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Ann Thorac Surg 2009;88:75. doi:10.1016/j.athoracsur.2009.04.048
© 2009 The Society of Thoracic Surgeons
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Original Articles: Adult Cardiac

Invited Commentary

Fred H. Edwards, MD

Division of Cardiothoracic Surgery, 653-2 West 8th St, Shands Jacksonville, University of Florida, Jacksonville, FL 32209-6511

(Email: fred.edwards{at}jax.ufl.edu).

This is a timely study by addressing a topic that has not been totally resolved in cardiothoracic surgery [1]. The study centers on differences between "early" and "late" times of the year. Unfortunately these threshold dates have been arbitrarily specified. A more meaningful approach might have been to select breakpoints defined by the data alone.

Although there is certainly some variation across the country, it does seem that beginning residents do not perform a significant portion of the procedures in the first 2 months of training. The first 2 months may actually be characterized by more staff-level involvement than in the subsequent months. In addition, there has been no account of the resident rotation schedule, which clearly has an impact on the resident contribution to surgical care.

The authors are to be commended for investigating this issue, but it should be emphasized that this work is not a study of the influence of resident experience, but rather an examination of different parts of the academic year.


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  1. Bakaeen FG, Huh J, LeMaire SA, et al. The July effect: impact of the beginning of the academic cycle on cardiac surgical outcomes in a cohort of 70,616 patients Ann Thorac Surg 2009;88:70-75.[Abstract/Free Full Text]

Related Article

The July Effect: Impact of the Beginning of the Academic Cycle on Cardiac Surgical Outcomes in a Cohort of 70,616 Patients
Faisal G. Bakaeen, Joseph Huh, Scott A. LeMaire, Joseph S. Coselli, Shubhada Sansgiry, Prasad V. Atluri, and Danny Chu
Ann. Thorac. Surg. 2009 88: 70-75. [Abstract] [Full Text] [PDF]




This Article
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