Cardiac surgery residency in Brazil: How to deal with the challenges of this unique specialty

Abstract

The first Brazilian open procedure, under cardiopulmonary bypass, was performed by Dr Felipozzi, in 1955. 1 Since then, Brazilian surgeons have contributed to the cardiac surgery subspecialty with innumerous novel procedures. In 1975, Dr Jatene pioneered the arterial switch operation. 2 This technique remains the standard of care treatment for transposition of great vessels. Dr Buffolo, along with Dr Benetti, from Argentina, described an alternative for coronary artery revascularization under cardiopulmonary bypass, the off-pump coronary artery bypass grafting, in 1985. 3 Dr Batista reported a partial left ventriculotomy for the surgical treatment of left ventricle aneurysm in nonischemic dilated cardiomyopathy. 4 Recently, Dr Da Silva described the cone procedure, which is now the preferred method for correction of Ebstein's anomaly. 5 Currently, the national case volume, embracing all cardiac surgical procedures, in Brazil is approximately 100,000 per year. 6 Among these interventions, the highest percentage is represented by coronary artery bypass grafting, followed by valve surgery, pacemaker or implantable cardioverter/defibrillator, congenital, aortic procedures, heart transplantation, and others.Throughout the past decades, cardiac surgery has changed and evolved dramatically. In Brazil, this scenario is not different. Therefore, the training of contemporary cardiac surgeons is being modified to adapt to current demands: residency curriculum reformulation, with more time devoted to endovascular and invasive cardiology rotations; creation of national workshops to expose the resident to novel techniques; and elimination of general surgery requirement to apply for cardiac surgery residency. We present the cardiac surgery residency experience in Brazil and how the residency program is changing to provide adequate training to future surgeons. DETAILS OF TRAINING Residency Options and Recruitment ProcessIn Brazil, cardiac surgery residency has a separate pathway from thoracic and vascular surgery. The Brazilian From the

Medical School, Cardiovascular Surgery, and Education: how we do it in Brazil’s scenario?

“…In 2018, after years of debate, both BSCVS and the Ministry of Education created a five-year program of medical residency without the need for two years of general surgery, with the possibility of acquiring knowledge in the various areas of clinical and interventional cardiology, as well as in cardiac and endovascular surgery [ 3 ] . It is important to notice that unlike most countries, like the United States of America, the cardiovascular surgery residency program does not englobe training in the thoracic track, which is a different acknowledged specialty in our country.…”

Change in the SBCCV’s Medical Residency Program — Perspectives of the Specialty and Challenges of Young Surgeons

“…The immediate reflection of these decisions was the alarming drop in candidates for training in the specialty, occupying only 24.2% of the 323 vacancies offered each year, and it became urgent to reverse this disastrous situation. We had a previous successful experience, which continues to this day, with SBCCV’s Teaching and Training Centers, which have always been of direct access and with a significant number of candidates, proving the negative impact of the inclusion of the prerequisite [ 4 , 5 ] . Then, a wave of innovation using new technologies introduced a series of procedures with less invasive potential, via mini-access and percutaneous catheters, occupying an important space in the treatment of valvular, aortic, and congenital heart diseases, implants of mechanical circulatory assistance devices, and in the treatment of arrhythmias.…”

COVID-19 and Cardiovascular Surgery. Do We Know What We Are Dealing With?

“…Additionally, this provision has, directly and indirectly, affected the learning curve of residents of the surgical area, as is the case with cardiovascular surgery evidencing a reduction in surgical procedures (elective vs. emergency), leading to a decrease in the hours of surgical training, progressively replaced by support hours in specific areas for COVID-19, like intensive care units and emergency rooms. A variety of technological alternatives has been suggested to try to compensate for the lack of traditional academic training in medical residency towards a virtual hybrid model [ 8 , 9 ] .…”