The 2010 Thoracic Surgery Residents Association Workforce Survey Report: A View From the Trenches⁎⁎The authors comprise the Thoracic Surgery Residents Association Executive Committee

Comparing Match Outcomes in a Surgical Subspecialty: Independent Versus Integrated Training Pathways

OBJECTIVE

In recent years, the Thoracic Surgery Match (TSM) has become increasingly competitive. The purpose of this study was to compare recent trends in application and match rates in the TSM by training pathway.

DESIGN

This was a retrospective cohort study of all applicants to Integrated and Independent pathways for Thoracic Surgery training (2008-2021). Chi square tests were used to elucidate temporal trends and make comparisons by training pathway.

SETTING

Accreditation Council for Graduate Medical Education (ACGME)-accredited Thoracic Surgery training programs in the United States.

PARTICIPANTS

1500 Independent and 1242 Integrated pathway applicants for Thoracic Surgery training.

RESULTS

From 2008 to 2021, the annual match rate decreased from 91% to 71% in the Independent pathway (p < 0.001). This was driven by a decrease in the number of training positions (130-101, 22% decrease) and increase in number of applicants (96-140, 46% increase). In the Integrated pathway, the annual match rate increased from 33% to 35% (p < 0.001) as did the number of training positions (3 to 46, 1430% increase) and applicants (9-129, 1333% increase). During each year, match rates in the Independent pathway exceeded those in the Integrated pathway (p < 0.001). U.S. Allopathic graduates had higher match rates than non-U.S. Allopathic graduates for both Integrated and Independent training pathways. The percentage of applicants in the Independent pathway matching at one of their top 3 choices decreased from 73% to 40% (p < 0.001). The percentage of Independent thoracic surgery training positions that went unmatched decreased from 28% to 2% (p < 0.001). This percentage was stable at an average of 1% in the Integrated pathway (p > 0.05).

CONCLUSIONS

The TSM has become increasingly competitive for Independent pathway applicants and remains ultracompetitive for Integrated pathway applicants. More research is needed to understand disparities in match rates by Thoracic Surgery training pathway.

The utilization of educational resources published by the Thoracic Surgery Residents Association

OBJECTIVE

The Thoracic Surgery Residents Association (TSRA) is a trainee-led cardiothoracic surgery organization in North America that has published a multitude of educational resources. However, the utilization of these resources remains unknown.

METHODS

Surveys were constructed, pilot-tested, and emailed to 527 current cardiothoracic trainees (12 questions) and 780 former trainees who graduated between 2012 and 2019 (16 questions). The surveys assessed the utilization of TSRA educational resources in preparing for clinical practice as well as in-training and American Board of Thoracic Surgery (ABTS) certification examinations.

RESULTS

A total of 143 (27%) current trainees and 180 (23%) recent graduates responded. A higher proportion of recent graduates compared with current trainees identified as male (84% vs 66%; P = .001) and graduated from 2- or 3-year traditional training programs (81% vs 41%; P < .001), compared with integrated 6-year (8% vs 49%; P < .001) or 4 + 3 (11% vs 10%; P = .82) pathways. Current trainees most commonly used TSRA resources to prepare for the in-training exam (75%) and operations (73%). Recent graduates most commonly used them to prepare for Oral and/or Written Board Exams (92%) and the in-training exam (89%). Among recent graduates who passed the ABTS Oral Board Exam on the first attempt, 82% (97/118) used TSRA resources to prepare, versus only 48% (25/52) of recent graduates who passed after multiple attempts, failed, have not taken the exam, or preferred not to answer (P < .001).

CONCLUSIONS

Current cardiothoracic trainees and recent graduates have utilized TSRA educational resources extensively, including to prepare for in-training and ABTS Board examinations.

CHEST Watch: A High School Outreach Program

As the US population ages, health care workforce shortages are projected in surgery, medicine, and nursing. We describe an outreach program aimed at exposing high school students to health care as a career choice while emphasizing science courses and prevention of tobacco use. High school students were invited to participate in CHEST Watch, a structured educational program based on thoracic pathology. Before students attended the program, parental consent was collected. Students engaged in a discussion with multiple professionals (physicians, nurses, smoking cessation counselors, social workers, basic science researchers) who presented their personal motivation and information about the corresponding career. Participants then observed a lung cancer surgery. A strong anti-tobacco message was emphasized throughout. Before and after the event, the participants completed anonymous opinion surveys which queried their interest in science, health care careers, and tobacco use. The Cochran-Mantel-Haenszel test was used for trend analysis. A total of 4400 students from 84 schools attended CHEST Watch over 15 years. A significant increase in the students' interest in health care careers and science courses (P-value 0.0001) and a significant decrease in tobacco use interest (P-value 0.0001) were observed. Overall, feedback was strongly positive and very popular within the school systems. The CHEST Watch program is an innovative approach intended to recruit youth into health care careers to address projected future shortages in the workforce. Furthermore, the participants' experience resulted in an increasingly positive attitude towards personal health and a decreased interest in use of tobacco products.

The Thoracic Surgery Residents Association: Past contributions, current efforts, and future directions

OBJECTIVE

The Thoracic Surgery Residents Association (TSRA) is a resident-led organization established in 1997 under the guidance of the Thoracic Surgery Directors Association to represent the interests and educational needs of cardiothoracic surgery residents. We aim to describe the past contributions, current efforts, and future directions of the TSRA within a conceptual framework of the TSRA mission.

METHODS

Primary review of educational resources was performed to report goals and content of past contributions. TSRA Executive Committee input was used to describe current resources and activities, as well as the future goals of the TSRA. Podcast analytics were performed to report national and global usage.

RESULTS

Since 2011, the TSRA has published 3 review textbooks, 5 reference guides, 3 test-preparation textbooks, 1 supplementary publication, and 1 multiple-choice question bank and mobile application, all written and developed by cardiothoracic surgery trainees. In total 108 podcasts have been recorded by mentored trainees, with more than 175,000 unique listens. Most recently, the TSRA has begun facilitating trainee submissions to Young Surgeon's Notes, fostered a trainee mentorship program, developed the monthly TSRA Newsletter, and established a wide-reaching presence on Facebook, Twitter, and Instagram to help disseminate educational resources and opportunities for trainees.

CONCLUSIONS

The TSRA continues to be the leading cardiothoracic surgery resident organization in North America, providing educational resources and networking opportunities for all trainees. Future directions include development of an integrated disease-based resource and continued collaboration within and beyond our specialty to enhance the educational opportunities and career development of cardiothoracic trainees.

Super Fellowships Among Cardiothoracic Trainees: Prevalence and Motivations

BACKGROUND

After completing traditional fellowship or integrated residency in cardiothoracic surgery, many trainees spend time in nonaccredited "super fellowships." The prevalence and motivations for pursuing super fellowships are unknown.

METHODS

A survey was distributed to all 776 cardiothoracic surgery graduates who completed training between 2008 and 2019. The number of graduates was used as the denominator to calculate response rate. Comparisons between responses were made using Fisher's exact test.

RESULTS

Over an 8-week period, 261 surveys were completed with a response rate of 34%. The majority were traditional graduates (75%), for example, not integrated residents, and of those, 64% did a 2-year program. The majority (60%) did not pursue super fellowships. Among those who did complete a super fellowship, areas of training included congenital, transplantation, aortic pathology, valvular disease, and other. Among the 90 who completed super fellowships, reasons included "congenital" (34%), "felt training inadequate" (28%), "required for position" (24%), "personal" (6%), and "other" (8%). Among the 25 who selected "training inadequate," 32% focused in general thoracic-related areas. There was no relationship between length of traditional training (2 vs 3 years) and completing additional training (P = .17), but there was a significant association between completing a traditional track versus integrated residency and pursuing a super fellowship (P = .02).

CONCLUSIONS

Additional training in cardiothoracic surgery is common. The reasons for further instruction are varied but relate to readiness and need for specialized skills. Program directors should consider employers' needs to ensure trainees graduate with the necessary skills for future practice.

Initial report on young cardiothoracic surgeons' first job: From searching to securing and the gaps in between

OBJECTIVE

Recent industry studies have projected a deficit in cardiothoracic surgeons by 2030. Little is known about the difficulties of the job search process after cardiothoracic training. The purpose of this study is to explore the current practices of the first job hunt and contract negotiation for young cardiothoracic surgeons, and to identify the gaps in resources available to applicants.

METHODS

In October 2017, a 56-question survey was e-mailed to recent (2013-2017) board-certified cardiothoracic surgeons in the United States inquiring about their experience securing their first cardiothoracic job. The survey was administered via REDCap, and responses were accepted over 3 months.

RESULTS

The response rate was 12.8% (61/475). The majority of cardiothoracic program graduates (86.9%) interviewed for jobs between October and March of their final cardiothoracic training year, and 79.7% of contracts were signed before completing training. Sixty-four percent of respondents negotiated their first contract. The most influential factor in job selection was partner mentorship. Average starting pretax salary for respondents was $375,588 (±$107,265). More than half of respondents reported needing more resources and support for the identification (59%) and comparison (54.1%) of job opportunities, contract negotiation (70.5%), and salary guidelines navigation (77%).

CONCLUSIONS

Little guidance exists to support the search and securing of young cardiothoracic surgeons' first employment. Resources, whether institutional or organizational, are sparse and difficult to tailor to individual needs. Given the potential ramification of early career decisions, focused support is needed to remediate the lack of preparation available to the newest generations of cardiothoracic surgeons.

Accreditation Council for Graduate Medical Education case log: general surgery resident thoracic surgery experience

BACKGROUND

General surgery resident training has changed dramatically over the past 2 decades, with likely impact on specialty exposure. We sought to assess trends in general surgery resident exposure to thoracic surgery using the Accreditation Council for Graduate Medical Education (ACGME) case logs over time.

METHODS

The ACGME case logs for graduating general surgery residents were reviewed from academic year (AY) 1989-1990 to 2011-2012 for defined thoracic surgery cases. Data were divided into 5 eras of training for comparison: I, AY89 to 93; II, AY93 to 98; III, AY98 to 03; IV, AY03 to 08; V, AY08 to 12. We analyzed quantity and types of cases per time period. Student t tests compared averages among the time periods with significance at a p values less than 0.05.

RESULTS

A total of 21,803,843 general surgery cases were reviewed over the 23-year period. Residents averaged 33.6 thoracic cases each in period I and 39.7 in period V. Thoracic cases accounted for nearly 4% of total cases performed annually (period I 3.7% [134,550 of 3,598,574]; period V 4.1% [167,957 of 4,077,939]). For the 3 most frequently performed procedures there was a statistically significant increase in thoracoscopic approach from period II to period V.

CONCLUSIONS

General surgery trainees today have the same volume of thoracic surgery exposure as their counterparts over the last 2 decades. This maintenance in caseload has occurred in spite of work-hour restrictions. However, general surgery graduates have a different thoracic surgery skill set at the end of their training, due to the predominance of minimally invasive techniques. Thoracic surgery educators should take into account these differences when training future cardiothoracic surgeons.

Trends in applications for thoracic fellowship in comparison with other subspecialties

BACKGROUND

Length of training (LOT), lifestyle, and decreasing reimbursement have been credited with contributing to the decline in applications to thoracic surgery (TS). Other surgical specialties share similarities in LOT and lifestyle; however, trends in applications for these specialties have not been compared. One cannot look at applications to TS without examining concurrent changes in the pool of residents finishing general surgery. To clarify the relative impact of LOT, lifestyle, applicant pool, and reimbursement on applications to TS, we analyzed these trends concurrently.

METHODS

National Resident Matching Program residency and fellowship match placement data (1997 to 2012) for general, TS, pediatric, transplant, and vascular surgery, including integrated TS and vascular surgery, were analyzed. Corresponding trends in reimbursement were analyzed from Medical Group Management Association data (1996 to 2010).

RESULTS

During the study period, percentage of medical students matching into general surgery has remained relatively constant (4.9% to 5.5%). Applications for TS have declined since 1997. Applications for pediatric and transplant surgery have increased. Vascular surgery has remained relatively constant, with an applicant to position ratio approximately 1:1. Integrated programs (thoracic and vascular) have been popular; 3 to 7.4 applicants per position and 2 to 3.47 applicants per position, respectively. Cardiovascular surgery median salaries have remained largely the same; salaries for general thoracic, pediatric, transplant, and vascular surgery have increased (1.95% to 7.13% per year) although cardiovascular surgeons continue to have the highest median salary.

CONCLUSIONS

Given the above data, it does not appear that LOT is the critical issue associated with the decline in fellowship applications for TS. The increased demand for integrated training programs may be reflective of other factors rather than LOT. The success of abbreviated programs in training competent thoracic surgeons has not yet been determined. Given that LOT does not appear to affect applications to surgical specialty, we may be able to maintain applications to the specialty without compromising LOT.

Spouses of thoracic surgery applicants: changing demographics and motivations in a new generation

INTRODUCTION

Applications to thoracic residency have decreased. The causes are multifactorial, but include changing motivations such as lifestyle concerns. Thoracic residents (TRs) have been well studied, but no one has ever characterized the influence or motivations of their spouses. We sought to evaluate the demographics and interests of TR spouses.

METHODS

An electronic survey was sent to all TR applicants over 2 years at 2 training programs and to all current TRs in 2010. Recipients were asked to forward the survey to their spouses. Responses were analyzed globally and compared in subgroups.

RESULTS

Sixty-six surveys were completed and returned for a response rate of 19%. Among them, 86% of respondents were female, with 82% being married for a mean of 4.3 years. Fifty-nine percent of respondents had children and 64% were planning on having more children within 3 years. Hundred percent felt optimistic that they would be financially stable after training, but only 57% were optimistic about quality of life after training. Eighty-four percent felt that they had influence on the choice of training program. Almost 80% wanted more information on salary, housing, and access to faculty spouses. Quality of fellowship, geographic location, and proximity to family were the top 3 factors in choosing a program.

CONCLUSIONS

Nearly 90% of respondents reported they want to travel to more interviews, and nearly 90% of respondents reported having some to complete influence over which training program to attend. It is safe to presume, therefore, that applicant spouses are not only highly influential on TR applicants but also interested in greater inclusion in the interview process. The results show numerous demographic and characteristic trends which, if further validated by definitive studies, would be applicable to all post-surgery residency training programs and may help TR programs to be more competitive in attracting applicants and their families.