDCap database and administered twice, in 2021 and 2022. Data were analyzed by descriptive and chi-square analysis using Stata. ResultsSeventy-three cardiothoracic surgical trainees responded to our survey, of whom 95.3% considered increasing cardiothoracic surgical access to be important, and 67.2% identified this as a future career priority. Most respondents (82.8%) would participate in global surgery if opportunities were available through their home institution. Lack of opportunities (70.0%) and finances (66.7%) were the primary barriers to participation. Respondents identified funding (85%) and institutional support (83.3%) as the most significant incentives to increase involvement. ConclusionsThere is strong interest in global surgery among cardiothoracic trainees; however, involvement remains low. A consensus among the North American cardiothoracic surgical community is needed to address barriers to global volunteerism within surgical residency and improve access to cardiac surgery worldwide.

Gender Bias in Letters of Recommendation for Cardiothoracic Surgery Applicants

BackgroundBias in letters of recommendation may have an impact on assessment of the cardiothoracic surgical applicant. Letters written for fellowship candidates might differ on the basis of the applicant's gender, although prior investigations have not explored this population. We aimed to evaluate gender differences in letters of recommendation written for cardiothoracic surgery applicants. MethodsLetters of recommendation written for applicants between 2015 and 2020 to a large, 2-year academic cardiothoracic surgical training program were reviewed. Data regarding applicants and letter writers were captured. A library of terms to describe applicants was created. Natural language processing was employed to detect differences in use of these terms in letters written for men vs letters written for women. Letter content was compared across applicant and writer characteristics by Kruskal-Wallis and t-tests. ResultsThere were 1707 letters of recommendation for 553 applicants analyzed: 430 letters for 147 (26.6%) women and 1277 letters for 406 (73.4%) men. Mean letter length was 498.4 (SD 209.3) words. Letters for men were longer (518.2 vs 491.7 words; P = .022). Men were more often described with terms of humility (P < .01), professionalism (P < .01), and integrity/honesty (P < .01), whereas women were more frequently described by terms of family (P < .01) and leadership (P < .01). Men writers described men applicants more often with gendered language (P < .01) and terms of humility (P < .01), personality (P < .01), and integrity/honesty (P < .01). ConclusionsWe identified gender-based differences in letters of recommendation for cardiothoracic surgery applicants as well as differences based on the writer's gender. These findings are critical to consider in the assessment of applicants as efforts are needed to minimize bias and to support a diverse future of our specialty’s workforce.

Developing Cardiothoracic Surgical Critical Care Intensivists: A Case for Distinct Training.

Cardiothoracic surgical critical care medicine is practiced by a diverse group of physicians including surgeons, anesthesiologists, pulmonologists, and cardiologists. With a wide array of specialties involved, the training of cardiothoracic surgical intensivists lacks standardization, creating significant variation in practice. Additionally, it results in siloed physicians who are less likely to collaborate and advocate for the cardiothoracic surgical critical care subspeciality. Moreover, the current model creates credentialing dilemmas, as experienced by some cardiothoracic surgeons. Through the lens of critical care anesthesiologists, this article addresses the shortcomings of the contemporary cardiothoracic surgical intensivist training standards. First, we describe the present state of practice, summarize past initiatives concerning specific training, outline why standardized education is needed, provide goals of such training standardization, and offer a list of desirable competencies that a trainee should develop to become a successful cardiothoracic surgical intensivist.

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.

1006 Supersized-Simulation vs Traditional Cardiothoracic Surgery Education: A Prospective, Randomised Controlled Trial

Abstract Aim Exposure to cardiothoracic surgery is limited during medical school in the United Kingdom. This study evaluated the effectiveness of a supersized simulation model (SSM) compared to traditional methods (TM) in developing coronary anastomosis surgical skills. Method This was a prospective, randomised controlled trial with a 1:1 allocation ratio. Undergraduate medical students with no prior cardiothoracic surgical skills training were eligible for inclusion. Both groups received a guided didactic lecture followed by modified Objective Structured Assessment of Technical Skills (OSATS) assessment for baseline. The control group then received traditional teaching and the intervention group received additional teaching with SSM before being reassessed. Modified OSATS score were the primary outcome, adjudicated by two senior cardiothoracic registrars. Performance time (PT), self-assessment (SA), confidence (CON) and global rating scale (GRS) were secondary outcomes. Results 48 novice medical students were randomised. OSATS scores were significantly higher in SSM group compared to TM group (13.2 vs 9.8, p&amp;lt;0.01). The secondary outcomes PT (17.7 minutes vs 22.2 minutes, p&amp;lt;0.01) and CON (3.04 vs 1.73, p&amp;lt;0.01) were also significantly different between groups, favouring SSM. SSM participants were more likely to want to pursue a career in cardiothoracic surgery (12 participants vs 2 participants). All participants agreed that SSM improved visualisation and comprehension of surgical procedure. SSM cost £0.75 per model. Conclusions Supersized simulation is effective for coronary anastomosis surgical training with technical skills successfully transferred to a clinical task. Supersized models can accelerate the novice trainee's surgical skill progression and represents a valuable resource in one's educational armamentarium.

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.

1306 Recommendations for the Use of Simulators in Cardiothoracic Surgical Training

Abstract Aim To systematically review the simulators that are currently available for cardiothoracic surgical procedures and the validation evidence supporting them. Additionally, to recommend several simulators for training based on analysis of results. Method A systematic literature search of the MEDLINE® (1946 to December 2019) and EMBASE® (1947 to December 2019) databases was performed to identify simulators for basic skills and procedures in cardiothoracic surgery. A selection of keywords and MeSH terms were used to execute the literature search. After identification of relevant articles, data were extracted and analysed. Results Ninety simulators were found in eighty-one articles. Simulators for basic skills (n=24) and coronary artery bypass graft (n=22) were the most commonly described, followed by miscellaneous (n=14), valve surgery (n=13), thoracic lobectomy (n=10), and mechanical circulatory support (n=7). The majority of models were either benchtop (n=42) or hybrid (n=33) modalities. Evidence of validity was demonstrated in 38 (42.2%) simulators. Five (5.6%) simulators had three or more elements of validity established and only one (1.1%) accomplished full validation. Conclusions Five simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills development and high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilised in early training, at which point the learning curve of trainees is steepest.

Commentary: Cardiothoracic surgery training made SIMPL.

Effective cardiothoracic surgical training requires an emphasis on education through timely feedback and constructive criticism. Review of the implementation of the System for Improving and Measuring Procedural Learning application within a cardiothoracic surgical training program. Here, we review a report by Bergquist et al. to the Journal of Cardiac Surgery detailing their implementation of the System for Improving and Measuring Procedural Learning application. It is feasible for the SIMPL application to be implemented with acceptable use in a cardiothoracic training program.

Multiinstitutional Evaluation of a Debate-Style Journal Club for Cardiothoracic Surgery Trainees

BackgroundTraditional journal clubs address individual articles and are limited in terms of breadth and depth of content covered. The present study describes the outcomes of a novel debate-style journal club in a multiinstitutional setting. MethodsParticipating institutions were recruited through the Thoracic Education Cooperative Group. The distributed curriculum included instructions, debate scenarios, suggested article lists, moderator slides, debate scoresheets, exams, and feedback surveys. ResultsSix institutions participated in the study (2015-2019), consisting of a total of 10 years’ worth of cumulative debates. Cardiothoracic surgery trainees participated in 10 monthly debates over each academic year. Trainee performance on the written examination in the realm of evidence-based medicine and critical appraisal improved over the course of the academic year (beginning 55.2% vs end 76.3%; P = .040). Importantly, written examination after debates revealed a significant improvement in scores on questions relating to topics that were debated as compared with those that were not (+27.1% vs +2.5%; P = .006), emphasizing the importance of the debates as compared with other sources of knowledge gain. Surveys completed by trainees and faculty overall favored the debate-style journal club as compared with the traditional journal club in gaining familiarity with seminal literature in the field, improving on oral presentation skills, and applying published literature to questions encountered clinically. ConclusionsIn this multiinstitutional prospective study, we demonstrate that the novel debate-style cardiothoracic surgery journal club is an effective educational intervention for cardiothoracic surgical trainees to acquire, retain, and gain practice in applying literature-based evidence to case-based scenarios.

Comparison of cardiothoracic surgical training before and during the COVID-19 pandemic in the United Kingdom

BackgroundCardiothoracic training during the Coronavirus disease 2019 (COVID-19) pandemic witnessed a dramatic change in the United Kingdom, resulting in changes in surgical provisions, centralization of services, and reduced surgical case volume. The aim of this study was to assess the impact COVID-19 on surgical training and seek opinions regarding the future role of surgical simulation in cardiothoracic training. MethodsA cross-sectional survey was designed and distributed to 200 cardiothoracic national and non-national trainees in the United Kingdom. The survey consisted of 31 questions in 4 sections: Demographics, Service Provision, Training, and Simulation Training. ResultsEighty-three of the 200 trainees (41.5%) completed the survey, including 44 of 129 national trainees (34.1%) and 39 of 71 non-national trainees (54.9%). Sixty-seven respondents (80.7%) agreed that cardiothoracic training had been negatively impacted as a result of COVID-19 (P < .001). In addition, 12% agreed that adequate resources were available for learning/practicing technical skills, 87% agreed that simulation had a role in cardiothoracic training, 81% recognized simulations is an important tool in improving their surgical skills, and 79.5% agreed that simulation should be used to meet the increasing need in training/education moving forward. ConclusionsCOVID-19 has had a significant impact on surgical training, with concerns that these effects could have further implications downstream. Simulation training has been underused thus far, and trainees face an uphill challenge to enhance their skills and technical abilities in the operating room. Simulation is recommended by trainees and may represent a solution to the challenges of safe and effective cardiothoracic surgical training.

“I Think I Can, I Think I Can”: Multiple Arterial Grafting, a Litmus Test for Cardiothoracic Surgical Training

“I Think I Can, I Think I Can”: Multiple Arterial Grafting, a Litmus Test for Cardiothoracic Surgical Training

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.

Global perspectives on cardiothoracic, cardiovascular, and cardiac surgical training

ObjectiveVarious methods for cardiothoracic, cardiovascular, and cardiac surgical training exist across the globe, with the common goal of producing safe, independent surgeons. A comparative analysis of international training paradigms has not been undertaken, and our goal in doing so was to offer insights into how to best prepare future trainees and ensure the health of our specialty. MethodsWe performed a comparative analysis of available publications offering detailed descriptions of various cardiothoracic, cardiovascular, and cardiac surgical training paradigms. Corresponding authors from previous publications and other international collaborators were also reached directly for further data acquisition. ResultsWe report various approaches to common challenges surrounding (1) selection of trainees and plans for the future surgical workforce; (2) trainee assessments and certification of competency before independent practice; and (3) challenges related to a changing practice landscape. ConclusionsCardiothoracic surgery remains a dynamic and rewarding specialty. Current and future trainees face several challenges that transcend national borders. To foster collaboration and adoption of best practices, we highlight international strengths and weaknesses of various nations in terms of workforce selection, trainee operative experience and assessment, board certification, and preparation for future changes anticipated in cardiothoracic surgery.

Simulation-based surgical education in cardiothoracic training.

Simulation has emerged as a feasible adjunct to surgical education and training for most specialties. It provides trainees with an immersive, realistic way to learn a variety of skills in a safe environment with the end goal of improving patient safety. There are three broad types of simulators: full mannequin simulators, part-task trainers or bench models and virtual reality systems. This review aims to describe the current use of simulation in cardiothoracic surgical education and training. We identified multiple procedures that can be simulated in cardiothoracic surgery using a combination of the above simulators, three-dimensional printing and computer-based simulation. All studies that assessed the efficacy of simulators showed that simulation enhances learning and trainee performance allowing for repetitive training until the acquisition of competence but further research into how it translates into the operating theatre is required. In Australia, cardiac surgery simulation is not yet part of the training curricula, but simulators are available for certain tasks and procedures.

Trainee Thoracic Surgery Social Media Network: Early Experience With TweetChat-Based Journal Clubs

Virtual journal clubs on Twitter (TweetChats) provide a platform to globally discuss publications. The Thoracic Surgery Social Media Network (TSSMN) is an organization that focuses on bringing social media attention to key publications in cardiothoracic surgery. TSSMN recently formed a Trainee Group with the goal of conducting chats covering key topics in cardiothoracic surgical training. The aim of this study was to characterize the pilot experience of this group. The TSSMN trainee group held 3 TweetChats during the study period between 2017 and 2018. Each TweetChat was a structured discussion of 2 to 4 publications. The number of tweets, participants, most popular tweets, and impressions was assessed for each of the TweetChats. The 3 TweetChats had a mean of 40 participants (range, 36-45), generating an average of 497 tweets (range, 451-526) with a mean of 809,746 impressions (range, 591,814-1,140,000). Fruitful discussions on the topics of simulation in surgery, assessment of resident autonomy, and development of optimal organizational cultures to maximize team performance were held. Twitter is a useful tool to collaborate and disseminate information. The 3 TweetChats organized by TSSMN trainee delegates generated approximately 1500 tweets with 2 million impressions. By these metrics, the feasibility of a trainee-led TSSMN TweetChat was confirmed.

Cadaveric Simulation Training in Cardiothoracic Surgery: A Systematic Review.

Simulation training has become increasingly relevant in the educational curriculum of surgical trainees. The types of simulation models used, goals of simulation training, and an objective assessment of its utility and effectiveness are highly variable. The role and effectiveness of cadaveric simulation in cardiothoracic surgical training has not been well established. The objective of this study was to evaluate the current medical literature available on the utility and the effectiveness of cadaveric simulation in cardiothoracic surgical residency training. A literature search was performed using PubMed, Cochrane Library, Embase, Scopus, and CINAHL from inception to February 2019. Of the 362 citations obtained, 23 articles were identified and retrieved for full review, yielding ten eligible articles that were included for analysis. One additional study was identified and included in the analysis. Extraction of data from the selected articles was performed using predetermined data fields, including study design, study participants, simulation task, performance metrics, and costs. Most of these studies were only descriptive of a cadaveric or perfused cadaveric simulation model that could be used to augment clinical operative training in cardiothoracic surgery. There is a paucity of evidence in the literature that specifically evaluates the utility and the efficacy of cadavers in cardiothoracic surgery training. Of the few studies that have been published in the literature, cadaveric simulation does seem to have a role in cardiothoracic surgery training beyond simply learning basic skills. Additional research in this area is needed.