Cardiothoracic Training Research Articles

Social Media as a Means of Networking and Mentorship: Role for Women in Cardiothoracic Surgery

As women represent <5% of practicing cardiothoracic (CT) surgeons, networking and mentorship is pivotal to support the growth of women in this field. With widespread use of social media in the healthcare domain, its role in enhancing mentorship for CT surgeons who lack access to same-sex mentors remains unknown. Methods: A 35-item survey investigating CT trainee and surgeon social media use was designed using online survey software and distributed via social media and email. Responses were analyzed using descriptive statistics. One hundred fifty-six respondents who completed the survey reported careers in surgery, among whom 27 (17.3%) were in CT surgery. Despite expressing value for the role of same-sex mentorship in their careers more than those in other surgical specialties (P = 0.044), respondents in CT surgery were more likely to lack exposure to same-sex mentors at their own institution (P = 0.028). Compared to other surgical specialties, CT surgery respondents more frequently engaged with mentors of the same sex by viewing social media sites (P = 0.041) to discuss topics regarding surviving a career in the field (P = 0.049) and promotion of scholarship opportunities (P < 0.001). CT surgery respondents reported a trend towards a greater likelihood of using social media to build a network of same-sex mentorship compared to other surgical specialties (P = 0.077). Conclusions: Social media serves as a valuable tool to enhance the networking and mentorship of surgeons, particularly for women in CT surgery who may lack exposure to same-sex mentors at their own institution. Longitudinal studies surrounding the effectiveness of mentorship by social media are warranted.

Modular training in cardiothoracic residency—practical considerations to revive and streamline Indian training systems

Modular training in cardiothoracic training is a structured approach to residency by standardising all the facets of resident training viz. knowledge, professionalism, communication and clinical skills, research and operative exposure needed for achieving a certain level of professional competence at the end of training. Literature search was done using PubMed, Scopus and Google Scholar in view of writing a narrative review. The standardised approach can streamline the various national training programmes and promote effective mentorship. Imparting surgical skills to ensure technical proficiency in a structured manner assumes a central role in modular training which is a major departure from the current residency practises in our country. Modular training model can improve the resident enrolment and quality of training in the long run.

Agreement between examiners in wet lab assessment of cardiothoracic trainees

Is there such a thing as non-biased, accurate and validated measurement of surgical acumen?

Variability in Integrated Cardiothoracic Training Program Curriculum

Development of curricula that appropriately progress a resident from medical school graduate to fully trained cardiothoracic surgeon is a key challenge for integrated cardiothoracic training programs. This study examined variability and perceived challenges in integrated curricula. Responses to the 2016 TSDA/TSRA survey that accompanies the annual in-training exam taken by current cardiothoracic surgery residents were analyzed. Standard statistical methods were utilized to examine trends in participant responses. General surgery experience decreased with post-graduate year, whereas cardiac operative experience increased. Rotations in a wide variety of adjunct fields were common. The majority (87%) of respondents reported had dedicated cardiothoracic intensive care unit (ICU) rotations, and surgical ICU and cardiac care unit rotations were less common (68% and 42%, respectively). The most common surgical subspecialty rotations were vascular (94%) and acute care surgery (88%), with a wide range of clinical exposure (ie, 3-44 weeks for vascular). Importantly, 52% felt competition with general surgery residents for experience and 22.5% of general surgery rotations were at hospitals without general surgery residents. Perceived challenges included optimization of rotations (78%), faculty allowing residents to perform case components (60%), faculty teaching in the operating room (29%), and improving surgical experience on general surgery rotations (19%). Significant variation exists in integrated cardiothoracic surgery curricula. Optimization of rotations, access to surgical experience, and integration with general surgery appear to be the most significant perceived challenges. These data suggest that optimization of early clinical and surgical experience within institutions could improve trainee preparedness for senior cardiothoracic surgery training.

The Influence of Physician and Patient Gender on Risk Assessment for Lung Cancer Resection

Women do not receive appropriate surgical therapy for lung cancer as often as men. Patient gender may influence treatment recommendations; less is known about the effect of physician gender on recommendations. Gender-neutral vignettes representing low-risk, average-risk, and high-risk candidates for lung resection were paired with concordant videos of standardized patients (SPs). Cardiothoracic trainees and practicing thoracic surgeons read a vignette, provided an initial estimate of the percentage risk of major adverse events after lung resection, viewed a video (randomized to male or female SP), provided a final estimate of risk, and ranked the importance of the video in the final risk estimate. Overall, 107 surgeons participated, of whom 90 were men. Initial estimated risks mirrored actual vignette risks: 10.4% ± 9.9 for low risk, 17.6% ± 13.2 for average risk, and 21.0% ± 14.7 for high risk (p < 0.001). After SP videos were viewed and final risk estimates were rendered, there was a significant difference between male and female physicians in the absolute change in estimated risk (p= 0.002), with male physicians having larger changes than female physicians. There was also an effect of SP gender that varied by vignette type (p < 0.001). Increasing video importance scores were directly associated with increasing change in risk scores for average-risk and high-risk vignette/video combinations (p < 0.001 for each). Differences in estimating complication risk for lung resection candidates are related to physician and patient gender. This may influence recommendations for surgical treatment. Understanding such differences may help reduce inequities in treatment recommendations.

Simulator Teaching of Cardiopulmonary Bypass Complications: A Prospective, Randomized Study

Complications of cardiopulmonary bypass (CPB) are rare, but life-threatening events that need prompt and rehearsed actions involving a team. This is not adequately taught to cardiothoracic surgical trainees. The objective of this study was to assess the knowledge of cardiothoracic trainees required to manage these events after simulation-based vs. lecture-based teaching. Totally, 17 cardiac surgical trainees with no formal teaching in intraoperative complications of CPB management were randomly assigned by computer to either a study group receiving simulation-based complications of CPB teaching via the Orpheus simulator (n = 9) or a control group receiving complications of CPB teaching via a lecture (n = 8). Each subject undertook a written test comprising 20 multiple choice questions on complications of CPB before and after teaching. Trainees were then asked to rate their satisfaction with each session from 1 to 5, with 5 being most satisfied. St George Simulation and Clinical Skills Laboratory, St George's Hospital, London. There was no significant difference in the pretest scores between the 2 groups (p = 0.29). After teaching, both groups showed a statistically significant improvement in their knowledge (p < 0.05). The trainees in the simulation group performed better than the lecture-based group; however, this was not statistically significant (p = 0.21). Satisfaction levels in both the lecture session and the simulation session were very high with means of 4.4/5 and 4.8/5, respectively. Despite the familiarity with CPB during surgery, the simulation group performed at least as well as the lecture group. Cardiothoracic trainees would benefit from formal teaching of complications of CPB management via either learning modality being incorporated into their training.

Are There Gaps in Current Thoracic Surgery Residency Training Programs?

Cardiothoracic surgery is rapidly evolving to adapt to a changing health care environment and a wider application of innovative techniques. The Society of Thoracic Surgeons Workforce on Thoracic Surgery Resident Issues Transition to Practice Task Force sought to identify new or existing gaps of training in contemporary thoracic surgery residency training programs. A voluntary survey consisting of 24 questions was distributed to recent graduates of thoracic surgery residency programs in the United States during the 2014 American Board of Thoracic Surgery oral examination application process. Fifty-five of 132 applicants anonymously participated. The majority of respondents admitted that they needed more instruction or lacked confidence with the following specific cardiothoracic procedures: minimally invasive cardiac operations (25/52, 48%), robotic cardiac operations (29/52, 55.8%), endovascular operations (28/52, 53.8%), robotic pulmonary operations (29/52, 55.8%), minimally invasive esophageal operations (24/52, 46.2%), robotic esophageal operations (32/52, 61.5%), and operations on congenital cardiac conditions (31/52, 59.6%). The respondents further declared either a need for more instruction or lack of confidence in employment contracting (17/21, 81.0%), negotiating terms of employment (17/21, 81.0%), and professional service agreements (16/21, 76.2%). Further exposure to minimally invasive robotic procedures, operations on congenital conditions, and issues of practice management appear to be needed in contemporary cardiothoracic training in the United States. These identified gaps may assist cardiothoracic surgery residency programs to optimally prepare future graduates for our evolving specialty.

In Memoriam: Lawrence H. Cohn, MD (1937–2016)

In Memoriam: Lawrence H. Cohn, MD (1937–2016)

Outcome of the Joint Council of Thoracic Surgery Education’s Early Review Course Project

The Joint Council on Thoracic Surgical Education was formed in 2008 to improve cardiothoracic education. Resident learning has been a concern as reflected in declining passing rates on the American Board of Thoracic Surgery examinations. The Joint Council on Thoracic Surgical Education piloted a program to determine whether early exposure to a cardiothoracic curriculum through participation in a board review course would improve learning. The purpose of this paper is to report the results of this project. Residents from the incoming classes of traditional 5-2 or 5-3 cardiothoracic training programs were randomly selected to attend a 3-day board review course (University of Utah) in September of their first year. For the 2012 and 2013 classes of cardiothoracic residents, we asked all incoming residents to take the prior spring in-training examination in July of their first year and then take the in-training examination in the spring of their first year. We combined the results of the incoming class of 2012 and 2013 and analyzed the results. There were 171 residents who participated in either 2012 or 2013. There were 38 residents (78.9% were men) who attended the board review course and 133 (79.7% men) who did not. Questionnaires completed by the program directors and the residents who took the review course showed a favorable opinion of the program. The number of correct answers on the in-training examination, the percentage correct, and the percentile rank score increased more for the residents who took the review course, but was not statistically significant. When only the general thoracic surgery questions were analyzed, there was a statistically significant increase in the rank change between residents who attended the review course and residents who did not (8.4% increase versus 2.0% decrease, respectively; p = 0.042, Student t test). This pilot study established for the first time the baseline level of knowledge of incoming residents assessed by the in-training examination. Participation in a board review type course early in the residency training program may increase learning by cardiothoracic residents, but there was not a clear statistical difference between the two groups. The program was viewed as favorable by both the participating residents and the program directors.

Cervical mediastinoscope: a cardiothoracic training centre experience in Malaysia

Mediastinoscopy since the introduction in year 1959 has remained a useful investigation tool for mediastinal lymphadenopathies. It is also commonly used for preop staging of lung carcinoma. However with the introduction of non-invasive methods, mediastinoscopy technique became least preferred by surgeons and training centres. We have reported a case serie of thirty mediastinoscopies performed in our setting, highlighting on diagnostic accuracy and safety. We believe mediastinoscopy still has a beneficial role for investigation of mediastinal lesions despite availability of minimally invasive methods.

Professor Richard A. Jonas: exploring ways to improve brain development in children with congenital heart disease.

Professor Richard A. Jonas joined the staff of Children’s National Medical Center in September 2004 as the Chief of Cardiovascular Surgery, Co-Director of the Children’s Heart Institute and Cohen Funger Professor of Cardiac Surgery. He undertook his general surgical training at the Royal Melbourne Hospital in Melbourne Australia and subsequently his cardiothoracic surgical training at Royal Children’s Hospital in Melbourne and Green Lane Hospital in Auckland New Zealand. After fellowships at the Brigham and Women’s Hospital and Children’s Hospital Boston he was appointed to the Department of Surgery at Harvard Medical School in 1984. In 1994 Professor Jonas was appointed to the William E. Ladd Chair of Surgery at Harvard Medical School and became the Cardiovascular Surgeon in Chief at Children’s Hospital Boston.

Weekly social gatherings to improve cardiothoracic trainee satisfaction at Golden Jubilee National Hospital

Weekly social gatherings to improve cardiothoracic trainee satisfaction at Golden Jubilee National Hospital

Basic Cardiac Surgery Skills on Sale for $22.50: An Aortic Anastomosis Simulation Curriculum

Current resident and student duty-hour restrictions necessitate efficient training, which may be aided by simulation. Data on the utility of low-cost simulation in cardiothoracic surgery are scant. We evaluated the effect and value of a low-cost, low-fidelity aortic anastomosis simulation curriculum. Twenty participants (11 medical students, 9 residents) completed an aortic anastomosis on a porcine heart as a pretest. Participants were then provided access to a 14-minute online video created by a cardiac surgeon and given a low-cost task trainer for self-directed practice. Five weeks later, participants performed another aortic anastomosis on a porcine heart as a posttest. Pretest and posttest performances were filmed, deidentified, and graded blindly and independently by two cardiac surgeons using a standardized assessment tool (perfect score, 110; passing score, 58 or higher). Participants were surveyed anonymously after the posttest. The mean (SD) aortic anastomosis performance score improved significantly from pretest (53.3 [25.3]) to posttest (83.6 [15.3]; p < 0.001). Pass rates also improved significantly (35% versus 95%, p < 0.001). Medical students' scores improved most (p = 0.01). All 20 participants reported improved confidence in performing the task, and 18 believed that the online video was essential to better performance. The cost of the curriculum totaled $22.50 per participant, with 6 hours of total staff time required for assessment. An aortic anastomosis training and simulation curriculum improves the skills of student and resident trainees with minimal expense and staff time commitment. Such a curriculum may be of great value to both cardiothoracic training programs and their trainees.

Inspiring the next generation of Cardiothoracic Surgeons: an easily reproducible, sustainable event increases UK undergraduate interest in the specialty.

There is believed to be declining interest in cardiothoracic surgical careers among UK medical students. Relative lack of undergraduate exposure to the specialty compared with other surgical specialties may be partly responsible. Using pre- and postintervention analysis, we assessed the ability of a student-led extracurricular engagement event to increase undergraduate interest in the specialty. Fifty-four students attended and 50 (93%) participated in the study. Of the total, 32% of delegates had identified a cardiothoracic mentor, with only 8 and 4% exposed to cardiac and thoracic surgery, respectively, compared with 50% exposed to other surgical specialties. Self-reported understanding of cardiothoracic training increased from 20 to 80% (P < 0.001) after the 1-day event; 77% of delegates reported increased interest in the specialty. We demonstrate that it is possible to provide a free-to-user event that increases engagement using a student-led design. Similar events could increase interest in the specialty and may improve recruitment rates. Current levels of cardiothoracic exposure are very low among UK students.

A Survey of Cardiothoracic Surgical Training in the United Kingdom: Realities of a 6-Year Integrated Training Program

In recent years, cardiothoracic (CT) surgical training has faced several challenges, including a reduction in working hours and trainees favoring shorter training programs. We carried out a national survey in the United Kingdom (UK) to assess the CT 6-year training program. All CT trainees in the UK (n = 121) were sent an online survey. This was combined with a debate at the Society for CT Surgery of Great Britain and Ireland. Ninety-one (75.2%) of all trainees responded. Despite 56 (68.1%) being rostered for more than a 48-hour week, 31 (34.1%) of all trainees work an extra 10 hours. The majority (56, 61.5%) thought that on-calls and night duty are useful. Just over half of the trainees (47, 51.6%) spend at least 2 full days in the operating room, but 79 (86.8%) thought that this is too little and would spend voluntary time operating. Simulation of operations is thought to be useful; however, few thought that this should take more precedence in their training program. The majority of trainees thought that the current assessment of surgical training is suboptimal and does not examine surgical skill. Similarly, the majority thought that a defined number of operations is required before qualification. Trainees remain committed to their profession and are willing to dedicate more time perfecting their art. They believe that despite wanting extra operating experience, they will be ready for independent practice at the completion of their training. It rests with training bodies to find alternative assessments for surgical ability and to define experience at the exit point of training.

Advances in training: A high fidelity practical course on cadavers for complex cardiac procedures

s / International Journal of Surgery 12 (2014) S13eS117 S76 0313: ADVANCES IN TRAINING: A HIGH FIDELITY PRACTICAL COURSE ON CADAVERS FOR COMPLEX CARDIAC PROCEDURES John Massey, Jasmine Winter-Beatty , Nigel Drury, Jitendra Parmar. University Hospital Coventry and Warwickshire, Coventry, UK. Introduction: Surgical education is changing owing to implementation of European Working time Directive. Cadaveric-based educational programs have had positive feedback from surgical trainees. Our training centre allows trainees to gain experience in complex cardiac procedures in a safe, non-time pressurised environment.We look at how trainees benefit from a high fidelity course-training surgeons to perform two complex cardiac procedures. Methods: Cadavers had been prepared through a midline sternotomy, pericardium opened with heart and great vessels exposed. Trainees performed a stentless aortic valve replacement and an aortic root replacement. Faculty surgeons facilitated learning as required. Results: There was a 100% response for a post course feedback form. Knowledge survey revealed an increase in perception of knowledge. There was an increase in trainees' confidence to assist these procedures in future. 100% of attendees would recommend it to their peers. Trainees stated that they felt more comfortable assisting and performing the procedures having practiced on cadavers. Conclusions: Simulated training using fresh frozen human cadavers can be incorporated into surgical training of cardiothoracic trainees. Such a course can have high face validity and significantly improve trainees' perception of technical knowledge as well as increasing confidence to assist and perform complex cardiac procedures. 0320: THE LESSER-SPOTTED MEDICAL STUDENT: UNDERSTANDING AND FACILITATING STUDENT PRESENCE ON WARDS Ian Henderson, Jessika Voll , Damian Bragg. Queen's Medical Centre (NUH),

Cadaveric simulation in surgical training: A high-fidelity model to increase trainee confidence

Cadaveric simulation in surgical training: A high-fidelity model to increase trainee confidence

Online Learning in Thoracic Surgical Training: Promising Results of Multi-Institutional Pilot Study

Cardiothoracic surgical education faces numerous challenges, including reduced duty hours and diminishing prioritization of teaching, in the setting of rapidly advancing knowledge, skills, and case complexity. Pass rates on the American Board of Thoracic Surgery exam remain suboptimal, and new training formats are being evaluated. We hypothesize that Internet-based courses can be developed and implemented to supplement learning of basic topics in cardiothoracic surgery. After a needs assessment, 4 online self-study courses were developed by content experts using a Moodle [modular object-oriented dynamic learning environment] platform. As a pilot cohort, students from 4 thoracic surgery training programs participated, accessing courses at their own pace. Each course included general and detailed readings, multimedia content, discussion forum, and a question-bank supported quiz (90% required to pass, multiple attempts allowed). Utilization and exam data were tracked electronically. The t tests were used to compare first versus final-year traditional track trainees. Post-course surveys collected data on trainee attitudes. Nineteen students completed 4 courses on tracheal disease. Mean time spent per course and quiz attempts to pass were 1.35 hours and 2.86, respectively. Scores improved with successive attempts. Senior trainees showed a trend toward less time per course and fewer quiz attempts. Post-course surveys uniformly demonstrated perceived benefits from the content and quizzes in an easy-to-navigate format. Online courses can be developed and integrated within cardiothoracic training programs. This pilot demonstrates evidence of active learning as shown through the embedded assessments. Internet-based courses may serve as a means of supplementing modern thoracic surgical training. Further development and evaluation are warranted.

The Impact of Perceived Frailty on Surgeons' Estimates of Surgical Risk

Physicians are only moderately accurate in estimating surgical risk based on clinical vignettes. We assessed the impact of perceived frailty by measuring the influence of a short video of a standardized patient on surgical risk estimates. Thoracic surgeons and cardiothoracic trainees estimated the risk of major complications for lobectomy based on clinical vignettes of varied risk categories (low, average, high). After each vignette, subjects viewed a randomly selected video of a standardized patient exhibiting either vigorous or frail behavior, then reestimated risk. Subjects were asked to rate 5 vignettes paired with 5 different standardized patients. Seventy-one physicians participated. Initial risk estimates varied according to the vignette risk category: low 15.2%±11.2% risk; average 23.7%±16.1%; high 37.3%±18.9% (p<0.001 by analysis of variance). Concordant information in vignettes and videos moderately altered estimates (high risk vignette, frail video 10.6%±27.5% increase in estimate, p=0.006; low risk vignette, vigorous video 14.5%±45.0% decrease, p=0.009). Discordant findings influenced risk estimates more substantially (high risk vignette, vigorous video 21.2%±23.5% decrease in second risk estimate, p<0.001; low risk vignette, frail video 151.9%±209.8% increase, p<0.001). Surgeons differentiated relative risk of lobectomy based on clinical vignettes. The effect of viewing videos was small when vignettes and videos were concordant; the effect was more substantial when vignettes and videos were discordant. The information will be helpful in training future surgeons in frailty recognition and risk estimation.

Introduction to Australian surgical training system and its reflections

Based on the first hand cardiothoracic surgical training experiences in Australia, the author introduced the Australian surgical training system＇s objective, structure, outline and specific training methods as well as its contents in detail. Its overall characters can be summarized as high standard, strict requirement and equal stress on both theory and practice. Hopefully, this introduction and reflection may shed some light on the improvement and evolvement of the resident training system in China. Key words: Specialist training; Surgery; Australia