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Gikandi A, Stock E, DeMatt E, Hirji S, Awtry J, Quin JA, Tolis G, Biswas K, Zenati MA. Performance of left internal thoracic artery-left anterior descending artery anastomosis by residents versus attendings and coronary artery bypass grafting outcomes. Eur J Cardiothorac Surg 2024; 65:ezae155. [PMID: 38598201 DOI: 10.1093/ejcts/ezae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES Performance of a technically sound left internal thoracic artery to left anterior descending artery (LITA-LAD) anastomosis during coronary artery bypass grafting (CABG) is critically important. We used prospectively collected data from the multicentre, randomized REGROUP (Randomized Endograft Vein Perspective) trial to investigate CABG outcomes based on whether a resident or an attending surgeon performed the LITA-LAD anastomosis. METHODS This was a post hoc subanalysis of the REGROUP trial, which randomized veterans undergoing isolated on-pump CABG to endoscopic versus open vein harvest from 2014 through 2017. The primary end point was major cardiac adverse events, defined as the composite of all-cause deaths, nonfatal myocardial infarctions or repeat revascularizations. RESULTS Among 1,084 patients, 344 (31.8%) LITA-LAD anastomoses were performed by residents and 740 (68.2%), by attending surgeons. Residents (compared to attendings) operated on fewer patients with high tercile SYNTAX scores (22.1% vs 37.4%, P < 0.001), performed fewer multiarterial CABGs (5.2% vs 14.6%, P < 0.001) and performed more anastomoses to distal targets with diameters > 2.0 mm (19.0% vs 10.9%, P < 0.001) and non-calcified landing zones (25.1% vs 21.6%, P < 0.001). During a median observation time of 4.7 years (interquartile range 3.84-5.45), major cardiac adverse events occurred in 77 patients (22.4%) in the group treated by residents and 169 patients (22.8%) in the group treated by attendings (unadjusted HR 1.00; 95% confidence interval, 0.76-1.33; P = 0.99). Outcomes persisted on adjusted analyses. CONCLUSIONS Based on this REGROUP trial subanalysis, under careful supervision and with appropriate patient selection, LITA-LAD anastomoses performed by the residents yielded clinical outcomes similar to those of the attendings.
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Affiliation(s)
- Ajami Gikandi
- Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eileen Stock
- VA Cooperative Studies Program Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, MD, USA
| | - Ellen DeMatt
- VA Cooperative Studies Program Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, MD, USA
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jake Awtry
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacquelyn A Quin
- Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - George Tolis
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kousick Biswas
- VA Cooperative Studies Program Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, MD, USA
| | - Marco A Zenati
- Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Wilder FG, Han JJ. Finding the Right Mentor. Thorac Surg Clin 2024; 34:1-7. [PMID: 37953046 DOI: 10.1016/j.thorsurg.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Quality mentorship is essential for a successful career in cardiothoracic surgery. From the premedical phase to the position of senior faculty, there are many benefits to having mentors who can provide insight, promote career advancement and facilitate professional opportunities. It is important to distinguish between a mentor and sponsor in seeking this career guidance because both are beneficial but serve different purposes. By being clear about one's professional goals, the mentor-mentee relationship can be optimized and lead to a fulfilling and productive career.
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Affiliation(s)
- Fatima G Wilder
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
| | - Jason J Han
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Civic Center Boulevard East Pavilion, 2nd Floor, Philadelphia, PA 19104, USA
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Tolis G, Piechura LM, Mohan N, Pomerantsev EV, Hirji SA, Bloom JP. Operative Teaching of Coronary Bypass and Need for Repeat Catheterization: Does it Matter Who is Sewing? JOURNAL OF SURGICAL EDUCATION 2023; 80:826-832. [PMID: 37080797 DOI: 10.1016/j.jsurg.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/22/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE There are no studies to date comparing the patency of coronary bypass grafts constructed by attending surgeons versus trainees and the potential consequences of any such disparities. We explored this issue by comparing the patency of individual anastomoses performed by residents versus the attending surgeon. DESIGN We reviewed 765 continuous cases performed by a single surgeon which involved at least 1 coronary bypass anastomosis, totaling 2,173 distal anastomoses. At a median follow-up time of 36 months (interquartile range 20.5-47.3), 83 (10.9%) patients had undergone 110 cardiac catheterization procedures after their original operation for various indications. This angiographic information provided the data for our comparison cohorts. SETTING Cardiac surgery practice within an academic setting PARTICIPANTS: Adult patient undergoing coronary bypass grafting RESULTS: Of the 83 patients that underwent repeat catheterization, 23 (27.7%) were resident cases, 25 (30.1%) were attending cases and 35 (42.2%) were mixed. There were 4/83 (4.8%) patients with angiographic evidence of internal mammary artery graft compromise of which 3/4 (75%) had been constructed by the attending surgeon. Angiographic evidence of saphenous vein graft compromise was appreciated in 16/83 (19.3%) patients of which 9/16 (56.3%) of the grafts were constructed by the attending surgeon. CONCLUSIONS Liberal involvement of surgical trainees as primary operators in coronary revascularization cases led to equivalent rates of postoperative ischemic complications between the attending and resident groups. The outcome equivalence was also maintained when evaluated at the individual anastomosis patency level between the 2 groups. We conclude that academic programs should continue providing trainees significant experience as primary operating surgeons without fear of clinical outcome compromise.
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Affiliation(s)
- George Tolis
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Laura M Piechura
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Navyatha Mohan
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Eugene V Pomerantsev
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Sameer A Hirji
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jordan P Bloom
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Nawalaniec JT, Elson M, Reznik SI, Wait MA, Peltz M, Jessen ME, Madrigales A, Lysikowski J, Kernstine KH. Training Cardiothoracic Residents in Robotic Lobectomy Is Cost-Effective With No Change in Clinical Outcomes. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:127-135. [PMID: 35341368 DOI: 10.1177/15569845221086278] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Our objective was to evaluate for any changes in quality or cost when robotic lung resection is used with significant trainee participation. Methods: All anatomic lung resections between January 2006 and June 2016 were identified from a prospectively maintained database. Clinical data were recorded by double entry. Cost and cancer-related data were gathered from the business analytics department and tumor registry. Robotic outcomes were compared to an ongoing thoracotomy and video-assisted thoracic surgery (VATS) experience. Propensity scores using age, sex, and comorbidities were assigned for statistical analysis. Survival was evaluated using the Kaplan-Meier method. Results: Of 523 consecutive cases, 483 were included (211 robotic, 210 thoracotomy, 62 VATS). There were 74 robotic cases (35%) performed by trainees as the console surgeon. Length of stay was shortest for robotics (3 days) compared to thoracotomy (7 days, P < 0.001) and VATS (5 days, P = 0.010). Complications occurred in 33% of robotic cases, 42% of VATS cases (P = 0.854), and 52% of thoracotomy cases (P < 0.001). Stage I non-small cell lung cancer 3-year overall survival for robotics, thoracotomy, and VATS was 79.5%, 74.3%, and 74.0%, respectively (P > 0.25). There was no significant difference in negative margin rates. Total cost related to the hospitalization for surgery was $5,721 less for robotics compared to thoracotomy (P = 0.003) but comparable to VATS. Trainees served as console surgeon in 0% of cases in the first 2 years of robotics but increased to 79% in the last year of the study. Conclusions: Robotic lung resection can be safely performed and taught in an academic medical center without sacrificing quality or cost.
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Affiliation(s)
- James T Nawalaniec
- Department of Surgery, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Elson
- Department of Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott I Reznik
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alejandra Madrigales
- Tumor Registry, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jerzy Lysikowski
- Biostatistics, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kemp H Kernstine
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
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Alicuben ET, Wightman SC, Shemanski KA, David EA, Atay SM, Kim AW. Training residents in robotic thoracic surgery. J Thorac Dis 2021; 13:6169-6178. [PMID: 34795968 PMCID: PMC8575838 DOI: 10.21037/jtd-2019-rts-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/12/2020] [Indexed: 11/06/2022]
Abstract
With growing integration of robotic technology in thoracic surgery, the need for structured training has never been greater with trainees expressing desire for additional experience. Determining the ideal education program is challenging as the collective experience is still relatively early and growing with many experienced surgeons still becoming facile with the platform. Understanding differences between robotic and thoracoscopic approaches including lung retraction and dissection, use of carbon dioxide insufflation, and lack of tactile feedback serves as the foundation for building a skillset. Currently, there is no standard accepted curriculum for residents. Inclusion of these trainees in structured programs has been shown to be safe with equivalent patient outcomes. There are multiple curricula under development, all of which incorporate use of simulation technology, dual console, and clear, graduated responsibilities within operations. These include introduction to the robotic system prior to progressing to bedside assistance and finally to time as console surgeon. The importance of clear definition of training milestones with deliberate graduation to more complex tasks once competency has been demonstrated cannot be overstated. It is crucial for surgeons practicing robotic surgery to make efforts to further the training of residents, but there has not been any perfect and suitable program identified yet.
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Affiliation(s)
- Evan T Alicuben
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sean C Wightman
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kimberly A Shemanski
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth A David
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Luc JGY, Nguyen TC, Ad N. Impact of the Coronavirus Disease 2019 Pandemic on Cardiac Surgical Education in North America. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:350-357. [PMID: 34167378 DOI: 10.1177/15569845211011459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We report the impact of the coronavirus disease 2019 (COVID-19) pandemic on cardiac surgery trainee education in North America. METHODS A survey was sent to participating academic adult cardiac surgery centers in North America. Data regarding the effect of COVID-19 on cardiac surgery training were analyzed. RESULTS Responses were received from 53 academic institutions with diverse geographic distribution. Cardiac surgery trainee re-deployment to alternative clinical duties peaked at the height of the pandemic. We stratified institutions based on high (n = 20) and low burden (n = 33) of patients hospitalized with COVID-19. The majority of institutions have converted didactics (high burden 90% vs low burden 73%) and interviews for jobs/fellowships (high burden 75% vs low burden 73%) from in-person to virtual. Institutions were mixed in preference for administration of the licensing examination, with the most common preference for examinations to be held remotely on normal timeline (high burden 45% vs low burden 30%) or in person with more than 3-month delay (high burden 20% vs low burden 33%). Despite the challenges experienced during the COVID-19 pandemic on trainee clinical experience, re-deployment, and decreased operative volume, institutions expected their trainees to graduate on schedule (high burden 95% vs low burden 91%). CONCLUSIONS Our study demonstrates that actions taken during the COVID-19 pandemic has led to disruptions in cardiac surgery training with transition of didactics and interviews virtually and re-deployment to alternative duties. Despite this, institutions remain optimistic that their trainees will graduate on schedule.
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Affiliation(s)
- Jessica G Y Luc
- 8166 Division of Cardiovascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, TX, USA
| | - Niv Ad
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Adventist White Oak Medical Center, Silver Spring, MD, USA
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Constants and Currents in the Education and Training of General Thoracic Surgeons. Thorac Surg Clin 2021; 31:303-308. [PMID: 34304838 DOI: 10.1016/j.thorsurg.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Teaching multiple, evolving surgical approaches to thoracic surgical residents at a time of decreasing surgeon volume, increasing scrutiny of quality, greater demands on surgical efficiency, and reduced resident work hours requires a new mindset and new methods of education. The challenge presented to general thoracic surgeon educators and residents is explained, and encouragement is drawn from the examples of previous educational crises and their solutions.
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Muller Moran HR, Maurice-Ventouris M, Alharbi M, Harley JM, Lachapelle KJ. A scoping review to identify competencies for transcatheter cardiovascular procedures. J Thorac Cardiovasc Surg 2020; 164:e457-e469. [PMID: 33485666 DOI: 10.1016/j.jtcvs.2020.11.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Transcatheter procedures are increasingly being recognized as a priority for cardiac surgeons and cardiac surgery trainees. The optimal method of teaching these procedures during residency training has not been established. We used an evidence-based approach to systematically review the literature and identify competencies to inform future paradigms of transcatheter training in cardiac surgery. METHODS A scoping review was conducted to retrieve relevant literature on the performance of transcatheter cardiovascular procedures, identify competencies required by surgical residents learning to perform these procedures, and develop a preliminary list of competencies for consideration during transcatheter training. MEDLINE, Scopus, and ERIC were queried until April 1, 2020, using a systematic search strategy. No limitations were placed on publication date or type. RESULTS A total of 1456 sources of evidence were retrieved. After deduplication and screening, there remained 33 that were included in the scoping review, published between 2006 and 2020. The distribution of publication types included 10 comparative studies (30.3% of total), 8 societal statements (24.2% of total), 5 surveys and 5 opinion articles (each 15.2% of total), 2 editorials and 2 descriptions of a simulator (each 6.1% of total), and 1 narrative review (3.0% of total). From these, a total of 400 items were identified and organized into 97 competencies. CONCLUSIONS Evidence on the competencies required to perform transcatheter cardiovascular procedures is available from a variety of sources. The identified competencies may be a useful resource for developing curricula and teaching transcatheter procedures to cardiac surgery residents.
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Affiliation(s)
- Hellmuth R Muller Moran
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Mohammed Alharbi
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Jason M Harley
- Department of Surgery, McGill University, Montreal, Quebec, Canada
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Mentorship Effectiveness in Cardiothoracic Surgical Training. Ann Thorac Surg 2020; 112:645-651. [PMID: 33011166 DOI: 10.1016/j.athoracsur.2020.07.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mentoring is an essential component of cardiothoracic surgery training, yet trainees report varied experiences despite substantial efforts to enhance mentorship opportunities. This study aimed to evaluate mentorship effectiveness and identify gaps in mentorship education. METHODS A survey was distributed to cardiothoracic surgical trainees in Accreditation Council for Graduate Medical Education-accredited programs (n = 531). Responses to 16 questions concerning trainee experiences, expectations, and perspectives on mentorship were collected. An 11-component mentorship effectiveness tool generated a composite score (0 to 55), with a score of 44 or lower indicating less effective mentorship. RESULTS Sixty-seven residents completed the survey (12.6%), with most (83.6%) reporting a current mentor. Trainees with mentors cited "easy to work with and approachable" (44 of 58; 75.9%) as the major criterion for mentor selection, whereas trainees without a mentor reported an inability to identify one who truly reflected the resident's needs (6 of 11; 45.5%). Resident age, gender, race or ethnicity, marital status, family status, postgraduate year, and training program type or size were not associated with having a mentor (P = .15 to .73). The median mentorship effectiveness score was 51 (interquartile range, 44, 55). More than one-third of residents (25 of 67) had either no mentor (n = 6) or less effective mentorship (n = 16), or both (n = 3). Resident and program characteristics were not associated with mentorship effectiveness (P = .39 to .99). Finally, 61.2% of residents had not received education on effective mentorship, and 53.8% did not currently serve as a mentor. CONCLUSIONS Many resident respondents have either no mentor or less effective mentorship, and most reported not having received education on mentorship. Addressing these gaps in mentorship training and delivery should be prioritized.
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Abstract
Robotic technology is positioned to transform the approach to tracheobronchial surgery. With its magnified 3D view, intuitive controls, wristed-instruments, high-fidelity simulation platforms, and the steady implementation of new technical improvement, the robot is well-suited to manage the careful dissection and delicate handling of the airway in tracheobronchial surgery. This innovative technology has the potential to promote the widespread adoption of minimally invasive techniques for this complex thoracic surgery.
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Affiliation(s)
- Brian D Cohen
- General Surgery Residency Program, MedStar Georgetown/Washington Hospital Center, Washington DC, USA
| | - M Blair Marshall
- Division of Thoracic Surgery, Brigham and Women's Hospital, Faculty, Harvard Medical School, Boston, MA, USA
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Al-Shaqsi S, Hong B, Austin RE, Wanzel K. Practice Management Knowledge Amongst Plastic Surgery Residents in Canada: A National Survey. Aesthet Surg J Open Forum 2020; 2:ojaa024. [PMID: 33791648 PMCID: PMC7671285 DOI: 10.1093/asjof/ojaa024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
Business and practice management principles are critical components of healthcare provision. Business and practice management is currently undertaught in plastic surgery training programs. The objective was to assess the status of business and practice management teaching amongst plastic surgery programs in Canada. An online survey of all enrolled plastic surgery residents was conducted in 2019 to 2020. Participants were invited to rate their knowledge and confidence about core principles in business and practice management. Sixty-five out of 126 residents responded to this survey (response rate, 51.6%). Only 7.8% of participants had previous business and practice management training; 23.1% reported receiving training in business and practice management during their residency. Participants reported a low level of knowledge and confidence in business and practice management (average Likert score between 3 and 4). Participants reported a high desire for future training in business and practice management particularly in billing and coding (91.2%) and business operations (91.2%). Plastic surgery residents in Canada reported a low level of knowledge and confidence about business and practice management. They desire the inclusion of business and practice management training in future curriculum.
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Affiliation(s)
- Sultan Al-Shaqsi
- Division of Plastic and Reconstructive Surgery, The University of Toronto, ON, Canada
| | - Brian Hong
- Division of Plastic and Reconstructive Surgery, The University of Toronto, ON, Canada
| | - Ryan E Austin
- Division of Plastic and Reconstructive Surgery, The University of Toronto, ON, Canada
| | - Kyle Wanzel
- Division of Plastic and Reconstructive Surgery, The University of Toronto, ON, Canada
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Massard G, Tabin N, Konge L, Frick AE, Batirel H, Brunelli A, Elia S, Huertgen M, Molins L, Papagiannopoulos K, Subotic D, van Schil P, Varela G, van Raemdonck D. Training curriculum for European thoracic surgeons: a joint initiative of the European Society of Thoracic Surgeons and the European Respiratory Society. Eur J Cardiothorac Surg 2020; 57:418-421. [PMID: 32025700 DOI: 10.1093/ejcts/ezz361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/15/2019] [Accepted: 11/29/2019] [Indexed: 11/13/2022] Open
Abstract
Because of the differing definitions of the margins of thoracic surgery as a specialty and the variability in the training curricula among European countries, the European Society of Thoracic Surgeons formed a task force to elaborate a consensual proposal. The first step comprised creating a harmonized syllabus that was completed and published in 2018. This publication presents a proposal for a curriculum upon which the task force and the external expert reviewers have agreed. The curriculum was developed by the task force: each module and item describe the expected level of knowledge, skills and attitudes to be attained by the participants; learning opportunities, assessment tools and minimal clinical exposures have been defined as well. Competence in terms of non-technical skills has been defined for each module according to the CanMEDS (http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e) glossary. The different modules were subsequently submitted to an internal and an external review process and re-edited accordingly before final validation. The authors hope that this document will serve as a roadmap for both thoracic surgical trainees and mentors. It should further guide continuous professional development. However, evolving scientific and technological advances are expected to modify the diagnosis and treatment of diseases and disorders in the future and hence will mandate periodical revisions of the document.
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Affiliation(s)
- Gilbert Massard
- Department of Medical Education, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
| | | | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University Medical School, Istanbul, Turkey
| | | | - Stefano Elia
- Department of Thoracic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Martin Huertgen
- Clinic of Thoracic Surgery, Catholic Clinic Koblenz-Montabaur, Koblenz, Germany
| | | | | | | | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research, Salamanca, Spain
| | - Dirk van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Commentary: The first year-Are you ready? J Thorac Cardiovasc Surg 2020; 159:1163. [PMID: 31898955 DOI: 10.1016/j.jtcvs.2019.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022]
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Holmstrom AL, Meyerson SL. Obtaining Meaningful Assessment in Thoracic Surgery Education. Thorac Surg Clin 2019; 29:239-247. [PMID: 31235292 DOI: 10.1016/j.thorsurg.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Training in thoracic surgery has evolved immensely over the past decade due to the advent of integrated programs, technological innovations, and regulations on resident duty hours, decreasing the time trainees have to learn. These changes have made assessment of thoracic surgical trainees even more important. Shifts in medical education have increasingly emphasized competency, which has led to novel competency-based assessment tools for clinical and operative assessment. These novel tools take advantage of simulation and modern technology to provide more frequent and comprehensive assessment of the surgical trainee to ensure competence.
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Affiliation(s)
- Amy L Holmstrom
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 2320, Chicago, IL 60611, USA
| | - Shari L Meyerson
- Department of Surgery, University of Kentucky, 740 South Limestone, Suite A301, Lexington, KY 40536, USA.
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Massard G, Tabin N, Mitchell S, Batirel H, Brunelli A, Elia S, Frick A, Huertgen M, Lerut A, Molins L, Papagiannopoulos K, Subotic D, van Schil P, Varela G, van Raemdonck D. A harmonized European training syllabus for thoracic surgery: report from the ESTS-ERS task force. Eur J Cardiothorac Surg 2019; 54:214-220. [PMID: 29800238 DOI: 10.1093/ejcts/ezy206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/02/2018] [Indexed: 11/14/2022] Open
Abstract
Training of European thoracic surgeons is subject to huge variations in terms of length of training, content of training and operative experience during training. Harmonization of training outcomes has been approached by creating the European Board of Thoracic Surgery, which has been accredited by the European Union of Medical Specialists (UEMS); however, a clear description of the content of training is lacking. Building on their recognized experience with curriculum building, task forces of the European Respiratory Society and the European Society of Thoracic Surgery agreed on a joint task force on training in thoracic surgery. The goal of this study is to report on the mission statement developed from the UEMS-driven survey, describe the Delphi method and the observed results and present the first large consensus-based syllabus. The working group is currently working on a description of the curriculum and assessment of learning outcomes.
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Affiliation(s)
- Gilbert Massard
- Department of Thoracic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nathalie Tabin
- Department of Education, European Respiratory Society Headquarters, Lausanne, Switzerland
| | - Sharon Mitchell
- Department of Education, European Respiratory Society Headquarters, Lausanne, Switzerland
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University Hospital, Istanbul, Turkey
| | | | - Stefano Elia
- Department of Thoracic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Anna Frick
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Martin Huertgen
- Clinic of Thoracic Surgery, Catholic Clinic Koblenz-Montabaur, Koblenz, Germany
| | - Antoon Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laureano Molins
- Department of Thoracic Surgery, Hospital Clinic & Sagrat Cor, University of Barcelona, Barcelona, Spain
| | | | - Dragan Subotic
- Department of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.,Clinic for Thoracic Surgery, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp University, Antwerp, Belgium
| | - Gonzalo Varela
- Chair of Thoracic Surgery, School of Medicine, Salamanca University, Salamanca, Spain
| | - Dirk van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Disparity between recent graduates’ and experienced surgeons' assessment of time to operative independence. J Thorac Cardiovasc Surg 2019; 157:1925-1932. [DOI: 10.1016/j.jtcvs.2018.08.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 11/15/2022]
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17
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Premyodhin N, Mandair D, Ferng AS, Leach TS, Palsma RP, Albanna MZ, Khalpey ZI. 3D printed mitral valve models: affordable simulation for robotic mitral valve repair. Interact Cardiovasc Thorac Surg 2018; 26:71-76. [PMID: 29049538 DOI: 10.1093/icvts/ivx243] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/26/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES 3D printed mitral valve (MV) models that capture the suture response of real tissue may be utilized as surgical training tools. Leveraging clinical imaging modalities, 3D computerized modelling and 3D printing technology to produce affordable models complements currently available virtual simulators and paves the way for patient- and pathology-specific preoperative rehearsal. METHODS We used polyvinyl alcohol, a dissolvable thermoplastic, to 3D print moulds that were casted with liquid platinum-cure silicone yielding flexible, low-cost MV models capable of simulating valvular tissue. Silicone-moulded MV models were fabricated for 2 morphologies: the normal MV and the P2 flail. The moulded valves were plication and suture tested in a laparoscopic trainer box with a da Vinci Si robotic surgical system. One cardiothoracic surgery fellow and 1 attending surgeon qualitatively evaluated the ability of the valves to recapitulate tissue feel through surveys utilizing the 5-point Likert-type scale to grade impressions of the valves. RESULTS Valves produced with the moulding and casting method maintained anatomical dimensions within 3% of directly 3D printed acrylonitrile butadiene styrene controls for both morphologies. Likert-type scale mean scores corresponded with a realistic material response to sutures (5.0/5), tensile strength that is similar to real MV tissue (5.0/5) and anatomical appearance resembling real MVs (5.0/5), indicating that evaluators 'agreed' that these aspects of the model were appropriate for training. Evaluators 'somewhat agreed' that the overall model durability was appropriate for training (4.0/5) due to the mounting design. Qualitative differences in repair quality were notable between fellow and attending surgeon. CONCLUSIONS 3D computer-aided design, 3D printing and fabrication techniques can be applied to fabricate affordable, high-quality educational models for technical training that are capable of differentiating proficiency levels among users.
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Affiliation(s)
- Ned Premyodhin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Divneet Mandair
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Alice S Ferng
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Timothy S Leach
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Ryan P Palsma
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Mohammad Z Albanna
- Department of Surgery, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Zain I Khalpey
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
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Robotic Thoracic Surgery Training for Residency Programs. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:417-422. [DOI: 10.1097/imi.0000000000000573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Robotic-assisted surgery is increasingly being used in thoracic surgery. Currently, the Integrated Thoracic Surgery Residency Program lacks a standardized curriculum or requirement for training residents in robotic-assisted thoracic surgery. In most circumstances, because of the lack of formal residency training in robotic surgery, hospitals are requiring additional training, mentorship, and formal proctoring of cases before granting credentials to perform robotic-assisted surgery. Therefore, there is necessity for residents in Integrated Thoracic Surgery Residency Program to have early exposure and formal training on the robotic platform. We propose a curriculum that can be incorporated into such programs that would satisfy both training needs and hospital credential requirements. Methods We surveyed all 26 Integrated Thoracic Surgery Residency Program Directors in the United States. We also performed a PubMed literature search using the key word “robotic surgery training curriculum.” We reviewed various robotic surgery training curricula and evaluation tools used by urology, obstetrics gynecology, and general surgery training programs. We then designed a proposed curriculum geared toward thoracic Integrated Thoracic Surgery Residency Program adopted from our credentialing experience, literature review, and survey consensus. Results Of the 26 programs surveyed, we received 17 responses. Most Integrated Thoracic Surgery Residency Program directors believe that it is important to introduce robotic surgery training during residency. Our proposed curriculum is integrated during postgraduate years 2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are required to complete introductory online modules, virtual reality simulator training, and in-house workshops. During clinical stage (postgraduate years 4–6), the resident will serve as a supervised bedside assistant and progress to a console surgeon. Each case will have defined steps that the resident must demonstrate competency. Evaluation will be based on standardized guidelines. Conclusions Expansion and utilization of robotic assistance in thoracic surgery have increased. Our proposed curriculum aims to enable Integrated Thoracic Surgery Residency Program residents to achieve competency in robotic-assisted thoracic surgery and to facilitate the acquirement of hospital privileges when they enter practice.
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Factors during training which predict future use of minimally invasive thoracic surgery. Ann Med Surg (Lond) 2018; 35:149-152. [PMID: 30302245 PMCID: PMC6174821 DOI: 10.1016/j.amsu.2018.09.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/22/2018] [Accepted: 09/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background While minimally invasive thoracic surgery (MIS) has increased nationwide over the years, most patients undergoing lung and esophageal resections still undergo an open approach. We performed a national survey to analyze factors associated with a propensity to perform MIS after completing a cardiothoracic training program. Materials and methods Cardiothoracic surgery trainees in 2 or 3-year programs from 2010 to 2016 were sent an online survey regarding the numbers and types of cases performed during training and current practice patterns as attending surgeons. Comfort level with MIS was also assessed. Responses were recorded and analyzed using SPSS. Results One hundred thirty-six trainees responded, with a mean of 121 lobectomies (30-250) and 40 esophagectomies (8-110) performed during training. Mean minimally invasive lobectomy and esophagectomy rates during training were 53% and 30% respectively. A greater ratio of MIS procedures performed during training correlated with a higher rate performed as an attending (lobectomies, p = 0.04; esophagectomies, p = 0.01) and a greater comfort level with performing these procedures (lobectomies, p = 0.01 and esophagectomies, p < 0.01). Conclusions Based on these results, performing a greater ratio of minimally invasive lobectomies and esophagectomies during fellowship training increases the likelihood of performing them as an attending. Trainees who perform more minimally invasive procedures as trainees are more likely to do so as attendings. Trainees who perform many open lobectomies do not necessarily convert to minimally invasive approaches as attendings. Trainees who perform many esophagectomies are less likely to convert as attendings.
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Cook CC, Wei LM, Roberts HG, Badhwar V. Mentoring the newly minted: Evolving the rules of engagement. J Thorac Cardiovasc Surg 2018; 156:2224-2225. [PMID: 30093149 DOI: 10.1016/j.jtcvs.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Chris C Cook
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Harold G Roberts
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
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Massard G, Tabin N, Mitchell S, Batirel H, Brunelli A, Elia S, Frick A, Huertgen M, Lerut A, Molins L, Papagiannopoulos K, Subotic D, van Schil P, Varela G, van Raemdonck D. A harmonised European training syllabus for thoracic surgery: report from the ESTS/ERS task force group. Eur Respir J 2018; 51:51/6/1800370. [PMID: 29903828 DOI: 10.1183/13993003.00370-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/21/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Gilbert Massard
- Dept of Thoracic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Hasan Batirel
- Dept of Thoracic Surgery, Marmara University Hospital, Istanbul, Turkey
| | | | - Stefano Elia
- Dept of Thoracic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Anna Frick
- Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Martin Huertgen
- Clinic of Thoracic Surgery, Catholic Clinic Koblenz-Montabaur, Koblenz, Germany
| | - Antoon Lerut
- Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laureano Molins
- Dept of Thoracic Surgery, Hospital Clinic and Sagrat Cor, University of Barcelona, Barcelona, Spain
| | | | - Dragan Subotic
- Dept of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.,Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Paul van Schil
- Dept of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Gonzalo Varela
- School of Medicine, Salamanca University, Salamanca, Spain
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Linsky PL, Wei B. Training in robotic thoracic surgery. J Vis Surg 2018; 4:1. [PMID: 29445587 DOI: 10.21037/jovs.2017.12.12] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/05/2017] [Indexed: 11/06/2022]
Abstract
The best way to teach robotic thoracic surgery is still being decided. New trainees, experienced video-assisted thoracoscopic surgery (VATS) surgeons, and predominantly open surgeons each have different needs when it comes to learning robotic surgery. The data shows that the learning curve and ability to learn robotics initially appears to be shorter and easier than surgeons learning VATS. Though the absolute best method for teaching is still under investigation, multiple centers have started to create systematic methods of teaching robotic surgery that increases resident autonomy while still protecting the patient.
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Affiliation(s)
- Paul L Linsky
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham Medical Center, Birmingham, AL 35294, USA
| | - Benjamin Wei
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham Medical Center, Birmingham, AL 35294, USA
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Vardas PN, Stefanescu Schmidt AC, Lou X, Goldstone AB, Pattakos G, Fiedler AG, Stephens EH, Tchantchaleishvili V. Current Status of Endovascular Training for Cardiothoracic Surgery Residents in the United States. Ann Thorac Surg 2017; 104:1748-1754. [DOI: 10.1016/j.athoracsur.2017.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/02/2017] [Accepted: 07/10/2017] [Indexed: 11/24/2022]
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Meyerson SL, Sternbach JM, Zwischenberger JB, Bender EM. The Effect of Gender on Resident Autonomy in the Operating room. JOURNAL OF SURGICAL EDUCATION 2017; 74:e111-e118. [PMID: 28669788 DOI: 10.1016/j.jsurg.2017.06.014] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/13/2017] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Discrimination against women training in medicine and surgery has been subjectively described for decades. This study objectively documents gender differences in the degree of autonomy given to thoracic surgery trainees in the operating room. DESIGN Thoracic surgery residents and faculty underwent frame of reference training on the use of the 4-point Zwisch scale to measure operative autonomy. Residents and faculty then submitted evaluations of their perception of autonomy granted for individual operations as well as operative difficulty on a real-time basis using the "Zwisch Me!!" mobile application. Differences in autonomy given to male and female residents were elucidated using chi-square analysis and ordered logistic regression. SETTING Seven academic medical centers with thoracic surgery training programs. PARTICIPANTS Volunteer thoracic surgery residents in both integrated and traditional training pathways and their affiliated cardiothoracic faculty. RESULTS Residents (n = 33, female 18%) submitted a total of 596 evaluations to faculty (n = 48, female 12%). Faculty gave less autonomy to female residents with only 56 of 184 evaluations (30.3%) showing meaningful autonomy (passive help or supervision only) compared to 107 of 292 evaluations (36.7%) at those levels for male residents (p = 0.02). Resident perceptions of autonomy showed even more pronounced differences with female residents receiving only 38 of 197 evaluations (19.3%) with meaningful autonomy compared to 133 of 399 evaluations (33.3%) for male residents (p < 0.001). Potential influencing factors explored included attending gender and specialty, case type and difficulty, and resident level of training. In multivariate analysis, only case difficultly, resident gender, and level of training were significantly related to autonomy granted to residents. CONCLUSIONS Evaluations of operative autonomy reveal a significant bias against female residents. Faculty education is needed to encourage allowing female residents more operative autonomy.
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Affiliation(s)
- Shari L Meyerson
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Joel M Sternbach
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Edward M Bender
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California
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Meyerson SL, Sternbach JM, Zwischenberger JB, Bender EM. Resident Autonomy in the Operating Room: Expectations Versus Reality. Ann Thorac Surg 2017; 104:1062-1068. [DOI: 10.1016/j.athoracsur.2017.05.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022]
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Teaching congenital heart disease: A new era? J Thorac Cardiovasc Surg 2017; 153:1541. [PMID: 28359576 DOI: 10.1016/j.jtcvs.2017.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 11/24/2022]
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Lee F, Sarkaria IS, Luketich JD. Surgeon proficiency and outcomes in esophagectomy: a perspective and comment on an analysis of the Swedish Cancer Registry. J Thorac Dis 2017; 9:E279-E281. [PMID: 28449520 DOI: 10.21037/jtd.2017.02.92] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Fred Lee
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Yoo SJ, Spray T, Austin EH, Yun TJ, van Arsdell GS. Hands-on surgical training of congenital heart surgery using 3-dimensional print models. J Thorac Cardiovasc Surg 2017; 153:1530-1540. [PMID: 28268011 DOI: 10.1016/j.jtcvs.2016.12.054] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/07/2016] [Accepted: 12/29/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patient-based congenital heart surgery (CHS) training is opportunity-based and difficult. Three-dimensional (3D) print models of the heart were used for hands-on surgical training (HOST) at the 2015 AATS and subsequently in 2 local institutions. We aim to introduce the process of 3D printing for surgical simulation and to present the attendee's responses. METHODS Using CT or MR angiograms, the models of congenital heart disease were created and printed with flexible rubberlike material. Altogether, 81 established surgeons or trainees performed simulated surgical procedures with the expert surgeons' guidance and supervision. At the completion of the session, 50 of 81 attendees participated in the questionnaire assessment of the program. RESULTS All responders found the course helpful in improving their surgical skills. All would consider including HOST sessions in the training programs. All found that the models showed the necessary pathologic findings. Most found that the consistency and elasticity of the model material were different from those of the human myocardium. However, the responders thought that the quality of the models was acceptable (88%) or manageable (12%) for surgical practice. The major weaknesses listed were related to the print material and poor representation of the cardiac valves. CONCLUSIONS HOST using 3D print heart models is achievable and allows surgical practice on pathological hearts without patients' risk. HOST is a highly applicable surgical simulation format for CHS. Incorporation of HOST in training programs could change the traditional opportunity-based education to the requirement-based standardized education.
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Affiliation(s)
- Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Thomas Spray
- Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Erle H Austin
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Norton Children's Hospital, Louisville, Ky
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, Seoul, South Korea
| | - Glen S van Arsdell
- Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Verrier ED. Invited Commentary. Ann Thorac Surg 2016; 101:2355-6. [DOI: 10.1016/j.athoracsur.2016.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
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