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Bougioukas L, Heiser A, Berg A, Polomsky M, Rokkas C, Hirashima F. Integrated cardiothoracic surgery match: Trends among applicants compared with other surgical subspecialties. J Thorac Cardiovasc Surg 2023; 166:904-914. [PMID: 35461707 DOI: 10.1016/j.jtcvs.2021.11.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate trends, qualifications, race/ethnicity, and gender of applicants to integrated cardiothoracic (CT I-6) residency programs and compare them with other competitive surgical subspecialties. METHODS Data were collected from the National Residency Matching Program, Electronic Residency Application Service, and Association of American Medical Colleges for thoracic surgery, orthopedic surgery, neurological surgery, otolaryngology (ENT), plastic surgery, and vascular surgery for 2010 t0 2020. Applicant gender, race/ethnicity, Alpha Omega Alpha (AOA) membership, United States Medical Licensing Examination scores, research productivity, and graduation from a top-40 medical school were analyzed. RESULTS From 2010 to 2020, CT I-6 experienced growth in postgraduate year 1 positions (280.0%), total applicants (62.2%), and US senior applicants (59.2%). No growth in CT I-6 positions (38) or programs (29) occurred from 2016 to 2020. CT I-6 had the lowest match rates among total applicants (31.7%) and US seniors (41.0%) in 2020. CT I-6 had fewer female applicants compared with ENT (P < .001) and plastic surgery (P < .001), but more than orthopedic surgery (P < .001). Although most CT I-6 US applicants self-identified as White (75.0%), there were more Asian applicants compared with applicants for orthopedic surgery (P < .001), ENT (P < .001), plastic surgery (P < .001), and neurological surgery (P < .01). Matched applicants averaged the highest Step 2-Clinical Knowledge scores (255.1), AOA membership (48.5%), and graduation rates from top-40 medical schools (54.5%). CONCLUSIONS Despite tremendous growth in positions, CT I-6 has consistently been the most difficult surgical subspecialty to match. CT I-6 has recently attracted an increasingly diverse applicant pool. For the 2019 to 2020 National Residency Matching Program Match Cycle, successful applicants had the highest Step 2-Clinical Knowledge scores, AOA membership rates, and graduation rates from a top-40 medical school among all surgical subspecialties examined.
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Affiliation(s)
- Lauren Bougioukas
- Division of Cardiothoracic Surgery, Department of Surgery, Larner College of Medicine at The University of Vermont, Burlington, Vt
| | - Alyssa Heiser
- Division of Cardiothoracic Surgery, Department of Surgery, Larner College of Medicine at The University of Vermont, Burlington, Vt
| | - Adrian Berg
- Division of Cardiothoracic Surgery, Department of Surgery, Larner College of Medicine at The University of Vermont, Burlington, Vt
| | - Marek Polomsky
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Vermont Medical Center, Burlington, Vt
| | - Chris Rokkas
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Vermont Medical Center, Burlington, Vt
| | - Fuyuki Hirashima
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Vermont Medical Center, Burlington, Vt.
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Silvestre J, Cevasco M. Comparing Match Outcomes in a Surgical Subspecialty: Independent Versus Integrated Training Pathways. JOURNAL OF SURGICAL EDUCATION 2023; 80:468-475. [PMID: 36464614 DOI: 10.1016/j.jsurg.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/31/2022] [Accepted: 11/12/2022] [Indexed: 06/17/2023]
Abstract
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.
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Deboever N, Bayley EM, Vaporciyan AA, Antonoff MB. Traits of the current traditional pathway cardiothoracic surgery training pool: Results of a cross-sectional study. J Thorac Cardiovasc Surg 2021; 165:1743-1750. [PMID: 34920868 DOI: 10.1016/j.jtcvs.2021.08.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/12/2021] [Accepted: 08/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE As new paradigms for cardiothoracic surgery training emerged in recent years, the traditional 2- or 3-year pathway has persisted as an option for trainees completing general surgery residencies. Although the applicant pool for 6-year integrated cardiothoracic surgery training programs has been superficially explored, little data exist characterizing those applicants to the traditional cardiothoracic surgery training pathway and the influence of 6-year integrated expansion on the traditional applicant pool. METHODS We reviewed materials from candidates applying to a single 2-year cardiothoracic surgery training program between 2015 and 2020. Descriptive and comparative analyses of multiple characteristics were performed over the years of the study. RESULTS During the years 2015 through 2020, we received 571 applications, accounting for 72% of the total National Residency Matching Program applicant pool. We saw no significant trends in numbers of peer-reviewed publications or presentations. There was a minimal year-to-year increase in number of first-authored posters, 2.04 in 2015 to 2.13 in 2020 (P = .008). Online publications, book chapters, and other publications were stable throughout the study period. Applicants consistently provided an average of 3.6 letters of recommendation, 1.9 from cardiothoracic surgery faculty. Mean in-service score percentiles were stable at the 54th percentile, whereas US Medical Licensing Examination scores increased. CONCLUSIONS Despite expansion of the 6-year integrated pathway to cardiothoracic surgery, we have seen no substantial year-to-year changes in attributes of traditional applicants. Our findings suggest that the cardiothoracic surgery applicant pool continues to be composed of a stable group of highly productive trainees. Future initiatives in candidate selection should emphasize interview strategies to highlight aspects of grit, emotional intelligence, and team dynamics.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Erin M Bayley
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
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Capdeville M. Gender Disparities in Cardiovascular Fellowship Training Among 3 Specialties From 2007 to 2017. J Cardiothorac Vasc Anesth 2019; 33:604-620. [DOI: 10.1053/j.jvca.2018.10.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Indexed: 11/11/2022]
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Stephens EH, Shah AA, Robich MP, Walters DM, DeNino WF, Aftab M, Tchantchaleishvili V, Eilers AL, Rice RD, Goldstone AB, Shelstad RC, Malas T, Cevasco M, Gillaspie EA, LaPar DJ. The Future of the Academic Cardiothoracic Surgeon: Results of the TSRA/TSDA In-Training Examination Survey. Ann Thorac Surg 2016; 102:643-50. [DOI: 10.1016/j.athoracsur.2016.01.106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/18/2016] [Accepted: 01/28/2016] [Indexed: 10/21/2022]
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Stephens EH, Odell D, Stein W, LaPar DJ, DeNino WF, Aftab M, Berfield K, Eilers AL, Groth S, Lazar JF, Robich MP, Shah AA, Smith DA, Stock C, Tchantchaleishvili V, Mery CM, Turek JW, Salazar J, Nguyen TC. A Decade of Change: Training and Career Paths of Cardiothoracic Surgery Residents 2003 to 2014. Ann Thorac Surg 2015; 100:1305-13; discussion 1313-4. [DOI: 10.1016/j.athoracsur.2015.04.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/15/2022]
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Meza JM, Rectenwald JE, Reddy RM. The Bias Against Integrated Thoracic Surgery Residency Applicants During General Surgery Interviews. Ann Thorac Surg 2015; 99:1206-12. [DOI: 10.1016/j.athoracsur.2014.11.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 11/06/2014] [Accepted: 11/24/2014] [Indexed: 11/25/2022]
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Varghese TK, Mokadam NA, Verrier ED, Wallyce D, Wood DE. Motivations and Demographics of I-6 and Traditional 5+2 Cardiothoracic Surgery Resident Applicants: Insights From an Academic Training Program. Ann Thorac Surg 2014; 98:877-83. [DOI: 10.1016/j.athoracsur.2014.04.120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/25/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
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Lebastchi AH, Tackett JJ, Argenziano M, Calhoon JH, Gasparri MG, Halkos ME, Hicks GL, Iannettoni MD, Ikonomidis JS, McCarthy PM, Starnes SL, Tong BC, Yuh DD. First nationwide survey of US integrated 6-year cardiothoracic surgical residency program directors. J Thorac Cardiovasc Surg 2014; 148:408-15.e1. [PMID: 24820188 PMCID: PMC4336151 DOI: 10.1016/j.jtcvs.2014.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/11/2014] [Accepted: 04/03/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The recently implemented integrated 6-year (I-6) format represents a significant change in cardiothoracic surgical residency training. We report the results of the first nationwide survey assessing I-6 program directors' impressions of this new format. METHODS A 28-question web-based survey was distributed to program directors of all 24 Accreditation Council for Graduate Medical Education-accredited I-6 training programs in November 2013. The response rate was a robust 67%. RESULTS Compared with graduates of traditional residencies, most I-6 program directors with enrolled residents believed that their graduates will be better trained (67%), be better prepared for new technological advances (67%), and have superior comprehension of cardiothoracic disease processes (83%). Just as with traditional program graduates, most respondents believed their I-6 graduates would be able to independently perform routine adult cardiac and general thoracic operations (75%) and were equivocal on whether additional specialty training (eg, minimally invasive, heart failure, aortic) was necessary. Most respondents did not believe that less general surgical training disadvantaged I-6 residents in terms of their career (83%); 67% of respondents would have chosen the I-6 format for themselves if given the choice. The greater challenges in training less mature and experienced trainees and vulnerability to attrition were noted as disadvantages of the I-6 format. Most respondents believed that I-6 programs represent a natural evolution toward improved residency training rather than a response to declining interest among medical school graduates. CONCLUSIONS High satisfaction rates with the I-6 format were prevalent among I-6 program directors. However, concerns with respect to training relatively less experienced, mature trainees were evident.
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Affiliation(s)
- Amir H Lebastchi
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - John J Tackett
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Michael Argenziano
- Section of Cardiac Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY
| | - John H Calhoon
- Division of Thoracic Surgery, University of Texas Health Science Center, San Antonio, Tex
| | - Mario G Gasparri
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - George L Hicks
- Division of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY
| | - Mark D Iannettoni
- Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - John S Ikonomidis
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Sandra L Starnes
- Division of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - David D Yuh
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
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Lebastchi AH, Yuh DD. Nationwide survey of US integrated 6-year cardiothoracic surgical residents. J Thorac Cardiovasc Surg 2014; 148:401-7. [DOI: 10.1016/j.jtcvs.2014.03.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/10/2014] [Accepted: 03/21/2014] [Indexed: 11/30/2022]
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Kansier N, Varghese TK, Verrier ED, Drake FT, Gow KW. Accreditation Council for Graduate Medical Education case log: general surgery resident thoracic surgery experience. Ann Thorac Surg 2014; 98:459-64; discussion 464-5. [PMID: 24968766 DOI: 10.1016/j.athoracsur.2014.04.122] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/24/2014] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Nicole Kansier
- Department of Surgery, University of Washington, Seattle, Washington.
| | - Thomas K Varghese
- Department of Surgery, University of Washington, Seattle, Washington; Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| | - Edward D Verrier
- Department of Surgery, University of Washington, Seattle, Washington; Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| | - F Thurston Drake
- Department of Surgery, University of Washington, Seattle, Washington
| | - Kenneth W Gow
- Department of Surgery, University of Washington, Seattle, Washington; Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
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Ikonomidis JS, Crawford FA, Fann JI. Integrated Surgical Residency Initiative: Implications for Cardiothoracic Surgery. Semin Thorac Cardiovasc Surg 2014; 26:14-23. [DOI: 10.1053/j.semtcvs.2014.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/11/2022]
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Griffith BP. The eggs may be teaching the chickens. Ann Thorac Surg 2013; 96:1520-1524. [PMID: 24088480 DOI: 10.1016/j.athoracsur.2013.05.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 02/04/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
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Tchantchaleishvili V, Barrus B, Knight PA, Jones CE, Watson TJ, Hicks GL. Six-year integrated cardiothoracic surgery residency applicants: Characteristics, expectations, and concerns. J Thorac Cardiovasc Surg 2013; 146:753-8. [DOI: 10.1016/j.jtcvs.2013.05.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 05/05/2013] [Accepted: 05/23/2013] [Indexed: 11/28/2022]
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Comparison of Cardiothoracic Training Curricula: Integrated Six-Year Versus Traditional Programs. Ann Thorac Surg 2013; 95:2051-4; discussion 2054-6. [DOI: 10.1016/j.athoracsur.2013.02.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/15/2013] [Accepted: 02/19/2013] [Indexed: 11/21/2022]
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Vaithianathan R, Panneerselvam S. Emerging alternative model for cardiothoracic surgery training in India. MEDICAL EDUCATION ONLINE 2013; 18:1-4. [PMID: 23651927 PMCID: PMC3647042 DOI: 10.3402/meo.v18i0.20961] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 03/28/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND In India, cardiothoracic (CT) surgery training follows a 3+3-year model, where 3 years of general surgery residency with certification (MS/DNB) is required for entering 3 years of thoracic surgery residency (MCh/DNB). There are two certifying boards at the national level. One being the Medical Council of India (MCI), which oversees the major accreditation process involving the undergraduate and postgraduate medical education in India, and the other being the National Board of Examinations (NBE), which was formed for the purpose of establishing a uniform standard of postgraduate medical education. Recently, the latter body has come up with an alternative model for thoracic surgery residency in India. This model includes an integrated 6-year residency, with lesser emphasis on general surgical skills and greater exposure to CT surgery. CONCLUSIONS Changes to the current model of training for CT surgery is the need of the hour and should be initiated very soon by the MCI to meet the future demand for CT surgeons in India. An integrated training program is essential to create a new generation of cardiovascular specialists. Future directions to achieve this goal must include modifications to the undergraduate programs so as to infuse interest for CT surgery in the young minds of medical students.
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Sullivan MC, Yeo H, Roman SA, Ciarleglio MM, Cong X, Bell RH, Sosa JA. Surgical Residency and Attrition: Defining the Individual and Programmatic Factors Predictive of Trainee Losses. J Am Coll Surg 2013; 216:461-71. [DOI: 10.1016/j.jamcollsurg.2012.11.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 11/03/2012] [Accepted: 11/14/2012] [Indexed: 10/27/2022]
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Masroor S, Gasparri M. Invited commentary. Ann Thorac Surg 2011; 92:1591-2. [PMID: 22051255 DOI: 10.1016/j.athoracsur.2011.06.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Saqib Masroor
- Cardiothoracic Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
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