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Ann Thorac Surg 2006;81:1179-1180
© 2006 The Society of Thoracic Surgeons

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Correspondence

The Future of Cardiac Surgery Training Programs

Department of Cardiothoracic Surgery, Stanford University, 2500 Grant Rd, Room 318, Mountain View, CA 94040

(Email: dunningtong{at}yahoo.com).

To the Editor:

Drs Lytle and Mack [1] made an interesting assessment of the state of cardiac surgery and its future. One omission was worth noting (ie, the future of the thoracic residency training program). Current requirements mandate a full general surgery residency prior to entry into a cardiothoracic residency. During that time, 2 to 3 of those training years are spent learning the mastery of diseases cared for by general surgeons (ie, skills that will never be used again once that trainee becomes a cardiothoracic surgeon). Instead of 5 years of studying general surgery, why couldn't the cardiac surgeons of the future have 4 to 5 years of cardiothoracic training after 2 years of general surgery residency? Drs Lytle and Mack [1] stressed the need for future cardiac surgeons to be trained in several new technologies, and they acknowledged the many fellowships for subspecialization that have developed, which only serve to lengthen the training process for cardiac surgeons. Instead of adding years to an already stretched-out training process, it is time to revisit the idea of a more compact and focused training program for thoracic residents. The increasing sophistication of cardiac surgery will require more focused training at a residency level to guarantee competent cardiac surgeons. The Canadian system of an integrated 6-year training program has not shattered the quality of cardiac surgery in that country. In fact, many hospitals in the United States already accept Canadian cardiac surgeons, certified by the Royal College of Physicians and Surgeons of Canada, without any concern for their purported general surgery deficiencies.

There are many benefits to adopting an integrated residency program, both for the residents and the program. For the resident, it would mean a more focused training on cardiothoracic disease, with rotations spent in the cardiac catheterization lab, the echocardiographic lab, in cardiovascular imaging, and rotations in cardiology and cardiac intensive care units. It would give them extra time to pursue focused fellowships in their area of choice (eg, minimally invasive surgery, surgery for arrhythmias, or surgery for heart failure). The resident would finish training not only as a cardiac surgery trainee, but would also have a special niche, allowing the person to flourish in the first years of practice while having a special area of contribution for a new group. For the training programs, guidance of the residents would come earlier, allowing them to mold the skills and exposure they receive. It would also provide them with a larger body to help with education and manpower issues related to resident work-hour requirements. The earlier access to these residents would ensure an ability to train their cardiothoracic skills, which are clearly different than general surgery skill sets. The argument is strong to favor this for 2 to 3 senior years of general surgery training that will be forever lost and unused.

The American Board of Thoracic Surgery agreed in principle to alternative training tracks for thoracic surgeons as long ago as 2001. It is time to implement a new paradigm and begin to offer residents a more complete and efficient training system the first time around.

	References

Top References

 

1. Lytle B, Mack M. The future of cardiac surgery Ann Thorac Surg 2005;79:1470-1472.[Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gan H. Dunnington Marc P. Pelletier Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dunnington, G. H. Articles by Pelletier, M. P. Search for Related Content PubMed PubMed Citation Articles by Dunnington, G. H. Articles by Pelletier, M. P. Related Collections Professional affairs