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Nissen AP, Smith JA, Schmitto JD, Mariani S, Almeida RMS, Afoke J, Asai T, Luc JGY, Shapira OM, Mennander A, Tanaka A, Kaleda VI, Wan S, Wick A, Reichenspurner H, Cohn BM, Nguyen TC. Global perspectives on cardiothoracic, cardiovascular, and cardiac surgical training. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)30218-X. [PMID: 32111431 DOI: 10.1016/j.jtcvs.2019.12.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Various 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. METHODS We 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. RESULTS We 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. CONCLUSIONS Cardiothoracic 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.
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Affiliation(s)
- Alexander P Nissen
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex; Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Tex
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia; Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia
| | - Jan Dieter Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Rui M S Almeida
- Division of Cardiovascular Surgery, Western Parana State University, Cascavel, Brazil
| | - Jonathan Afoke
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, United Kingdom
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oz M Shapira
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ari Mennander
- Tampere University Heart Hospital and Tampere University, Tampere, Finland
| | - Akiko Tanaka
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex; Memorial Hermann Heart and Vascular Institute, Houston, Tex
| | - Vasily I Kaleda
- Department of Cardiac Surgery, Central Clinical Hospital of the President Administration, Moscow, Russia
| | - Song Wan
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alexander Wick
- Department of Cardiothoracic and Vascular Surgery, University Hospital Tubingen, Tubingen, Germany
| | - Hermann Reichenspurner
- Department of Cardiac and Vascular Surgery, University Hospital Hamburg, Hamburg, Germany
| | - Benjamin M Cohn
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex; Memorial Hermann Heart and Vascular Institute, Houston, Tex.
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Campbell RJ, El-Defrawy SR, Bell CM, Gill SS, Hooper PL, Whitehead M, Campbell EDLP, Nesdole R, Warder D, Ten Hove M. Effect of cataract surgery volume constraints on recently graduated ophthalmologists: a population-based cohort study. CMAJ 2017; 189:E424-E430. [PMID: 27920012 PMCID: PMC5359091 DOI: 10.1503/cmaj.150674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/02/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Across Canada, graduates from several medical and surgical specialties have recently had difficulty securing practice opportunities, especially in specialties dependent on limited resources such as ophthalmology. We aimed to investigate whether resource constraints in the health care system have a greater impact on the volume of cataract surgery performed by recent graduates than on established physicians. METHODS We used population-based administrative data from Ontario for the period Jan. 1, 1994, to June 30, 2013, to compare health services provided by recent graduates and established ophthalmologists. The primary outcome was volume of cataract surgery, a resource-intensive service for which volume is controlled by the province. RESULTS When cataract surgery volume in Ontario entered a period of government-mandated zero growth in 2007, the mean number of cataract operations performed by recent graduates dropped significantly (-46.37 operations/quarter, 95% confidence interval [CI] -62.73 to -30.00 operations/quarter), whereas the mean rate for established ophthalmologists remained stable (+5.89 operations/quarter, 95% CI 95% CI -1.47 to +13.24 operations/quarter). Decreases in service provision among recent graduates did not occur for services without volume control. The proportion of recent graduates providing exclusively cataract surgery increased over the study period, and recent graduates in this group were 5.24 times (95% CI 2.15 to 12.76 times) more likely to fall within the lowest quartile for cataract surgical volume during the period of zero growth in provincial cataract volume (2007-2013) than in the preceding period (1996-2006). INTERPRETATION Recent ophthalmology graduates performed many fewer cataract surgery procedures after volume controls were implemented in Ontario. Integrated initiatives involving multiple stakeholders are needed to address the issues facing recently graduated physicians in Canada.
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Affiliation(s)
- Robert J Campbell
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
| | - Sherif R El-Defrawy
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont
| | - Chaim M Bell
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont
| | - Sudeep S Gill
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont
| | - Philip L Hooper
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont
| | - Marlo Whitehead
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont
| | - Erica de L P Campbell
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont
| | - Robert Nesdole
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont
| | - Daniel Warder
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont
| | - Martin Ten Hove
- Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont
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