Weathering the storm: How can thoracic surgery training programs meet the new challenges in the era of less-invasive technologies?

Prasad, Sunil M.; Massad, Malek G.; Chedrawy, Edgar G.; Snow, Norman J.; Yeh, Joannie T.; Lele, Himalaya; Tarakji, Ahmed; Maniar, Hersh S.; Herren, Heather; Gay, William A.

doi:10.1016/j.jtcvs.2009.02.029

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 6 , Pages 1317-1326.e1, June 2009

Weathering the storm: How can thoracic surgery training programs meet the new challenges in the era of less-invasive technologies?

Sunil M. Prasad, MD
- Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Ill
- Address for reprints: Sunil M. Prasad, MD, Division of Cardiothoracic Surgery, The University of Illinois at Chicago, 840 S. Wood Street, CSB Suite 417 (MC 958), Chicago, IL 60612.
Malek G. Massad, MD
- Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Ill
Edgar G. Chedrawy, MD
- Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Ill
Norman J. Snow, MD
- Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Ill
Joannie T. Yeh, MS
- Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Ill
Himalaya Lele, MD
- Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Ill
Ahmed Tarakji, MD
- Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Ill
Hersh S. Maniar, MD
- Division of Cardiothoracic Surgery, Christiana Care Health System, Newark, Del
Heather Herren, RN, MPH
- Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Ill
William A. Gay, MD
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo

Received 8 May 2008; received in revised form 7 January 2009; accepted 16 February 2009.

Objective

The introduction of new technologies has shifted some resident index procedures to nonsurgical specialists. We examined the operative case volume of thoracic surgery residents during the last 6 years to objectively identify changes and trends.

Methods

Program and resident data from 2002 to 2007 were entered into a database and analyzed. Program match information was obtained from the National Resident Matching Program. Resident operative experience and board examination results were obtained from the American Board of Thoracic Surgery.

Results

A total of 795 residents qualified for the written American Board of Thoracic Surgery examination; 627 residents graduated from 2-year programs, and 168 residents graduated from 3-year programs. The total number of resident cases was higher in 3-year programs compared with 2-year programs in all 10 index categories studied (P < .01). The total volume of cases has not significantly increased in 2-year programs. The volume of coronary artery bypass graft surgeries decreased in every resident program model studied. The volume of general thoracic cases increased in all program models. Two-year, 2-resident programs had the lowest volume in 5 of the 10 categories, reaching significance in 3 categories. The written board pass rate was lower among 2-year programs than among 3-year programs (86% vs 95%, respectively, P = .003).

Conclusion

Training programs have so far weathered the storm by maintaining index volume with a new case mix, but significant trends in revascularization procedures are concerning. This study indicates a significant advantage in case volume and board pass rates among 3-year programs. Thoracic residency programs should be reorganized so that the number of residents does not exceed the capacity of the program to provide a meaningful experience.

Abbreviations and Acronyms: ABTS, American Board of Thoracic Surgery, ACGME, American Council on Graduate Medical Education, ANOVA, analysis of variance, NRMP, National Resident Matching Program, RRC-TS, Residency Review Committee for Thoracic Surgery