Cardiothoracic surgery resident education: update on resident recruitment and job placement

Shortage of Cardiothoracic Surgeons Is Likely by 2020

Background— Even as the burden of cardiovascular disease in the United States is increasing as the population grows and ages, the number of active cardiothoracic surgeons has fallen for the first time in 20 years. Meanwhile, the treatment of patients with coronary artery disease continues to evolve amid uncertain changes in technology. This study evaluates current and future requirements for cardiothoracic surgeons in light of decreasing rates of coronary artery bypass grafting procedures.

Methods and Results— Projections of supply and demand for cardiothoracic surgeons are based on analysis of population, physician office, hospital, and physician data sets to estimate current patterns of healthcare use and delivery. Using a simulation model, we project the future supply of cardiothoracic surgeons under alternative assumptions about the number of new fellows trained each year. Future demand is modeled, taking into account patient demographics, under current and alternative use rates that include the elimination of open revascularization. By 2025, the demand for cardiothoracic surgeons could increase by 46% on the basis of population growth and aging if current healthcare use and service delivery patterns continue. Even with complete elimination of coronary artery bypass grafting, there is a projected shortfall of cardiothoracic surgeons because the active supply is projected to decrease 21% over the same time period as a result of retirement and declining entrants.

Conclusion— The United States is facing a shortage of cardiothoracic surgeons within the next 10 years, which could diminish quality of care if non–board-certified physicians expand their role in cardiothoracic surgery or if patients must delay appropriate care because of a shortage of well-trained surgeons.

Optimizing the surgical residents' educational experience on transplant surgery

INTRODUCTION

Surgical specialties with high service demands like transplant surgery are challenged to provide good educational value for rotating surgical residents while maintaining quality patient care. Based on poor resident evaluations, the Resident Review Committee for Surgery (RRC-S) has proposed removing the requirement for transplant surgery rotations from general surgery residency programs.

OBJECTIVES

The objectives of this article are to provide a situation analysis pertaining to the problem of poor resident evaluations from the perspective of the American Society of Transplant Surgeons (ASTS), and to propose an action plan to improve the current situation.

SETTING AND PARTICIPANTS

The Fellowship Training and Curriculum committees of the ASTS together with ASTS leadership and ASTS fellowship program directors collaborated to address these concerns by identifying key contributory factors and by initiating an action plan to correct them.

RESULTS

The following 4 major issues pertaining to transplant surgery rotations were considered most relevant to the problem: (1) high service demands, (2) inadequate prioritization of resident education, (3) competition with fellows for educational opportunities, and (4) the need by many programs to send their residents to other centers to obtain transplant experience. Based on these issues, the ASTS leadership issued directives to all programs with rotating residents to (1) designate a transplant surgeon to resident education experience on transplant; (2) create a service infrastructure that is not dependent on surgical residents; (3) re-educate faculty, fellows, support staff and residents regarding resident expectations on transplant surgery; (4) create a structured and sustainable educational experience; (5) increase resident involvement in surgical procedures; and (6) obtain ongoing feedback from rotating residents and the program directors.

CONCLUSIONS

Transplant surgery can be a valuable educational experience for surgical residents. The ASTS is dedicated to collaborating with general surgery residents and program directors in ongoing efforts to enhance this experience.

Global Trends in Cardiology and Cardiothoracic Surgery – An Opportunity or a Threat?

Coronary heart disease is currently the leading cause of death globally, and is expected to account for 14.2% of all deaths by 2030. The emergence of novel technologies from cardiothoracic surgery and interventional cardiology are welcome developments in the light of an overwhelming chronic disease burden. However, as these complementary yet often competing disciplines rely on expensive technologies, hastily prepared resource plans threaten to consume a substantial proportion of limited healthcare resources. By describing procedural and professional trends as well as current and emerging technologies, this review aims to provide useful knowledge to help managers make informed decisions for the planning of cardiovascular disease management. Since their inception, developments in both specialties have been very rapid. Owing to differences in patient characteristics, interventions and outcomes, results of studies comparing cardiothoracic surgery and interventional cardiology have been conflicting. Outcomes for both specialties continue to improve through the years. Despite the persistent demand for coronary artery bypass surgery (CABG) as a rescue procedure following percutaneous coronary intervention (PCI), there is a widening gap between the numbers of PCI and CABG. Procedural volumes seem to have affected career choices of physicians. Emerging technologies from both disciplines are eagerly awaited by the medical community. For long-term planning of both disciplines, conventional health technology assessment methods are of limited use due to their rapid developments. In the absence of established prediction tools, planners should tap alternative sources of evidence such as changes in disease epidemiology, procedural volumes, horizon scan reports as well as trends in disease outcomes. Key words: Cardiac surgery, Interventional cardiology, Planning

Inspiring medical students to pursue surgical careers: outcomes from our cardiothoracic surgery research program

BACKGROUND

The past several years have witnessed a dramatic decline in the number of general surgery residents pursuing cardiothoracic surgery residency training. We believe that attracting individuals to pursue surgical careers should begin during the formative years of medical education. We implemented a program to introduce first-year medical students to cardiothoracic surgery and laboratory research.

METHODS

In 2003, we began a program providing an introduction to cardiothoracic laboratory research and surgery for medical students. Students are competitively selected for our three-part 8-week summer program. First, students are paired with a cardiothoracic surgery attending for shadowing in clinic and the operating room. Second, students actively participate in large-animal operations in the laboratory. Finally, students complete a clinical research project under the direction of a laboratory resident and faculty mentor. These projects are the students' own. They are responsible for presenting their findings to the division of cardiac surgery at the end of the program.

RESULTS

Since 2003, 18 students have completed the program. Each one has completed a project, collectively resulting in 39 peer-reviewed manuscripts. One student has published 28 peer-reviewed manuscripts. Of 10 students eligible for residency, 8 have applied in general surgery or surgical subspecialty (3 general, 2 plastic, 2 cardiothoracic, and 1 neurosurgery).

CONCLUSIONS

Implementing a program to introduce medical students to clinical and laboratory surgery has been successful, as measured by academic productivity. Eighty percent of eligible students entered a surgical field. Programs like these serve to stimulate interest in our specialty.