Factors affecting interest in cardiothoracic surgery: Survey of North American general surgery residents

In-State Retention Rates of Female Neurosurgery Graduates

OBJECTIVE

We sought to determine the rate of retaining female neurosurgery graduates in the same states as their medical education and identify medical school and state characteristics associated with high retention rates.

METHODS

Database from the Centers for Medicare & Medicaid Services was used to extract female physicians indicating "neurosurgery" as their specialty. The top 25 medical schools with the highest number of female neurosurgery graduates were selected. Descriptive analysis was used to determine the retention rate of female neurosurgery graduates. Univariable and multivariable analyses were used to identify medical school and state characteristics associated with high retention rates.

RESULTS

Medical schools with the highest retention rate included the University of California, San Francisco (60%), the University of Alabama (60%), and the University of Pennsylvania (60%). Univariable and multivariable analysis showed the number of female neurosurgery attendings (β = 0.036, 95% confidence interval [CI] = 0.003 to 0.070, P = 0.04 and β = 0.036, CI = 0.001 to 0.071, P = 0.04.) and the healthcare employment rate (β = 0.098, CI = 0.011 to 0.186, P = 0.03 and β = 0.117, CI = 0.021 to 0.212, P = 0.02) to be positively associated with the retention rate of female neurosurgery graduates.

CONCLUSIONS

Retaining female neurosurgery graduates within a state is essential for addressing the physician shortage and gender inequality. To encourage female medical students to practice in the same state, medical schools and states should work collectively to improve the visibility of female neurosurgeons and increase employment opportunities.

The Representation of Women Moderators at The Society of Thoracic Surgeons Annual Meeting

BACKGROUND

Recently, there has been an increase in the representation of women within the cardiothoracic surgery workforce, with discussions about gender equity garnering interest. We sought to identify whether this increase is accompanied by commensurate selection for representation at national meetings.

METHODS

Online archives of The Society of Thoracic Surgeons (STS) Annual Meetings were reviewed from 2015 to 2024. Data regarding the moderator's gender were abstracted. The gender distribution of moderators across the various session categories was surveyed, and subgroup analyses were performed.

RESULTS

During the years of study, the STS Annual Meeting Taskforce selected 983 moderators to participate in the conference, including 218 women. The representation of women moderators demonstrated a favorable, upward trend. In 2015, 12.1% of moderators were women, with a consistent rate from 2015 to 2018. There was a noticeable rise in invited women moderators in 2019, with 25.4% of moderators being women. This proportion increased to 36.9% women in 2024. General Thoracic sessions have consistently included a greater percentage of women moderators compared with other sessions. Other topic areas, such as Education and Quality Improvement and Critical Care, transitioned to greater representation of women in recent years.

CONCLUSIONS

There has been an increase over time in women moderators selected for participation in the STS Annual Meeting, with progress in gender diversity seen in most session types. Although the overall proportion of women within cardiothoracic surgery remains low, the STS has increasingly worked toward encouraging inclusivity. Efforts to further support well-rounded representation are of important benefit.

The Society of Thoracic Surgeons Looking to the Future Scholarship Program: A 15-Year Review

BACKGROUND

It has been postulated that a possible barrier to pursuing cardiothoracic surgery is a lack of exposure and mentorship during training. In 2006, The Society of Thoracic Surgeons began the Looking to the Future Scholarship to expand interest in the field. Undecided trainees with limited exposure were prioritized in the selection process. This report summarizes the career outcomes of general surgery resident and medical student recipients.

METHODS

Scholarship recipients and nonrecipients (control) were queried in a Google search. The percentage of those who were cardiothoracic surgeons or in cardiothoracic training (%CTS) was calculated, as well as the percentage of female surgeons in cardiothoracic surgery.

RESULTS

From 2006 to 2021, there were 669 awardees. The %CTS was 63.7% for resident recipients and 31.4% for students, respectively. There was no significant difference in %CTS between resident and student recipients compared to nonrecipients. Notably, the percentage of female cardiothoracic surgeons was significantly greater for both resident and student recipients.

CONCLUSIONS

The majority of resident recipients are now in cardiothoracic surgery, comparable to nonrecipients. While there was no significant difference between the percentage of recipients and non-recipients in cardiothoracic surgery, these groups differed substantially as nonrecipients had greater exposure and commitment to the field at the time of application.

Integrated cardiothoracic surgery match: Trends among applicants compared with other surgical subspecialties

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.

A nationwide survey of Turkish medical students' upon interest and decision for cardiovascular surgery as a future career: A cross-sectional survey

Background

In this study, we aimed to investigate the current interest of Turkish medical students to pursue a career in cardiovascular surgery and to identify possible factors which positively or negatively affected their decisions.

Methods

Between January 2022 and August 2022, a cross-sectional survey of 34 questions was created using the Google Forms online survey platform. Questions were directed to participants to evaluate demographic features, interest level in cardiovascular surgery, interest in other specialty programs, and interest in residency abroad using fivepoint Likert scales.

Results

A total of 5338 Medical Students were reached who were balanced to 7 geographical regions across Türkiye and 1233 (23%) medical students participated in the questionnaire. Of the respondents, 544 were males and 689 were females with a mean age of 21.2±0.5 (range, 17 to 28) years. More than half of the students (56.2%) considered residency training programs in Türkiye. Cardiology had the highest preference rate for residency training (8.3%), followed by cardiovascular surgery (7.5%). More than one-third of students (36.5%) who were interested in pursuing a career in cardiovascular surgery decided to be trained abroad. Achieving a prestigious job, motivation for life saving, prioritizing innovations, and high academic studies were the main factors that positively affected the perspective of students on cardiovascular surgery, while stressful surgeries, intense and tiring night shifts, and a relatively poor social life/work balance were the main deterrent factors. Attendance to cardiovascular surgeries positively affected the decisions of students (p=0.008).

Conclusion

Although it is thought that the interest in pursuing a career in cardiovascular surgery has reduced in recent years all over the world, our study shows that cardiovascular surgery still continues to be a popular specialty among Turkish medical students. Therefore, we believe that guiding medical students by using their current potential and encouraging the students to attend cardiovascular surgeries more frequently throughout their education life are essential in choosing cardiovascular surgery as a future career option.

Knowledge and Perception of Cardiac Surgery Among Medical Students in the Western Region of Saudi Arabia

Introduction Medical undergraduates' educational programs and clinical experiences are important factors in determining their preferred future career path. Unfortunately, the cardiac surgery specialty is experiencing a decline in medical graduates due to many influencing factors as a lack of involvement with the cardiac surgery specialty and a lack of training centers. A detailed evaluation of the student's knowledge and perceptions about cardiac surgery is required to assess the career options in a specialty like cardiac surgery. This study aims to evaluate medical students' knowledge and perceptions of the cardiac surgical specialty. Methodology This is a cross-sectional study that was approved by the institutional research board of Umm Al-Qura University. Adapting a previously published questionnaire data to fit our scope and aims. Necessary adjustments were made adhering to the cardiac surgery experts' instructions. Data was collected through an electronic survey by Google Forms and distributed through social media apps.  Results A total of 637 students participated in the study. The majority (75.2%) admitted to having little knowledge of the specialty of cardiac surgery, and 62.8% reported no interest in it. In addition, 88.9% had never done a cardiac surgery rotation before. One of the top concerns of becoming a cardiac surgeon (45.2%) was the amount of time spent studying and working. Conclusion The findings of our study highlight the value of using innovative and targeted learning methods for medical students to enhance their knowledge and pique their interest in cardiac surgery since it was evident that there was a misperception regarding the scope of cases dealt with by cardiac surgery as opposed to other surgical subspecialists.

Recent Changes in Characteristics of Applicants and Matriculants to Thoracic Surgery Fellowships

The match rate for traditional thoracic surgery fellowships decreased from 97.5% in 2012 to 59.1% in 2021, reflecting an increase in applications. We queried whether characteristics of applicants and matriculants to traditional thoracic surgery fellowships changed during this time period. Applicant data from the 2008 through 2018 application cycles were extracted from the Electronic Residency Application System (ERAS) and Graduate Medical Education (GME) Track Resident Survey and stratified by period of application (2008-2014 vs 2015-2018). Characteristics of applicants and matriculants were analyzed. There were 697 applicant records in the early period and 530 in the recent period (application rate 99.6/year vs 132.5/year; P = 0.0005), and 607 matriculant records in the early period and 383 in the recent period (matriculation rate 87% vs 72%; P < 0.0001). There was no difference in representation of university-affiliated versus community-based general surgery residency programs among applicants comparing the periods. Higher proportions of applicants and matriculants in the early period trained in general surgery programs affiliated with a comprehensive cancer center or a thoracic surgery fellowship. Applicants and matriculants of the recent period had higher median numbers of journal publications and had higher impact factor journal publications. The increase in applicants for thoracic surgery training is primarily from general surgery trainees in residency programs not affiliated with a comprehensive cancer center or a thoracic surgery fellowship. The increased interest in thoracic surgery training was accompanied by overall enhanced scholarship production among the applicants and matriculants regardless of their residency characteristics.

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them: A Systematic Scoping Review

OBJECTIVE

This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles.

BACKGROUND

Visible and invisible impediments can hinder female doctors' pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression.

METHODS

Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included.

RESULTS

Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition.

CONCLUSIONS

Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.

The effect of receiving an award from the American Association for Thoracic Surgery Foundation

Objective

This study's objective was to evaluate the scholastic and career effects of receiving either the American Association for Thoracic Surgery (AATS) Foundation research scholarship or surgical investigator program.

Methods

AATS annual reports and recipient listings were used to generate the awardees. MEDLINE and SCOPUS were used to assess publications, citations, and H-Index for awardees. The National Institutes of Health (NIH) RePorter was used to collate NIH grant awarding to awardees. Publicly available institutional profiles were used to assess promotion status and leadership positions.

Results

Awardees of the research scholarship had a median of 4733 citations and a median H-Index of 33. The surgical investigator program recipients had a median of 1346 citations with a median H-Index of 17. Across both funding mechanisms, 45% secured subsequent NIH funding. Most awardees received an academic promotion, with 62% of the research scholarship awardees promoted to full professor and 37% of the surgical investigator program to associate professor. Approximately half (48%) of all awardees hold leadership positions, with most being a clinical director or division chief.

Conclusions

Receiving the AATS Foundation research scholarship or surgical investigator program positions early-career cardiothoracic surgeons for a promising future in academic surgery.

Medical Students' Attitudes Towards Cardiothoracic Surgery in the United Kingdom: A Cross-Sectional Survey of 1675 Students

OBJECTIVES

The objectives of this study were the following: (i) assess interest levels in cardiothoracic surgery (CTS) among UK-based medical students, (ii) identify potential motivators and barriers to pursuing CTS training, (iii) explore the influence of gender on interest in CTS in greater depth.

METHODS

Medical students from all year groups across UK medical schools were invited to participate in a cross-sectional, national online survey. Responses were collected from 02/12/2019 to 08/12/2019.

RESULTS

1675 medical students from 31 UK medical schools responded, with an estimated 5.3% response rate. Of the respondents, 33.7% respondents reported having exposure to CTS, primarily through their medical school or through extracurricular activities (48.4% and 38.8%, respectively). When assessing interest in CTS, 31.4% were interested in undertaking a career in CTS, with a larger proportion of students expressing interest with no exposure to CTS than those with exposure. However, interest in pursuing CTS decreased with exposure as medical students transitioned from pre-clinical to clinical stages. Additionally, male participants were more interested in seeking a CTS post than their female counterparts (38% vs. 27.6%). The length of training (p = 0.0009) and competitive nature (p < 0.0001) of gaining a CTS post were the primary deterring factor for female participants, compared to their male counterparts.

CONCLUSIONS

This study shows the importance of quality of exposure and its impact on students' interests in pursuing a career in CTS. The negative relationship between exposure and interest in CTS can be associated with the realisation of the challenges that come with pursuing CTS.

60 Years After the First Woman Cardiac Surgeon: We Still Need More Women in Cardiac Surgery

In 1960, Dr Nina Starr Braunwald became the first woman to perform open heart surgery. Sixty years later, despite the fact that women outnumbered men in American medical school in 2017, men still dominate the field of cardiac surgery. Women surgeons remain underrepresented in cardiac surgery; 11% of practicing cardiac surgeons in Canada were women in 2015, and 6% of practicing adult cardiac surgeons in the US were women in 2019. Although women remain a minority in other surgical specialties also, cardiothoracic surgery remains one of the most unevenly–gender distributed specialties. Why are there so few women cardiac surgeons, and why does it matter? Evidence is emerging regarding the benefits of diversity for a variety of industries, including healthcare. In order to attract and retain the best talent, we must make the cardiac surgery environment more diverse, equitable, and inclusive. Some causes of perpetuation of the gender gap have been documented in the literature—these include uneven compensation and career advancement opportunities, outdated views on family dynamics, and disproportionate scrutiny of women surgeons, causing additional workplace frictions for women. Diversity is an organizational strength, and gender-diverse institutions are more likely to outperform their non-gender-diverse counterparts. Modifiable issues perpetuate the gender gap, and mentorship is key in helping attract, develop, and retain the best and brightest within cardiac surgery. Facilitating mentorship opportunities is key to reducing barriers and bridging the gap.

Traits of the current traditional pathway cardiothoracic surgery training pool: Results of a cross-sectional study

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.

Away Rotations at Integrated Thoracic Surgery Programs: Applicant and Program Director Perspectives

OBJECTIVE

Integrated thoracic surgery residency program (IP) applicants often complete away rotations to stand out from the objective standard criteria. Little is known about the perceptions of these rotations. We aimed to examine the perceptions of value, cost, and expectations of away rotations among IP applicants and program directors.

DESIGN

Between March and April 2020, anonymous electronic surveys were distributed through e-mails gathered from the Electronic Residency Application Service and the Accreditation Council for Graduate Medical Education IP email list. A follow-up email was sent to all applicants and program directors 1 week after the initial request to improve response rate. Questions assessed the cost, frequency, goals, and objectives for away rotations, as well as the perceived value of these experiences.

SETTING

United States PARTICIPANTS: All IP program directors and United States senior medical students who applied to our institution's IP during the 2019-2020 cycle.

RESULTS

Seventy-eight US medical students participated in the 2020 IP Match with 65 applicants applying to our institution's IP. Thirty-three responses were obtained from applicants who applied to our program (51% response rate). Survey responses were obtained from 8 program directors (31% response rate). Ninety-four percent of applicant respondents completed an IP away rotation (n = 31). Fifty-seven percent of these applicants spent on average $5000 in total for away rotations (n = 19). Overall, applicants felt that away rotations helped refine their perception of program location, educational and operative experience, treatment of medical students, and collegiality. Applicants and program directors acknowledged that creating a good impression and finding a compatible program were central values for participating in away rotations. However, program directors viewed the overall strength of the applicant as the most important factor when evaluating applicants. Fifty-five percent of applicant respondents matched at an IP (n = 17) with 35% matching at an IP where they had completed an away rotation (n = 6).

CONCLUSION

Extended interactions that can help create good impressions and establish compatibility are benefits to away rotations. However, given the current application conditions imposed by the pandemic, future studies should examine the impact of no away rotations on the IP Match process so that moving forward applicants and program directors can continue to weigh benefits to the costs and logistics of completing an away rotation.

Diversity in cardiothoracic surgery: The time has come

Historically, cardiothoracic surgery has been one of the least diverse specialties in medicine. There has been progress during the last 20 years, but we are far from equality in regard to gender or racial and ethnic makeup of the cardiothoracic surgical workforce. This phenomenon is not isolated to America, but exists throughout the globe. Diversity has been shown to improve productivity and profits in manufacturing and other fields. In addition, diversity has been shown to improve outcomes in select patient populations with a wide range of chronic and acute medical conditions. So, what can we do about it? This article summarizes the current situation in regard to equality and equity in cardiothoracic surgery and proposes solutions to bring about lasting change. Diversity in cardiothoracic surgery will not occur passively. It will require a concerted effort and a commitment to change.

Interviews During the Pandemic: A Thoracic Education Cooperative Group and Surgery Residents Project

BACKGROUND

The 2020 interview cycle for cardiothoracic fellowships was affected by the coronavirus-19 pandemic. Many programs shifted from in-person to virtual interviews. We evaluated applicant perceptions of the various formats.

METHODS

All 2019-2020 cardiothoracic fellowship applicants received an electronic survey after completion of the match process. The survey assessed number of in-person/virtual interviews completed, perception of efficacy, and likelihood of ranking a program based on format, and strengths/inadequacies of virtual interviews.

RESULTS

Response rate was 36% (48 of 133). Seventy-three percent of respondents (35 of 48) interviewed with more than 10 programs. Fifty-two percent of respondents (25 of 48) were able to schedule additional interviews once virtual formats were available. A slight majority (56%, 27 of 48) ranked a program at which they had an in-person interview as their first choice. Interviewing at more than 10 programs was associated with an increased likelihood of successfully matching at a program (P = .02). Overwhelmingly, respondents favored an in-person component to the interview process (96%, 46 of 48). Few respondents (29%, 14 of 48) thought they could adequately evaluate a program virtually. The factors that had the highest percentages of adequate portrayal during virtual interviews were the didactic schedule/curriculum (81%, 39 of 48) and case number/autonomy (58%, 28 of 48). The factors with the lowest percentages were culture/personality (19%, 9 of 48) and city/lifestyle (15%, 7 of 48).

CONCLUSIONS

Applicants strongly favored an in-person component to interviews, highlighting potential deficiencies in the virtual interview process. Programs should consider the addition of virtual tours of their hospitals, narrations from staff, and vignettes from current fellows about lifestyle and well-being.

Recent Trends in Cardiothoracic Surgery Training: Data from the National Resident Matching Program

OBJECTIVE

In 2008, integrated thoracic residency programs (IP) for cardiothoracic (CT) training were created in response to a decline in CT trainees. However, few studies have reported on trends in the CT training pathway since the inception of IPs. This manuscript examines the current trends related to the overall number of surgical trainees entering CT surgery training following the introduction of IPs into the National Resident Match Program (NRMP).

DESIGN

Main and specialty match data were gathered from NRMP annual reports between 2008 and 2018. Descriptive statistics were used to analyze program size, applications, and filled and unfilled positions for IPs and traditional CT residency programs. Pearson's correlation coefficient was used to determine associations between program variables.

SETTING

NRMP main and specialty match in 2008 to 2018.

PARTICIPANTS

Participants of the NRMP main and specialty match in 2008 to 2018.

RESULTS

IPs increased from 2 programs offering 3 positions in 2008 to 28 programs offering 36 positions in 2018. However, during the same time period, the number of available traditional CT residency positions have decreased by 29% (130 to 92). As the number of IPs increased, there was a significant decrease in the number of traditional CT residency positions (ρ = -0.95, p < 0.001). Although, the overall number of CT residency programs (traditional and IP) remained largely unchanged, the proportion of filled CT residency positions increased from 67.7% in 2008 up to 97.7% in 2018.

CONCLUSION

The IP training format has shown success in increasing the number of trainees entering into CT training programs. Consideration should be given to increasing the number of IP positions or increase interest in CT among general surgery residents to increase the number of CT surgery trainees with the goal of increasing the size of the future CT workforce.

Characteristics and Attitudes of Aspiring Cardiothoracic Surgeons: A Survey Study

BACKGROUND

Although recruiting highly qualified, diverse applicants into cardiothoracic surgery remains a national priority, their characteristics remain unknown. This study aims to describe current and future applicants in cardiothoracic surgery.

METHODS

Aspiring cardiothoracic surgeons (students interested in matriculating in a North American training program) were voluntarily enrolled in the study through Twitter and email outreach. A 33-question survey evaluated their backgrounds, research experiences, attitudes, and interests within cardiothoracic surgery. Standard descriptive statistics were used.

RESULTS

There were 111 participants, 40 of whom were female (36.0%) and 27 of whom identified as an underrepresented minority (24.3%). Of the total, 63 belonged to an institution with a cardiothoracic surgery training program (56.8%). A total of 91 students envisioned having a mostly operative career (82.0%) and 75 envisioned pursuing educational roles (67.6%). The most popular surgical specialties were heart transplantation (50.5%) and aortic surgery (47.8%). Participants selected having a high-intensity operative environment (81.2%) and an innovative academic environment (58.8%) as the most attractive qualities. Perceived lack of work-life balance (46%) and toxic training or work environment (28%) were the greatest deterrents. Finances during the application process were perceived as a potential barrier by 41 students (36.9%). Approximately 75% of students (83 of 111) had faculty as mentors; 46.8% (56 of 111) thought that cardiothoracic surgery faculty were approachable but had limited time for mentorship.

CONCLUSIONS

This survey study characterized a nationally selected pool of aspiring cardiothoracic surgeons using social media. Future studies involving larger and more diverse cohorts are warranted to find areas for improvement in recruitment, retention, and diversity.

Evaluating the Impact of Medical Student Inclusion Into Hands-On Surgical Simulation in Congenital Heart Surgery

OBJECTIVE

Over the last decade medical students' interest in pursuing surgery as a career has declined. This is more apparent in high-specialized specialities such as congenital heart surgery (CHS). Early hands-on simulation has shown to have a positive impact on medical students' interest in pursuing surgery, however, its incorporation into medical school curricula is lacking. This study aimed to evaluate the impact of incorporating medical students as surgical assistants during the Hands On Surgical Training course in CHS.

METHODS

Local preclinical medical students were invited to participate as surgical assistants during the 5th annual Hands On Surgical Training course in CHS. Among those who responded to the invitation, students were randomly selected and allocated to assist a congenital heart surgeon. All selected students attended an assistants' session prior to the course to familiarize themselves with assisting and to practice basic surgical skills. At the end of both courses students completed a questionnaire based on Likert 5-point scale to evaluate the courses' usefulness.

RESULTS

Fifteen medical students completed the questionnaires. All reported a beginner level of understanding of congenital heart disease. All students were highly satisfied with using 3D-printed models to help their understanding of congenital heart disease (4.80 ± 0.41) and agreed that the sessions improved their assisting skills (4.93 ± 0.26). All expressed a desire to attend similar sessions in the future and agreed that surgical simulation inclusion into medical school curricula would enhance learning (5.00 ± 0.00). Interest in pursuing a career in CHS increased from 33% (5) to 87% (13) by the end of the course.

CONCLUSIONS

Integration of preclinical medical students into surgical simulation increases interest in pursuing highly specialised surgical specialities such as CHS. Early exposure and the incorporation of such simulation programs into medical school curricula will likely improve surgical skill acquisition and may enable students to be better informed when selecting future career choices.

Equal means equal: Cardiothoracic surgery in its second century

OBJECTIVE

As the specialty of cardiothoracic surgery turns the corner into its second century of existence, there has been an uptick in the number of women and underrepresented minorities entering the field, but we have a long way to go before race and gender equity prevails.

METHODS

In this report, specific barriers to diversity without exclusion and mechanisms to breakdown these barriers will be explored.

RESULTS

Barriers to inclusion include a long-standing deficiency in exposure, encouragement, mentorship, and sponsorship to actively attract underrepresented groups to the specialty. Diversity will not occur passively. It will take a concerted effort best employed through a top-down approach at the local and national level, and it has to seem normal.

CONCLUSIONS

Cardiothoracic surgery is an outstanding field for anyone and everyone who seeks a challenging, rewarding career, regardless of their gender, race, or ethnic background. It is the responsibility of leadership to dispel the tradition that certain individuals are not welcome.

Gender Differences in Cardiothoracic Surgery Interest Among General Surgery Applicants

BACKGROUND

Although the overall gender gap in medicine is narrowing, significant gender disparities remain in the cardiothoracic surgery (CTS) field; women represent only 7% of practicing surgeons and 20% of residents. The purpose of this study was to identify gender differences in CTS exposure and interest among fourth year medical students applying to general surgery residency.

METHODS

An anonymous survey was emailed to general surgery residency applicants at a major academic program for the 2019 and 2020 application cycles. Data were stratified by gender and analyzed using the χ² and t tests.

RESULTS

Of the 303 responders to the survey, 44% were women. A total of 58% of women were unlikely to be interested in or were definitely not interested in pursuing a career in CTS compared with 35% of men (P < .05). Men were 2.5 times more likely than women to be interested in CTS (odds ratio, 2.5; 95% confidence interval, 1.5 to 4.1). More men had rotated through CTS (55% vs 44%; P = .04) and shadowed a cardiothoracic surgeon (41% vs 29%; P = .03). More than 30% of women interested in CTS reported mentorship as the most important factor in their decision. Mentorship and CTS rotations were both independently associated with CTS interest after adjusting for gender.

CONCLUSIONS

Interest in CTS is disappointingly low among women and represents a troublesome disparity that must be addressed. Early exposure to CTS and more mentorship from cardiothoracic surgeons are critical to reverse the current trend. Further studies are necessary to determine factors limiting female exposure to CTS rotations and dissuading female applicants from pursuing careers in CTS.

Ten Years Into the Integrated Residency Era: A Pilot Study Shows Many Cardiothoracic Surgery Faculty Still Favor the Traditional Pathway

The first integrated cardiothoracic surgery residents (I-6) graduated in 2013. Predominantly, there is still the option to pursue a traditional training pathway via general surgery residency followed by 2-3 years of specialized cardiothoracic surgery training. Our aim was to understand the perspectives of academic cardiothoracic faculty on the various training models. An anonymous web-based survey was distributed to all academic cardiothoracic surgeons in the United States. Respondents were asked about their perceptions of the 2 training models (I-6 and traditional). Descriptive statistics and Fisher exact test were used to analyze the data. A total of 15.4% (111/719) of faculty completed responses. When comparing training models, 23.4% of faculty believe the I-6 is a superior structure, 31.5% believe they are about the same, and 45.0% believe the traditional model is better. Also, 51.4% of the faculty said they would still apply into a traditional fellowship, with 27.9% picking an I-6 program and 20.7% picking a 4 + 3 model. A total of 40.5% believe the I-6 is good for the specialty and 55.0% think the I-6 attracts higher achieving applicants, but 26.1% and 19.8% believe it is improving training or increasing the scholarly activity of residents, respectively. When asked about resident experience, 56.4% of I-6 faculty feel there is a bias against their residents on the general surgery service, which some believe leads to poor educational outcomes for I-6 residents. The integrated residency represents a major shift in cardiothoracic surgery training. Faculty opinions vary regarding the quality and effectiveness of this model with many preferring the traditional model.

The effect of an organ procurement experience on preclinical medical student perceptions of transplant surgery

Transplant surgery is a predominantly male specialty with high burnout rates. There are currently limited data regarding how programs can attract a diverse applicant pool to the field of transplant surgery. This study evaluated the effect of an Organ Procurement Experience elective on preclinical medical students' perceptions of transplant surgery in a prospective, longitudinal study. Preclinical medical students were anonymously surveyed before and after attending a deceased donor organ procurement. Questions focused on the following themes: Personal Beliefs, Personal/Professional Life, Diversity, and Gender Equality. Responses were rated on a five-point Likert scale. Ninety-nine and 45 students completed pre/post-procurement survey, respectively. Post-procurement responses demonstrated increased education about the field (2.1/5 vs 3.89/5, P < 0.001) and perceptions of the personalities and collegiality between surgeons (3.06/5 vs 3.73/5, P = 0.005). Post-procurement, women were less likely to feel that female transplant surgeons are treated differently (3.98/5 vs. 3.45/5, P < 0.017). Post-procurement, 19% agreed that transplant surgeons have a high quality of life. One percent of respondents felt the current gender distribution in transplant surgery is satisfactory. The Organ Procurement Experience significantly improved preclinical students' perceptions of the field. However, there remains a strong concern about quality of life and gender diversity within the field.

Factors Influencing Saudi Medical Student's Decision Towards Cardiothoracic Surgery as a Future Career, a Cross Sectional Study

Introduction:

There has been a progressive decline in students’ interest to consider cardiothoracic surgery as future career in the distant regions in the world. There are many factors could explain declining interest in cardiothoracic surgery including diminished caseloads due to the expansive growth of interventional cardiology; length of training programs that influences medical student’s perception. King Abdulaziz University student’s interest to join the speciality explored in our study. We determined some factors that influence their decision making toward their cardiothoracic career.

Aim:

We aimed to estimate the current interests of medical students at King Abdulaziz University to pursue a career in Cardiothoracic surgery and to determine the factors that positively or negatively affect their decision.

Material and Methods:

A self-administered online survey designed on Google form was distributed through email to fourth, fifth, and sixth-year medical students. Five domains; demographics, current career intentions, previous exposure to surgery, experiences and perceptions of cardiothoracic surgery were covered in the questionnaire to identify factors affecting student decision to choose cardiothoracic surgery as a future career.

Results:

Among 486 students at our institution, 179 (36, 83%) medical students completed the questionnaire more than half of them 91 (50.8%) were males. The percentage of students who considered cardiothoracic surgery as a future career was (4.5%); when asked if they were serious in pursuing a career in cardiothoracic surgery, (14.5%) of the student were affirmative. Of those participated in the survey, Twenty-four students believed they had adequate introduction to the cardiothoracic surgery during their undergraduate program.

Conclusion:

cardiothoracic surgery is falling away behind other specialties as career of choice for many future physicians. It is believed mainly related to inadequate introduction to the field. Increasing exposure and close mentorship is needed to attract more students to pursue a career in cardiothoracic surgery.

Is someone listening? The first IJTC National Survey of CTVS trainees

Cardiothoracic surgery will soon have a shortage of qualified surgeons in India, because the profession is losing appeal among surgical residents. Do we really understand why the profession is not their first choice, or what the current cardiothoracic residents think about their training? This article is the first nationwide survey meant only for cardiothoracic residents in training, conducted through online survey tool to report on the issues concerning our residents.

Attrition rates in integrated vascular and cardiothoracic surgery residency and fellowship programs

BACKGROUND

Attrition in surgical programs remains a significant problem resulting in trainee dissatisfaction and wasted time and educational dollars. Attrition rates in general surgery training programs approximate 5% per year (30% cumulative). Attrition rates in cardiovascular surgery training for the traditional vascular surgery fellowship (VSF), the vascular surgery residency (VSR), and the corresponding programs in cardiothoracic surgery have yet to be described, although they are assumed to be similar to those associated with general surgery training.

METHODS

A retrospective review of the Association of American Medical Colleges Annual Physician Specialty Data Book was performed. Data from consecutive academic years 2007-2008 to 2013-2014 were analyzed. The number of total residents, the number who did not complete their training, and those who successfully completed the program were recorded. Attrition rates were then calculated for VSF, VSR, general surgery residency (GSR), cardiothoracic surgery fellowship (CTF), and cardiothoracic surgery integrated residency (CTR).

RESULTS

Annually, between 2007-2008 and 2013-2014, there were zero to two vascular surgery residents who failed to complete the program (0%-5.9%). In the last 4 years of the study, whereas the absolute number of residents who failed to complete the program remained constant at 1 or 2 per year, the attrition rate decreased to 1 of 171 trainees (0.6%) in 2013-2014 as the total number of programs (and numbers of vascular surgery residents) significantly increased. During the same 7-year period, the number of vascular surgery fellows who did not complete their training ranged from one to six annually (0.4%-2.5%). Compared with the VSF, the VSR data show a relatively low and constant rate of attrition. In contrast, the number of general surgery residents who did not complete their program during the study period varied from 255 to 388 residents annually (3.3%-5.2%). During its first 3 years of inception, the CTR program had an attrition rate of 0%, and it was not until 2012-2013 that trainees failed to complete the program, resulting in an annual attrition rate of 1.2% to 3.2% from that point on. The annual attrition rate of CTF training programs ranged from 7 to 15 fellows (2.9%-6.8%) during the study period.

CONCLUSIONS

The inception of VSR and CTR programs dramatically changed the paradigms for training in these highly specialized surgical fields. Comparisons of attrition rates between these two programs and the traditional VSF and CTR as well as GSR suggests lesser rates of attrition in the integrated programs. These data may prove reassuring to VSR and CTR program directors, whose significantly smaller programs are more vulnerable to the loss of even a single trainee than general surgery training programs are. In addition, the VSF program has stable and lower attrition rates compared with the CTF and GSR programs.

Addressing the recruitment shortfall in surgery - How do we inspire the next generation?

•Application rates to surgery by medical students have declined in recent years.•More hands-on experience, information and mentorship is needed in medical schools.•Within surgery, gendered stereotyping of roles and environments must be challenged.•Reform of the current systems of outcome reporting is necessary.

"Resident as teacher" in pediatric surgery: Innovation is overdue in Central Europe

PURPOSE

We set out to evaluate how residents in pediatric surgery learn and how they teach. We hypnotized that European residents learn as much from their peers and teach as much as their fellows worldwide, but that they receive comparably less educational training.

METHODS

An online questionnaire was distributed to the participants of the combined annual meeting for German, Swiss and Austrian residents in pediatric surgery. Participants were asked whom they learn from in different workplace environments (ward, operating room, emergency department), how, when and why they adopt the role of teacher and how they were prepared for this role.

RESULTS

Response rate was 48%. 65 questionnaires were analyzed. Residents stated that they predominantly learn from each other on wards and in the emergency department, less frequently in the operating room. They ranked fellow residents as first or second most important source of instruction. 53% of participants have never had any educational training, for another 33% the instruction was being done by fellow residents without any set curriculum. 93% of the participating residents had no or did not know about any resident as teacher training program available to them. Nevertheless, motivation to teach was stated to be high and interest in educational training was assured.

CONCLUSIONS

Our data delivers evidence that peer teaching during residency is the rule rather than the exception in Central Europe. Educational training however is scarce. Resident as teacher-training programs need to be introduced. Next to local initiatives, we strongly recommend national initiatives powered by regulatory authorities and surgical associations.

TYPE OF STUDY

Research paper.

LEVEL OF EVIDENCE

II.

Factors affecting interest in cardiothoracic surgery among junior surgical residents in Nigeria

Objective:

A survey was undertaken to determine the factors that affect interest in cardiothoracic surgery (CTS) among junior surgical residents in Nigeria.

Methods:

A cross-sectional study was done using a pilottested, 56-item, semi-structured questionnaire, which was filled in by 238 junior surgical residents in accredited hospitals in Nigeria.

Results:

Few of the respondents (8.4%) were committed to specialising in CTS. A minority of them, 28.2 and 2.1%, had assisted in major thoracic procedures and open-heart surgeries, respectively. The relationship between the level of training, rotation in CTS in junior residency and interest in CTS were statistically significant (p < 0.05). The main important factors responsible for the low interest in CTS include the lack of equipment (92%), limited training positions (64.9%), poor or lack of exposure in CTS as a junior resident (63%) and in medical school (58.8%).

Conclusion:

There is a dire need to provide facilities and training opportunities to improve the cardiothoracic workforce in Nigeria.

Winning Hearts and Minds: Inspiring Medical Students into Cardiothoracic Surgery Through Highly Interactive Workshops

BACKGROUND

The cardiothoracic surgical (CTS) specialty has witnessed a decline in the applicant pool. Early exposure, positive experiences, inspiring role models, and career insight are key in the decision-making process for specialty choice. Our objective was to assess the effect of high tutor:student ratio interactive CTS workshops in influencing the career choice of UK undergraduate medical students.

METHODS

Medical students attended a workshop comprising (1) guided dissection of fresh animal hearts, (2) surgical skills practice on models and fresh hearts, (3) operative videos (adult, congenital, transplant, and aortic) with interactive commentary, and (4) careers seminar. The tutor:student ratio was very high (between 3-1 and 5-1). A questionnaire was completed at the end of each workshop to assess its effect, including a 10-point Likert scale on the perceived attraction to CTS before and after the workshop.

RESULTS

A total of 96 delegates attended 5 workshops in 3 UK medical schools. Response rate was 83% from 80 undergraduate students. In all, 58% were male (46/80). There was an equal proportion of sexes in the early years of medical school, but was significantly skewed toward male in the later years. There was a statistically significant increase of 2.1 (standard deviation [SD] = 1.5) in the Likert scores before (μ = 5.0, SD = 2.1) and after (μ = 7.1, SD = 1.9) (p = 0.001). This represents a 42% increase in the perceived attraction to the CTS specialty because of the workshops.

CONCLUSIONS

Our workshops have a significant effect in stimulating undergraduate medical students toward a career in cardiothoracic surgery. We encourage national take-up of these easily organized daylong workshops to foster interest in the next generation of cardiothoracic surgeons.

A survey of 0 + 5 vascular surgery residency candidates: Perceptions of an applicant pool

Background

Applications to integrated (0 + 5) vascular surgery residencies have increased, while total applications have stayed relatively constant. This survey sought to document the perceptions of 0 + 5 vascular surgery applicants.

Methods

Academic faculty conducted interviews for 0 + 5 residency match at an academic medical center in preparation for the National Resident Matching Program (NRMP) Main Residency Match. Applicant pool (n = 20) perceptions were determined with surveys. Participation was anonymous and voluntary.

Results

Nineteen interviewees (26.3% female: 73.7% male), age (26.8 ± 2.6 years) responded (95% response rate). Of 19 respondents, 68% became interested in vascular surgery in their third year with 53% becoming aware of 0 + 5 programs in their third year. All respondents identified a vascular surgery attending at their institution as significant mentors. Forty-seven percent identified their mentor during their third year of medical school. All respondents felt that 0 + 5 training would prepare them adequately for the workforce and board certification exams. Almost all (89%) had plans to seek jobs immediately upon completion of residency.

Conclusion

Applicants remained positive about their planned training and career paths. Attending vascular surgeons were identified as the strongest mentors, yet most students decided only in their third and fourth years to pursue 0 + 5 residencies. Educational debt remains a concern, and there may be consideration for a concerted effort to recruit potential candidates sooner.

Inspiring the next generation of Cardiothoracic Surgeons: an easily reproducible, sustainable event increases UK undergraduate interest in the specialty

There is believed to be declining interest in cardiothoracic surgical careers among UK medical students. Relative lack of undergraduate exposure to the specialty compared with other surgical specialties may be partly responsible. Using pre- and postintervention analysis, we assessed the ability of a student-led extracurricular engagement event to increase undergraduate interest in the specialty. Fifty-four students attended and 50 (93%) participated in the study. Of the total, 32% of delegates had identified a cardiothoracic mentor, with only 8 and 4% exposed to cardiac and thoracic surgery, respectively, compared with 50% exposed to other surgical specialties. Self-reported understanding of cardiothoracic training increased from 20 to 80% (P < 0.001) after the 1-day event; 77% of delegates reported increased interest in the specialty. We demonstrate that it is possible to provide a free-to-user event that increases engagement using a student-led design. Similar events could increase interest in the specialty and may improve recruitment rates. Current levels of cardiothoracic exposure are very low among UK students.

A Survey of Cardiothoracic Surgical Training in the United Kingdom: Realities of a 6-Year Integrated Training Program

BACKGROUND

In recent years, cardiothoracic (CT) surgical training has faced several challenges, including a reduction in working hours and trainees favoring shorter training programs. We carried out a national survey in the United Kingdom (UK) to assess the CT 6-year training program.

METHODS

All CT trainees in the UK (n = 121) were sent an online survey. This was combined with a debate at the Society for CT Surgery of Great Britain and Ireland.

RESULTS

Ninety-one (75.2%) of all trainees responded. Despite 56 (68.1%) being rostered for more than a 48-hour week, 31 (34.1%) of all trainees work an extra 10 hours. The majority (56, 61.5%) thought that on-calls and night duty are useful. Just over half of the trainees (47, 51.6%) spend at least 2 full days in the operating room, but 79 (86.8%) thought that this is too little and would spend voluntary time operating. Simulation of operations is thought to be useful; however, few thought that this should take more precedence in their training program. The majority of trainees thought that the current assessment of surgical training is suboptimal and does not examine surgical skill. Similarly, the majority thought that a defined number of operations is required before qualification.

CONCLUSIONS

Trainees remain committed to their profession and are willing to dedicate more time perfecting their art. They believe that despite wanting extra operating experience, they will be ready for independent practice at the completion of their training. It rests with training bodies to find alternative assessments for surgical ability and to define experience at the exit point of training.

Current interest in careers in surgery and cardiothoracic surgery from the millennial generation

OBJECTIVE

Interest in cardiothoracic surgery (CTS) as a career has decreased over the past decade. Anecdotal evidence suggests that many surgeons develop an interest in CTS before medical school and even before college. This study evaluates the interest of high-school students at a magnet high school, with regard to careers in medicine, in surgery, and in CTS.

DESIGN

A survey assessing career interests and values was conducted among junior and senior high-school students. Students were given a 1-hour presentation by a cardiothoracic (CT) surgeon on the postgraduate training process and then completed a postpresentation survey.

SETTING

A magnet math and science high school, the Kalamazoo Area Mathematics and Science Center.

PARTICIPANTS

Of 128 students, 117 (91% response rate) completed the survey.

RESULTS

Overall, 38% of students reported having a high interest in medicine; of this group, 58% reported a high interest in surgery and 36% reported having a high interest in CTS. Men were more likely than women were to have a high interest in surgery and CTS (p < 0.001). Students with at least 1 family member as a physician vs those without were more likely to be interested in medicine, surgery, and CTS and also have a higher level of concern for postgraduation debt (p < 0.01). Women were more likely than men were to have a high level of concern about postgraduation debt (p = 0.018). After a presentation by a CT surgeon, students showed no changes in interest in medicine careers but did report an increased level of knowledge about the process of becoming a CT surgeon, going from 31% to 72%.

CONCLUSIONS

There exists a large interest in both surgery and CTS at the high-school level, but there may be a need for more active outreach to maintain and foster their interest in surgery and CTS through undergraduate and medical school.