First nationwide survey of US integrated 6-year cardiothoracic surgical residency program directors

Abstract

Objective The recently implemented integrated 6-year (I-6) format represents a significant change in cardiothoracic surgical residency training. We report the results of the first nationwide survey assessing I-6 program directors' impressions of this new format. Methods A 28-question web-based survey was distributed to program directors of all 24 Accreditation Council for Graduate Medical Education-accredited I-6 training programs in November 2013. The response rate was a robust 67%. Results Compared with graduates of traditional residencies, most I-6 program directors with enrolled residents believed that their graduates will be better trained (67%), be better prepared for new technological advances (67%), and have superior comprehension of cardiothoracic disease processes (83%). Just as with traditional program graduates, most respondents believed their I-6 graduates would be able to independently perform routine adult cardiac and general thoracic operations (75%) and were equivocal on whether additional specialty training (eg, minimally invasive, heart failure, aortic) was necessary. Most respondents did not believe that less general surgical training disadvantaged I-6 residents in terms of their career (83%); 67% of respondents would have chosen the I-6 format for themselves if given the choice. The greater challenges in training less mature and experienced trainees and vulnerability to attrition were noted as disadvantages of the I-6 format. Most respondents believed that I-6 programs represent a natural evolution toward improved residency training rather than a response to declining interest among medical school graduates. Conclusions High satisfaction rates with the I-6 format were prevalent among I-6 program directors. However, concerns with respect to training relatively less experienced, mature trainees were evident.

Disparity between recent graduates’ and experienced surgeons' assessment of time to operative independence

“…In the first nationwide survey of I-6 program directors, 75% believed their I-6 graduates would be able to independently perform routine cardiac and thoracic operations by the time of graduation, with this rate increasing to 86% in mature programs. 6 Sixty-seven percent believed I-6 graduates would be ''better trained'' than traditional pathways, although this was not specific to operative preparedness.…”

A Survey of Cardiothoracic Surgical Training in the United Kingdom: Realities of a 6-Year Integrated Training Program

“…Some other concerns included the unwillingness of the surgical faculty to train such junior residents, and residents' attrition in midcourse. The nationwide surveys indicated that the programs attract and retain highly qualified trainees, with high satisfaction among the program directors [3,4].…”

“…In a recent survey of residents in the United States who have entered the 6-year integrated program, although 94% considered the time saved in total years of training an advantage, 58% favored a 7-year program for the additional board certification in vascular surgical procedures, or wished to take time off for dedicated research and favored an extra year as a fellowship at the completion of their training [2]. Among the directors of 6-year programs in the United States, 75% believed that their graduates would be able to competently and independently perform routine cardiothoracic operations in adults [4].…”

Commentary: Innovate or perish in cardiac surgical training

“…The external pressures to cardiac surgical training are remarkably consistent to reports from North America, Europe, and Asia. [2][3][4] The major challenges to recruitment represent a combination of (1) the perceived small pool of jobs, (2) low reimbursement, and (3) adequate ''work-life balance.'' Attracting top-class medical students and more women to cardiac surgery is crucial to ensure the continued vitality of our specialty.…”