Thoracic Surgery In-Training Exam Predicts Written But Not Oral Board Pass Rates: A 15-Year Single-Center Analysis

Congenital Heart Surgery Training Experiences and Perceptions Among Cardiothoracic Surgery Residents

Interest and core training in congenital heart surgery (CHS) has not been characterized among current cardiothoracic surgical trainees. This study aimed to evaluate perceptions, interest, exposure, and experience among current trainees. A 22 question survey was distributed to all cardiothoracic surgical trainees in ACGME-accredited thoracic surgery residencies. Questions included demographics, exposure to CHS during, perceptions of, participation in and quality assessment of CHS training. There were 106 responses (20.1% response rate) of which 31 (29.0%) were female and 87 (81.3%) were cardiothoracic track. While 69 (64.5%) reported having an interest in CHS at some point during training, only 24 (22.4%) were actively pursuing CHS. All but 7 (6.5%) residents reported having easy access to congenital mentorship, with 35 (32.7%) actively participating in CHS research. Three months was the median duration of congenital rotations. Residents reported less operative participation on CHS compared to adult cardiac surgery. Several residents noted the need for earlier exposure and increased technical/operative experience as areas in need of improvement. The most cited primary influences to pursue CHS included: mentorship, breadth of pathology, and technical nature of the specialty. Lack of consistent job availability and length of additional training were reported as negative influences. Cardiothoracic residents report adequate exposure to obtain case requirements and knowledge for board examinations in CHS but highly variable operative involvement. Mentorship and early exposure remain important for those interested in CHS, while additional training time and limited job availability remain hurdles to CHS.

The Vascular Surgery In-Training Examination Predicts Performance on the Qualifying Examination

OBJECTIVE

Vascular surgery trainees participate in the Vascular Surgery In-Training Examination (VSITE) during each year of their training. Although the VSITE was developed as a low-stakes, formative examination, performance may correlate with the pass rates on the Vascular Surgery Board (VSB) written Qualifying (VQE) and oral Certifying (VCE) exams and may, therefore, guide both trainees and program directors. This study was designed to examine the ability of the VSITE to predict performance on the VQE and VCE.

METHODS

All first-time candidates of the VSB VQE and VCE were analyzed from 2016 to 2020, including those from both the integrated (0 + 5) and independent (5 + 2) training pathways. VSITE scores from the final year of training were associated with VQE scores and with the probability of passing both the VQE and VCE. Linear and logistic regression models were used to determine the ability of VSITE results to predict VQE scores and the probability of passing each board examination.

RESULTS

VSITE scores available for the 559 (69.3% male, 30.7% female) candidates who completed the VQE and 369 (66.7% male, 33.3% female) who completed both the VQE and VCE. Linear regression model results for the final year of training showed that VSITE scores explained 34% of the variance of VQE scores, 29% for the integrated and 37% for the independent trainees. Logistic regression demonstrated that final year VSITE scores were a significant predictor of passing the VQE for both integrated and independent trainees (p<0.001). A VSITE score of 500 during the final year of training predicted a VQE passing probability of >90% for each group of candidates. The probability of passing the VQE decreased to 73% for candidates from integrated programs, 61% for candidates from independent programs, and 64% for the whole cohort when the score was 400. VSITE scores were a significant predictor of passing the VCE for only the candidates from independent programs (OR = 1.01; 95% CI, 1.00-1.02; p < .01), where a VSITE score of 400 correlated to an 82% probability of passing the VCE.

CONCLUSION

VSITE performance is predictive of passing the VQE for trainees from both the integrated and independent training paradigms. Vascular surgery trainees and training programs should optimize their preparation and educational efforts to maximize performance on the VSITE during their final year of training to improve the likelihood of passing the VQE. Further analysis of the predictive value of VSITE scores during the earlier years of training may allow the board certification examinations to be administered earlier in the final year of training.

Considerations for a Holistic Model in Evaluating Medical Students for Cardiothoracic Surgical Residency

Program directors are tasked with selecting whom they think will be the best fit for residency and the next leaders of the field. While numerical metrics have played a vital role in this process, recent changes to student evaluation are reducing the availability of these metrics. This poses unique challenges for both applicants and program directors. Here we discuss how this will likely shift the focus on other parts of the application and the consequences (good and bad) of doing so.

Multimodal In-training Examination in an Emergency Medicine Residency Training Program: A Longitudinal Observational Study

Background

In-training examination (ITE) has been widely adopted as an assessment tool to measure residents' competency. We incorporated different formats of assessments into the emergency medicine (EM) residency training program to form a multimodal, multistation ITE. This study was conducted to examine the cost and effectiveness of its different testing formats.

Methods

We conducted a longitudinal study in a tertiary teaching hospital in Taiwan. Nine EM residents were enrolled and followed for 4 years, and the biannual ITE scores were recorded and analyzed. Each ITE consisted of 8–10 stations and was categorized into four formats: multiple-choice question (MCQ), question and answer (QA), oral examination (OE), and high-fidelity simulation (HFS) formats. The learner satisfaction, validity, reliability, and costs were analyzed.

Results

486 station scores were recorded during the 4 years. The numbers of MCQ, OE, QA, and HFS stations were 45 (9.26%), 90 (18.5%), 198 (40.7%), and 135 (27.8%), respectively. The overall Cronbach's alpha reached 0.968, indicating good overall internal consistency. The correlation with EM board examination was highest for HFS (ρ = 0.657). The average costs of an MCQ station, an OE station, and an HFS station were ~3, 14, and 21 times that of a QA station.

Conclusions

Multi-dimensional assessment contributes to good reliability. HFS correlates best with the final training exam score but is also the most expensive format among ITEs. Increased testing domains with various formats improve ITE's overall reliability. Program directors must understand each test format's strengths and limitations to bring forth the best combination of exams under the local context.

The Plastic Surgery In-service Training Examination: An In-depth Reference Analysis

The goal of this study was to characterize the references provided as supporting evidence of the Plastic Surgery In-service Training Examination (PSITE) syllabi, including those on the novel “core surgical principles” section.

Thoracic Surgery Foundation Research Awards: Leading the Way to Excellence

BACKGROUND

Combining clinical and research excellence has become an increasingly difficult endeavor for thoracic surgeons, with typical success rates for the NHLBI and NCI being 25.1% and 11.3% respectively. The Thoracic Surgery Foundation (TSF), which is an arm of the Society of Thoracic Surgeons, provides research awards and grants aimed at early career faculty to assist in securing federal peer reviewed funding. The aim of this study was to assess the impact of these awards.

METHODS

Faculty awardees of the TSF research awards from 1995 to 2019 were included in the study. The scholarly work of awardees was assessed using SCOPUS , MEDLINE, and google scholar for publications, citations and h-index. NIH RePorter and federal RePorter was used to search for any grants awarded to these individuals. For publications and citations associated with a TSF grant, a four-year window from the time of the research award was utilized.

RESULTS

Fifty-two research awards were given to early career faculty during this study period, 8 (15%) were awarded to MD PhDs. Six (12%) of awardees were female. Cardiac faculty were awarded 27 (52%) of awards and general thoracic faculty were awarded 25 (48%); of the cardiac faculty, 4 (17.4%) were congenital cardiac faculty. In the 4-year period following the TSF grant award, the mean number of published articles per awardee was 23 (interquartile range (IQR) 12-36) with a median citation count of 147 (IQR 32-327). The current median h-index was 26 (IQR 15-36) with 2,323 (IQR 1,173-4,568) median citations. Forty-eight percent of all awardees received at least 1 subsequent grant grant, with 40.4% being awarded from the NIH and25% having two or more NIH grants. Comparing academic position at the time of the award to current position, 54% of awardees had an advancement in their professional rank. On analyzing leadership positions, 42% of awardees were division chiefs, 21% were associate clinical directors, and 28% were clinical directors.

CONCLUSIONS

Being a recipient of the TSF award may position an individual to excel in academic medicine, with a large portion of awardees improving their academic standing with time. The rate of successful NIH grant funding after being a TSF awardee is higher than typical institutional success rates.