Thoracic Surgery Training Research Articles

The implications of the effect of tricuspid regurgitation on mortality in transcatheter aortic valve implantation patients with a low ejection fraction.

Journal of Cardiac SurgeryVolume 36, Issue 10 p. 3671-3672 COMMENTARY The implications of the effect of tricuspid regurgitation on mortality in transcatheter aortic valve implantation patients with a low ejection fraction Oktay Korun, Corresponding Author Oktay Korun oktay_korun@hotmail.com orcid.org/0000-0002-5776-6993 Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey Correspondence Oktay Korun, Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 13 Tıbbiye Caddesi, Selimiye, 34668 Üsküdar, İstanbul, Turkey. Email: oktay_korun@hotmail.comSearch for more papers by this author Oktay Korun, Corresponding Author Oktay Korun oktay_korun@hotmail.com orcid.org/0000-0002-5776-6993 Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey Correspondence Oktay Korun, Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 13 Tıbbiye Caddesi, Selimiye, 34668 Üsküdar, İstanbul, Turkey. Email: oktay_korun@hotmail.comSearch for more papers by this author First published: 14 July 2021 https://doi.org/10.1111/jocs.15818Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume36, Issue10October 2021Pages 3671-3672 RelatedInformation

Objective performance assessment on trainees of a VATS simulation program: A prospective single center study

Abstract Objective A prospective single center study to assess the objective impact on motion performance of a VATS simulation program on thoracic surgery trainees. Methods We developed a 6-month VATS simulation training program including exercises of progressive complexity on 3 different black box simulators: a 2D and 3D lobectomy model (Stupnik®) and a 3D perfused lobectomy model (Crabtree®). Between November 2019 and 2020, all consecutive thoracic surgery residents (study group) were prospectively enrolled in this weekly training program that was supervised by a board certified thoracic surgeon. We compared an objective performance evaluation of the study group before and after the training program by assessing movement parameters (distance in cm, time in sec) and absence of shock/extreme motion (%) on 3 simple standardized thoracoscopic exercises (peg placement on a board, rope insertion in loops and precision circle cutting) using the Simball®. Also, we determined the objective performance 6 months apart of 5 final year medical students (unexperienced controls) that were not trained. Results There were 7 residents (2 female and 5 male, median age: 29 [range: 26-34] years) who completed the 6-month VATS simulation training program. Five residents were in their first year while two had >3 year experience. The study group's objective performance improved significantly for all three movement parameters in all standardized exercises (Figure 1) after the training program. The objective performance of the unexperienced control group was comparable to the study group before training, but it remained unchanged at 6 months (p > 0.05). When comparing unexperienced and advanced residents, we observed that the training program had more impact on improving the performance for unexperienced residents (p < 0.05). Conclusion This study suggests that the implementation of a VATS simulation training program improves the objective performance of trainees compared to controls. Such programs could be interesting adjuncts for residents.

Low Cost Training Models for Videothoracoscopic Surgical Training

Objective: We designed novel practical simulation models for VATS lung nodule palpation and vessel dissection, and subsequently evaluated the performances of the residents in our thoracic surgery program to account for the appropriate level of difficulty and grade the learning experience. Methods: Artificial lung nodules were formed by injecting sheep heart lung blocks with either cyanoacrylate or construction grade silicone diluted with synthetic thinner. Artificial lung and vessel environment was formed using a sponge, with a tube balloon placed inside a tunnel within the sponge and fixed with a flexible glue. Both models were placed in a standard laparoscopy training box, and both conventional and minimally invasive surgery instruments were used as applicable per the attendee's discretion. Results: In the lung nodule simulation, among 4 residents (postgraduate year (PGY) 1, 3, 4 and 4), the average time to palpating the first nodule was 57 seconds,and the average time of whole lung palpation was 7,7 minutes. In the vascular dissection model, of the five residents (PGY 4, 3, 3, 3, 1), median distance dissected at the first attempt was 3,1 cm (1-4,7), and it was shorter in the second attempt, 2,5 cm (2-3,2). Median dissection duration was shorter in the second attempt (5 vs. 3 minutes). All residents were able to complete the dissection of the balloon from the sponge within 9 attempts. Conclusion: Surgical simulation models can be created with minimal resources, allowing for enough difficulty to maintain engagement and accomplish progressive skill through practice. As clinics shift case volume to minimally invasive procedures, resident exposure to open cases can become more scarce; so simulation training in thoracic surgery can not be perceived as a luxury, it has to be accessible even though the learning environment does not have resources to invest in virtual reality sets or computerized simulators.

Simulation-based VATS resection of the five lung lobes: a technical skills test.

Video-Assisted Thoracoscopic Surgery (VATS) lobectomy is an advanced procedure and to maximize patient safety it is important to ensure the competency of thoracic surgeons before performing the procedure. The objective of this study was to investigate validity evidence for a virtual reality simulator-based test including multiple lobes of the lungs. VATS experts from the department of Cardiothoracic Surgery at Rigshospitalet, Copenhagen, Denmark, worked with Surgical Science (Gothenburg, Sweden) to develop VATS lobectomy modules for the LapSim® virtual reality simulator covering all five lobes of the lungs. Participants with varying experience in VATS were recruited and classified as either novice, intermediate, or experienced surgeons. Each participant performed VATS lobectomy on the simulator for three different randomly chosen lobes. Nine predefined simulator metrics were automatically recorded on the simulator. Twenty-two novice, ten intermediate, and nine experienced surgeons performed the test resulting in a total of 123 lobectomies. Analysis of Variances (ANOVA) found significant differences between the three groups for parameters: blood loss (p < 0.001), procedure time (p < 0.001), and total instrument path length (p = 0.03). These three metrics demonstrated high internal consistency and significant test-retest reliability was found between each of them. Relevant pass/fail levels were established for each of the three metrics, 541ml, 30min, and 71m, respectively. This study provides validity evidence for a simulator-based test of VATS lobectomy competence including multiple lobes of the lungs. The test can be used to ensure basic competence at the end of a simulation-based training program for thoracic surgery trainees.

Training in thoracic surgery within Europe—the different pathways

Training in thoracic surgery within Europe—the different pathways

A Study on the Influence of COVID-19 on Cardiovascular and Thoracic Surgery Training in India and Future Prospective

Purpose: COVID-19 has destabilized the routine across the members of cardiac surgery including the postgraduates. In view of this, we conducted a survey among the residents to capture their thoughts on the impact of COVID-19. Methods: An electronic questionnaire was constructed and sent to the residents on May 17, 2020. Participation was voluntary and anonymized. The survey ended on May 27, 2020. Results: A total of 91 postgraduates across the country participated in the survey. A strong majority was attributed when more than 50% of the postgraduates agreed on an opinion, and a moderate majority was attributed when 40%–50% of postgraduates agreed on an opinion. Among the specialties, thoracic surgery and peripheral posting were severely affected, and it was the surgical skill which was severely affected compared to their lectures and thesis work. Multi-institutional collaboration teaching programs were useful in understanding the protocols of different units across the country. Conclusion: Virtual lectures have to continue integrating different institutions for the benefit of students. The students' involvements in the discussion are essential. A national forum for postgraduates has to be formed, promoting their participation and publications.

The Role of Sublobar Resection in T1 N0 Non-Small-Cell Pulmonary Carcinoma.

In this study, we aimed to investigate the effect of resection type on survival in patients with stage IA non-small-cell lung cancer (NSCLC) and other factors affecting the prognosis. Between January 2005 and December 2016, we retrospectively screened 269 patients who were resected and were having T1N0M0 non-small-cell pulmonary carcinoma. The survival time after surgery was obtained from the National Population Registration System (MERNIS) system. Patients were classified according to the extent of resection. Additionally, age, sex, smoking, concomitant disease, histological type, pathological stage (T1a-T1b-T1c), and the presence of postoperative complications were evaluated to determine whether they are prognostic factors or not. A lobectomy was performed in 257 cases (95.5%), and a sublobar resection was performed in 12 patients (4.5%). The 5-year survival was 62.5% for lobectomies and 73.3% for sublobar resections. Although 5-year survival was better in patients with a limited resection, it was not statistically significant (p=0.301). Histopathological evaluation revealed that 130 patients (48.3%) had adenocarcinoma, 113 (42.0%) had squamous cell carcinoma, and 26 (9.7%) had the other types. The 5-year survival rate was 69.9% in patients with adenocarcinoma and 53.2% in squamous cell carcinoma, and this was statistically significant (p=0.036). The overall 5- and 10-year survival rates in all patients were 65.0% and 47.2%, respectively. Although lobectomy is the standard type of resection in the early stage of lung cancer cases in the Thoracic Surgery Department of Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital patients who underwent sublobar resection were found to be having partially better survival, but it was not statistically significant. Owing to the small number of cases, we think that sublobar resections should be prospectively investigated with more extensive series in patients with T1 NSCLC.

Lifestyle Intervention Using Mobile Technology in Patients with High Cardiovascular Risk: A Pragmatic Randomized Clinical Trial

Aims: Mobile technology-based solutions present promising effects against cardiovascular diseases. Long-term follow-up in mobile phone-based interventions has not yet been elucidated as a primary prevention technique for cardiovascular diseases. The objective of the present trial is to evaluate the effectiveness of lifestyle intervention on the change in the atherosclerotic cardiovascular disease (ASCVD) risk score in a 1-year follow-up using smartphone technology in patients with high cardiovascular risk. Methods and Results: This prospective, randomised and single-centre clinical investigation enrolled 242 and 241 patients to the intervention plus usual care and usual care arms, respectively. After a follow-up of 1-year, the intervention plus usual care reduced the ASCVD score by 2.7% (adjusted treatment effect -2.7, 95% confidence interval (CI): -2.2, -3.3, p<0.0001). An improvement was observed in favour of the intervention plus usual care arm in the majority of the pre-specified secondary end points. The high sensitive-troponin and high sensitive-C reactive protein levels at 1 year were similar between the two arms. The treatment effect was homogenous for diabetes mellitus, gender, systolic blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides and body mass index; however, heterogeneity in the treatment effect was observed for age. Conclusion: The lifestyle intervention using smartphone technology compared to usual care alone in patients with high cardiovascular risk reduced the ASCVD score at 1-year follow-up. Clinical Trial Registration: The trial was registered at www.clinicaltrials.gov (NCT03397849). Funding Statement: TThis work was supported by Turk Telekomunikasyon A.S. The study was performed at Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Turkey. Declaration of Interests: None declared. Ethics Approval Statement: The study protocol complies with the Declaration of Helsinki and it was approved by the local ethics committee of the Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (approval no. 2017/78). All the participants provided written informed consent.

Coronary Anastomosis Simulation: Directed Interventions to Optimize Success

The role of simulation-based training in coronary artery bypass grafting remains undefined. Barriers to simulator use include clinical and personal obligations, insufficient materials, and lack of mentorship. The purpose of this study was to implement a longitudinal, residency-wide coronary anastomosis simulation curriculum. A prospective observational study was conducted from 2018 to 2019 at a single academic center. All residents of the Thoracic Surgery training program participated. Each participant was provided a low-fidelity coronary anastomosis simulator, high-quality instruments, and faculty mentor. Formal assessments were held quarterly, and residents were encouraged to practice alone and with their mentor. Baseline and follow-up metrics were compared with simple descriptive statistics. Seventeen residents and 12 faculty participated in the study. Residents demonstrated increased use of the simulator, with 21% participating in independent practice at baseline and 82% in the fourth quarter (P= .02). The median score on the Thoracic Surgery Directors Association Vessel Anastomosis Assessment improved from 42 out of 65 at baseline to 54 out of 65 in the fourth quarter (P= .04), and mean anastomosis time was reduced by 5 minutes 6 seconds (P= .02). Over 12 months, junior residents demonstrated a mean reduction in anastomosis time of 6 minutes 36 seconds, and senior residents decreased anastomosis time by 3 minutes 6 seconds (P= .02). Providing residents with a low-fidelity coronary anastomosis trainer with high-quality instruments and a faculty mentor improved rates of independent practice, Thoracic Surgery Directors Association assessment scores, and anastomosis time. Our next step is validating the coronary simulator curriculum by measuring improvement of resident performance in the operating room.

Video-assisted thoracic surgery lobectomy simulation and training with a new human cadaver model

Video-assisted thoracic surgery (VATS) lobectomy is the gold standard for the treatment of early-stage lung cancer. The use of surgical models for training and simulation in minimally invasive surgery simulation is an integral part of surgical education and skills acquisition for residents, and also for more experienced surgeons.Live animals are still the most frequently used realistic surgical models. In this video tutorial, we demonstrate the use of a new human cadaver model with the aim of replacing the live animal model without compromising the fidelity of the simulation. To prepare the cadaver, selective cannulation of the heart was performed to fill the pulmonary vessels with a gel used to improve the visibility and tactile feed-back of the vessels, and to simulate any bleeding complications. The complete cadaver was then used for the simulation, with all the same instruments and devices required in normal clinical practice, to demonstrate and practice both surgical and non-surgical skills for VATS lobectomy. In our opinion this model provides most of the features necessary for a valid surgical simulator and allows realistic training for VATS lobectomy. We believe that the cadaver model can be an effective alternative to anesthetized animals for VATS lobectomy training and simulation.

Competency Assessment for Mediastinal Mass Resection and Thymectomy: Design and Delphi Review Process

Mediastinal mass resection and thymectomy are complex and related operations that are core components of competency for a general thoracic surgeon and an important learning objective for thoracic surgery trainees. This study aimed to design a combined competency assessment instrument for mediastinal mass resection and thymectomy. A comprehensive competency assessment instrument was designed by a process of logical analysis by 3 expert thoracic surgeons with an interest in mediastinal surgery. The instrument was then assessed and refined using a modified Delphi process. The Delphi questionnaire was distributed to all members of the Canadian Association of Thoracic Surgeons in 2018 to 2019. The first round of the Delphi review was completed by 58 respondents (response rate 43.9%). Respondents represented all Canadian provinces with a wide range of clinical experience and a high rate of involvement in resident education. A first draft of the competency assessment instrument included 42 steps in 6 categories. A total of 3 rounds of Delphi review were performed. Cronbach's alpha for the final round was 0.83. Ultimately, 29 items were retained from the original instrument and two modified and three new items were added. The final instrument has 34 steps in 5 categories. A nationwide consensus was established on the key components of assessing competence to perform mediastinal mass resection and thymectomy. The resulting instrument could be used to guide competency based assessments of thoracic surgeons and trainees.

An Evaluation of the Availability and Accessibility of Online Content of Integrated Vascular Surgery, Interventional Radiology, and Thoracic Surgery Training Program Websites for Residency Applicants

Residency websites are an important recruitment resource, introducing applicants to programs across the country and allowing for comparison. Recruitment is highly competitive between vascular surgery (VS), CT, and interventional radiology (IR) with the ratio of applicants to positions being highest in CT, then IR, and last VS, as reported by the Electronic Residency Application Service. Thus, we sought to evaluate the accessibility and availability of online content for those integrated residency programs. A list of accredited VS, IR, and CT residencies was obtained from Accreditation Council for Graduate Medical Education. Program websites were evaluated by independent reviewers for content items pertaining to program recruitment and education (scored absent or present). Statistical analysis was performed in R. Of Accreditation Council for Graduate Medical Education-accredited programs, 74 (87%) of 85 IR, 56 (92%) of 61 VS, and 27 (100%) of 27 CT had functional websites. IR websites contained 19.4 ± 9.54 (mean ± SD) content items (interquartile range [IQR], 14.8-25.1), VS websites contained 24.2 ± 10.7 (mean ± SD) content items (IQR, 19-31.5), and CT websites contained 26.6 ± 7.15 (mean ± SD) content items (IQR, 21.8-31.5). CT and VS websites contained significantly more content items than IR websites (P = .0004 and P = .0026, respectively). Two content items highly influential to applicant program decision are operative experience and faculty mentorship, reported at 50% and 14.9% for IR, 32.1% and 10.7% for VS, and 18.5% and 11.1% for CT. Key deficits were work hours, debt management, and curriculum for IR; resident profiles, sample contract, and departmental research interests for VS; and operative experience, PD contact, and message for CT. IR deficits in work hours and CT deficits in operative experience both represent information highly valued by applicants. All had deficits in evaluation criteria and faculty mentorship. Detailed information on availability of specific content items can be seen in the Table. This study has uncovered key differences in availability of online content for residencies recruiting from the same pool of applicants. CT has the most information, then VS, with IR reporting the least content. To attract valuable candidates, programs should aim to increase the availability of online content for potential applicants.TableAvailability of content on US integrated interventional radiology (IR), integrated vascular surgery (VS), and integrated thoracic surgery training program websitesIR, No. (%) of programs (n = 74)VS, No. (%) of programs (n = 56)Thoracic surgery, No. (%) of programs (n = 27)Program recruitment Program description69 (93.2)56 (100.0)26 (96.3) Faculty listing73 (98.6)53 (94.6)27 (100.0) Faculty education (training history)68 (91.9)52 (92.9)25 (92.6) Admin/coordinator contact63 (85.1)53 (94.6)22 (81.5) Application requirements50 (67.6)42 (75.0)22 (81.5) ERAS link47 (63.5)35 (62.5)16 (59.3) Benefits51 (68.9)39 (69.6)19 (70.4) No. of incoming positions available45 (60.8)44 (78.6)20 (74.1) Salary48 (64.9)34 (60.7)17 (63.0) Current residents47 (63.5)40 (71.4)20 (74.1) Faculty publications40 (54.1)24 (42.9)19 (70.4) Wellbeing strategies37 (50.0)26 (46.4)17 (63.0) Interview dates29 (39.2)32 (57.1)13 (48.1) Alumni listing17 (23.0)20 (35.7)7 (25.9) Alumni career placement17 (23.0)15 (26.8)6 (22.2) Selection process13 (17.6)4 (7.1)2 (7.4) Debt management8 (10.8)22 (39.3)11 (40.7) Work hours6 (8.1)12 (21.4)12 (44.4)Program education Rotation schedule45 (60.8)47 (83.9)19 (70.4) Research interests (department)49 (66.2)22 (39.3)16 (59.3) Didactic instruction42 (56.8)39 (69.6)17 (63.0) Research requirements39 (52.7)41 (73.2)19 (70.4) Operative experience37 (50.0)18 (32.1)5 (18.5) Journal club25 (33.8)34 (60.7)11 (40.7) Meetings attended23 (31.1)26 (46.4)11 (40.7) Elective rotation20 (27.0)25 (44.6)12 (44.4) Curriculum12 (16.2)21 (37.5)10 (37.0) National organization link8 (10.8)4 (7.1)7 (25.9) Evaluation criteria5 (6.8)9 (16.1)6 (22.2) Simulation training3 (4.1)19 (33.9)9 (33.3)ERAS, Electronic Residency Application Service. Open table in a new tab

Developing training for uniportal video-assisted thoracic surgery: a commentary.

Today, thoracic surgeons have many possible pathways to advance their training in video-assisted thoracic surgery (VATS). For uniportal VATS (uVATS) in particular, what are the training options available and does regulating training matter? The relevant literature pertaining to uVATS training is reviewed. Current options for surgeons looking to train in uVATS range from videos on the internet, through 'experts' demonstrating live surgery, to symposia and hands-on wet labs being held in all regions of the world. All have merits, and the aspiring VATS surgeon can choose from a range of preceptorship and proctorship modules to suit his/her own training needs. However, issues in the formalizing training in uVATS remains unresolved. Is there an ideal pathway through uVATS training? At what point can a trainee be considered to have 'graduated' to become an expert in uVATS? Who indeed trains the trainer, and certifies the competence of a training centre? Although a plethora of training options exist, formulation of a robust training curriculum can further bolster the status of uVATS as a sustainable surgical approach that can be delivered with consistent quality.

Training curriculum for European thoracic surgeons: a joint initiative of the European Society of Thoracic Surgeons and the European Respiratory Society

In the most recent issue of the European Journal of Cardio-Thoracic Surgery , the joint task force group on training in thoracic surgery, set up by both the European Society of Thoracic Surgeons and the European Respiratory Society (ERS), has published the core document describing the recommended training curriculum [1]. This document takes its roots from the European syllabus published in 2018 [2, 3]. According to a methodology validated by education scientists, the working group has described, for each item, the expected level of competence in terms of knowledge, skills and attitudes, listed possible learning resources, and recommended appropriate tools for assessment of learning outcomes [4]. This consensual curriculum for thoracic surgeons intends to promote homogeneity of training and and its outcome in terms of competence throughout Europe <http://bit.ly/3a2tTZI>

Critical Comparison of the Quality and Content of Integrated Vascular Surgery, Thoracic Surgery, and Interventional Radiology Residency Training Program Websites

Objective: With the move to virtual interviewing, residency websites are an important recruitment resource, introducing applicants to programs across the country and allowing for comparison. Recruitment is highly competitive from a common potential pool between vascular surgery, thoracic surgery and interventional radiology with the ratio of applicants to positions being highest in interventional radiology, followed by thoracic surgery and lastly vascular surgery, as reported by the National Resident Matching Program. The aim of this study is to evaluate the accessibility and availability of online content for those integrated residency programs. Methods: A list of accredited vascular surgery, thoracic surgery, and interventional radiology residencies was obtained from the ACGME. Program websites were evaluated by trained independent reviewers (n=2) for content items pertaining to program recruitment and education (scored absent or present). Statistical analysis was performed in R software. Results: Of ACGME accredited programs, 56 of 61 (92%) vascular surgery, 27 of 27 (100%) thoracic surgery, and 74 of 85 (87%) interventional radiology programs had functional websites (P=0.122). Vascular surgery websites contained a median of 26 content items (IQR: 20, 32), thoracic surgery websites contained a median of 27 content items (IQR: 21, 32), and interventional radiology websites contained a median of 23 content items (IQR: 18, 27). Two content items considered highly influential to applicant program decision are procedural experience and faculty mentorship, were reported at 32% and 11% for vascular surgery, 19% and 11% for thoracic surgery, and 50% and 15% for interventional radiology (P=0.008 and P=0.751, respectively). Key deficits were work hours, debt management and curriculum for interventional radiology; resident profiles, sample contracts, and research interests in vascular surgery; operative experiences, program director contact and message for thoracic surgery. Interventional radiology deficits were work hours and thoracic surgery deficits were procedural experience. Both IR and CT websites lacked information in evaluation criteria and faculty mentorship. Conclusions: This study has uncovered key differences in availability of online content for residencies recruiting from the same pool of applicants. Thoracic surgery has the most information, followed by vascular surgery, with interventional radiology reporting the least content. In the era of virtual interviewing from the same potential pool of applicants, programs should review and revise their web presence with the aim to increase the availability of online content in order to attract valuable candidates.

Impact of Accredited Training Programs in Congenital Heart Surgery

Historically, training in congenital heart surgery was variable and followed 1 of 3 pathways: residents identified during the primary training process were given the opportunity for a career training position within their own or other institution, residents would travel abroad for training and return to look for a faculty appointment based on their training experience, or a resident would enter a 1-year fellowship position after completing Thoracic Surgery training. These training opportunities and fellowships lacked uniformity and quality control. The purpose of an Accreditation Council of Graduate Medical Education (ACGME)-accredited residency program and an American Board of Thoracic Surgery subspecialty certificate in congenital heart surgery was to recognize and document a standard of education, operative experience, and cognitive knowledge for surgeons practicing in the field. There have been several important papers related to congenital cardiac training published over the years: (1) a manuscript by Kogon published in 2006 outlining congenital cardiac training prior to ACGME program accreditation, (2) a manuscript by Kogon et al published in 2016 outlining congenital cardiac training subsequent to ACGME accreditation with a focus on job transition and early work experience, and (3) a manuscript published in 2017 focusing primarily on job transition and early work experience. The purpose of this review is to provide an update with respect to congenital cardiac training. More importantly, in comparing survey results from these previous papers with the current survey, some interesting trends have been revealed, good and bad.

The Feasibility of Domiciliary Non-Invasive Mechanical Ventilation due to Chronic Respiratory Failure in Very Elderly Patients.

The aim of this study was to investigate the use of domiciliary non-invasive mechanical ventilation (NIMV) in very elderly patients (age 80 and over). This retrospective study included a total of 44 patients aged 80 years or older, who were admitted to the Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Pulmonary Intensive Care Outpatient Clinic between 2012 and 2018 and applied NIMV for chronic respiratory failure. The patients were divided into two groups: survivors (n=15) and non-survivors (n=29). Data were obtained from the retrospectively formed hospital database. The characteristics of patients, comorbidities, NIMV compliance, pulmonary function tests, and blood gas analyses were compared between the survivors and non-survivors. From the retrospective analysis of 44 cases, the non-survivors were found to have a significantly shorter duration of domiciliary NIMV (737 days vs. 890 days, p=0.027) and lower hemoglobin concentration (11.1 g/L vs. 12.9 g/L, p=0.004). The number of comorbid conditions, pulmonary function test, and blood gas analyses results did not differ significantly between the groups. Compliance was moderate in this elderly population, at 4.9±1.9 h/day (range: 0.8-9.1 h/day). NIMV was well-tolerated in 36 of the 44 elderly patients (81.8%). Overall mortality was 65.9%. Domiciliary NIMV can be of benefit to very elderly patients, and age is not an obstacle. Therefore, this population should not be excluded from this treatment solely on the basis of age.

Thoracic surgery training in the United States 6th Oriental Conference on Thoracic Surgery

In 1925, representatives from the American Association for Thoracic Surgery (AATS) met with members of the National Board of Medical Examiners to discuss whether specialty certification was needed in thoracic surgery. The conclusion at that time was that there was no need for specialty thoracic surgery certification.

Preliminary exploration of reserved talents training in thoracic surgery

Based on the Nanshan class of clinical medicine in Guangzhou Medical University, the center established an interest-oriented thoracic surgery learning collaboration group. All recruited students received the full-range cultivation, including MDT learning collaboration with characteristics of early clinical practice, early scientific research, English training and thoracic surgery collaboration group as the core, accelerated clinical skills training under the naked-eye 3D thoracoscopic system, and scientific research thinking which recommended by new media — WeChat public platform. A total of 10 undergraduate students from 2013 to 2017 batch were recruited into the this group and they showed advantages in clinical technique, scientific research and higher education enrollment after cultivation, demonstrating that part of the clinical teaching and scientific research thinking of thoracic surgery gave to undergraduates in advance can pave the way for the training of thoracic surgeons and formulate more detailed and individualized programs to teach students in accordance with their aptitude in the future. Key words: Thoracic surgery teaching; Reserved talent training; Undergraduate teaching

Ultrasonographically marked catheterization of internal jugular vein in intensive care patients: Retrospective cohort study

Aim: This study was designed to compare the method of internal jugular vein (IJV) catheterization with prior ultrasonographic (USG) skin marking with the conventional method regarding the performance of a less experienced practitioner in learning ultrasonographic manipulation and safely performing the cannulation. Methods: The records of patients admitted to the Intensive Care Unit of Ataturk Pulmonology and Thoracic Surgery Training and Research Hospital between April and September 2018 were retrospectively examined. 14 female and 26 male patients (n=40) whose IJV cannulations had been performed with the two above-mentioned methods were included in the study. The practitioner was theoretically trained by an experienced radiologist before the cannulation. Results: The success rate was 65% in the conventional group and 95% in the USG skin-marked group; the difference was statistically significant (P=0.019). The mean time from the first entry of the needle to the skin to the placement of the catheter in successful cannulations in conventional and USG-marked methods were 110.6(25.6) and 121.6(28.3) seconds, respectively. There was no statistically significant difference (P=0.22). Conclusion: This study shows that educating the inexperienced practitioner about the use of USG in IJV cannulation and successful application of skin marking method is important.