John F. Lazar

Resident Perceptions of 2-Year Versus 3-Year Cardiothoracic Training Programs

BACKGROUND Resident perceptions of 2-year (2Y) vs 3-year (3Y) programs have never been characterized. The objective was to use the mandatory Thoracic Surgery Residents Association and Thoracic Surgery Directors Association In-Training Examination survey to compare perceptions of residents graduating from 2Y vs 3Y cardiothoracic programs. METHODS Each year Accreditation Council for Graduate Medical Education cardiothoracic residents are required to take a 30-question survey designed by the Thoracic Surgery Residents Association and the Thoracic Surgery Directors Association accompanying the In-Training Examination with a 100% response rate. The 2013 and 2014 survey responses of residents graduating from 2Y vs 3Y training programs were compared. The Wilcoxon signed rank test was used to analyze ordinal and interval data. RESULTS Graduating residents completed 167 surveys, including 96 from 2Y (56%) and 71 from 3Y (43%) programs. There was no difference in the perception of being prepared for the American Board of Thoracic Surgery examinations or amount of debt between 2Y and 3Y respondents. There was no difference in intended academic vs private practice. Graduating 3Y residents felt more prepared to meet case requirements and better trained, were more likely to pass their written American Board of Thoracic Surgery examinations, and were less likely to pursue additional training beyond their cardiothoracic residency. CONCLUSIONS There was no difference in field of interest, practice type, and amount of debt between graduating 2Y vs 3Y residents. Respondents from 2Y programs expressed more difficulty in meeting case requirements, whereas residents from 3Y programs felt more prepared for independent practice and had higher American Board of Thoracic Surgery written pass rates.

Predictors of Career Choice Among Cardiothoracic Surgery Trainees

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

Ensuring more opportunity for robotics

I am writing in response to Hall et al.’s brief communication titled “Should every medical student receive exposure to robotic surgery?” [1]. The authors are strong proponents of medical student exposure to robotics believing that “integrating (robotic) education at a student level is the perfect opportunity to enlighten the next generation of clinicians and surgeons” [1]. I think this idea should be taken a step further: robotics should be an essential part of their overall medical education, not just their surgical education as we do not know which student’s experience with robotics may be the launching pad for virtuosity either in robotics and/or medicine as a result. What the article did not discuss is the limitations currently preventing our students from robotic exposure: a structured robotic experience designed for the rotating medical student. This is probably not an issue for senior author Dr. Reddy, who is well known in the thoracic surgery community as an early adopter of integrating robotic education for residents. In my operating room, all medical students and general surgery residents can observe my robotic cases. The residents, after appropriate training can operate on the dual console with me usually starting in their third year. Unfortunately, having the medical students use the robot the same way we let them operate open or laparoscopically has proven more challenging. For example, I was taken aside by the former robotic medical director for letting my medical student merely transfer a gauze between robotic instruments during a case while sitting at the dual console. He and the nursing supervisor were upset he did not have “appropriate” training even though he was safely and completely supervised by me. The robot, regardless of platform or specialty, is here to stay, though it will undoubtedly have numerous iterations. Therefore, we as educators must ensure that all students have the opportunity to explore this evolving technology by actively carving out a place for medical students in our teaching labs and operating rooms. By ensuring their future through robotics we simultaneously ensure our own.