RESUMO
BACKGROUND: The Joint Surgery-Thoracic Surgery (JS-TS) pathway began as a pilot program to grant both general surgery (GS) residency and thoracic surgery (TS) fellowship credit for 12 months of the PGY-4 and 5 years. This review updates the outcomes of this novel program. STUDY DESIGN: GS and TS programs in all approved JS-TS institutions were contacted for data collection, including JS-TS enrollee demographics and GS and TS case logs (CLs). National GS and TS CL data, and program and institutional data were publicly available. Enrollee case numbers were compared with those of their contemporaries. The American Board of Surgery and American Board of Thoracic Surgery provided certification data. Only enrollees who completed GS through 2019 were included. RESULTS: There were 90 JS-TS enrollees in 14 institutions. Two enrollees withdrew and 1 had not completed TS at the time of data collection leaving 87 for analysis. GS CLs were available for all 87 enrollees. TS CLs were available for all 62 enrollees who completed fellowship in 2016 or later. In GS, enrollees recorded fewer cases than their contemporary PGY-5s nationally in all domains except thoracic and endocrine. In TS, mean enrollee case numbers exceeded those of national contemporaries in every major category. Sixty-two JS-TS enrollees have achieved American Board of Surgery certification. Eighty-two enrollees are American Board of Thoracic Surgery certified with 5 currently in the certification process. CONCLUSIONS: The JS-TS pathway has proven a successful alternative route for TS training and could be a blueprint for other specialties considering novel avenues to specialty training.
Assuntos
Cirurgia Geral , Internato e Residência , Cirurgia Torácica , Procedimentos Cirúrgicos Torácicos , Humanos , Estados Unidos , Certificação , Inquéritos e Questionários , Cirurgia Geral/educaçãoRESUMO
It is, indeed, a privilege to stand here before you this morning to give the annual Flege Lecture. Dr. Sande Starnes has kindly supplied me with a list of prior visiting professors, who previously have had the honor to deliver this talk. When we examine the names of those who have been so honored, and note their many accomplishments, I cannot help but remember the words of Winston Churchill, who, when speaking of another person, could well have been speaking of me, when he described "a modest little person, with much to be modest about."
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Procedimentos Cirúrgicos Cardíacos/história , Cardiologia/história , Cirurgia Torácica/história , História do Século XX , História do Século XXI , Humanos , Masculino , Estados UnidosRESUMO
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic. METHODS: A detailed survey was sent to recruit participating adult cardiac surgery centers in North America. Data regarding cardiac surgeons' perceptions and changes in practice were analyzed. RESULTS: Our study comprises 67 institutions with diverse geographic distribution across North America. Nurses were most likely to be redeployed (88%), followed by advanced care practitioners (69%), trainees (28%), and surgeons (25%). Examining surgeon concerns in regard to COVID-19, they were most worried with exposing their family to COVID-19 (81%), followed by contracting COVID-19 (68%), running out of personal protective equipment (PPE) (28%), and hospital resources (28%). In terms of PPE conservation strategies among users of N95 respirators, nearly half were recycling via decontamination with ultraviolet light (49%), followed by sterilization with heat (13%) and at home or with other modalities (13%). Reuse of N95 respirators for 1 day (22%), 1 week (21%) or 1 month (6%) was reported. There were differences in adoption of methods to conserve N95 respirators based on institutional pandemic phase and COVID-19 burden, with higher COVID-19 burden institutions more likely to resort to PPE conservation strategies. CONCLUSIONS: The present study demonstrates the impact of COVID-19 on North American cardiac surgeons. Our study should stimulate further discussions to identify optimal solutions to improve workforce preparedness for subsequent surges, as well as facilitate the navigation of future healthcare crises.
Assuntos
COVID-19 , Cirurgiões , Adulto , Descontaminação , Humanos , Pandemias , Percepção , SARS-CoV-2RESUMO
Barney Brooks, MD, was the first Professor of Surgery in the newly reconstituted Vanderbilt University School of Medicine in 1925, a position he held until 1951. He was born on the remote plains of Texas and came from obscure beginnings, but through much hard work and determination, he rose to occupy a position of prominence and was a leader in surgery of national scope. Of his major contributions, he considered teaching to be of the utmost importance, and it was for his efforts in teaching that he was most widely known. His reputation as a stern taskmaster was well deserved, but there are other aspects of this most complex man that bear a closer look. An examination of his archived correspondence is revealing, and it shows him to have been a caring and compassionate individual who formed lasting bonds with medical students and residents, members of his faculty, and others. Thus, his life and contributions to surgery and surgical education should be remembered and celebrated.
RESUMO
BACKGROUND: The Early Specialization Program (ESP) in surgery was designed by the American Board of Surgery, the American Board of Thoracic Surgery, and the Residency Review Committees for Surgery and Thoracic Surgery to allow surgical trainees dual certification in general surgery (GS) and either vascular surgery (VS) or cardiothoracic surgery (CTS) after 6 to 7 years of training. After more than 10 years' experience, this analysis was undertaken to evaluate efficacy. STUDY DESIGN: American Board of Surgery and American Board of Thoracic Surgery records of VS and CTS ESP trainees were queried to evaluate qualifying exam and certifying exam performance. Case logs were examined and compared with contemporaneous non-ESP trainees. Opinions of programs directors of GS, VS, and CTS and ESP participants were solicited via survey. RESULTS: Twenty-six CTS ESP residents have completed training at 10 programs and 16 VS ESP at 6 programs. First-time pass rates on American Board of Surgery qualifying and certifying exams were superior to time-matched peers; greater success in specialty specific examinations was also found. Trainees met required case minimums for GS despite shortened time in GS. By survey, 85% of programs directors endorsed satisfaction with ESP, and 90% endorsed graduate readiness for independent practice. Early Specialization Program participants report increased mentorship and independence, greater competence for practice, and overall satisfaction with ESP. CONCLUSIONS: Individuals in ESP programs in VS and CTS were successful in passing GS and specialty exams and achieving required operative cases, despite an accelerated training track. Programs directors and participants report satisfaction with the training and confidence that ESP graduates are prepared for independent practice. This documented success supports ESP training in any surgical subspecialty, including comprehensive GS.
Assuntos
Internato e Residência/organização & administração , Especialização , Especialidades Cirúrgicas/educação , Atitude do Pessoal de Saúde , Certificação , Competência Clínica , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Estados UnidosRESUMO
Communication with patients and their families is a challenge for busy trainees. It is essential, however, that these trainees learn effective communication skills to create rapport with their patients, to add to their own satisfaction in caring for these patients and to use these conversations to constantly reassess their plans for treating their patients. Reflecting on the plans for and the outcomes of the care of their patients will also significantly enhance the educational value of the participation of trainees in this patient care, while simultaneously improving the care of both their current and their future patients. Finally, gaining facility in elaborating on their plans for and the delivery of patient care will help trainees become more articulate and thoughtful practitioners.
Assuntos
Competência Clínica , Educação Médica/normas , Assistência ao Paciente/normas , Relações Médico-Paciente , HumanosRESUMO
BACKGROUND: We sought to define an accurate measure of thoracic surgical education costs. METHODS: Program directors from six distinct and differently sized and geographically located thoracic surgical training programs used a common template to provide estimates of resident educational costs. These data were reviewed, clarifying questions or discrepancies when noted and using best estimates when exact data were unavailable. Subsequently, a composite of previously published cost-estimation products was used to capture accurate cost data. Data were then compiled and averaged to provide an accurate picture of all costs associated with thoracic surgical education. RESULTS: Before formal accounting was performed, the estimated average for all programs was approximately $250,000 per year per resident. However, when formal evaluations by the six programs were performed, the annual cost of resident education ranged from $330,000 to $667,000 per year per resident. The average cost of $483,000 per year was almost double the initial estimates. Variability was noted by region and size of program. Faculty teaching costs varied from $208,000 to $346,000 per year. Simulation costs ranged from $0 to $80,000 per year. Resident savings to program ranged from $0 to $135,000 per year and averaged $37,000 per year per resident. CONCLUSIONS: Thoracic surgical education costs are considerably higher than initial estimates from program directors and probably represent an unappreciated source of financial burden for cardiothoracic surgical educational programs.
Assuntos
Educação Médica Continuada/economia , Internato e Residência/economia , Avaliação de Programas e Projetos de Saúde/economia , Cirurgia Torácica/educação , Análise Custo-Benefício , Humanos , Cirurgia Torácica/economia , Estados UnidosRESUMO
Dr James D. Hardy served as Chairman of the Department of Surgery at the University of Mississippi Medical Center Jackson, Mississippi, from 1955 to 1987. During his tenure, he had an unprecedented effect on the education of medical students, residents, and professionals in his field. Not only did he speak and write voluminously about medical education and the roles both teacher and student play in this interaction but also emphasized the importance of the family unit to the academic physician. This article serves to highlight Dr Hardy's thoughts about discipline, research, and personal experience as they pertain to medical education, as well as to impart some of his wisdom about life, family, and personal well-being.
Assuntos
Educação Médica/história , Cirurgia Geral , Cirurgia Geral/história , História do Século XX , HumanosRESUMO
BACKGROUND: With our specialty going through a critical phase of re-evaluation and adaptation, our aim was to evaluate and compare the perceptions and expectations among residents and faculty regarding cardiothoracic training. METHODS: A content-validated, 13-item survey was distributed electronically from August 14 to August 24, 2010 to 728 cardiothoracic surgery residents, recent program graduates (on or after June 2006), cardiothoracic surgery chairpersons, and program directors identified in the Cardiothoracic Surgery Network database. RESULTS: The response rate was 34% (244 of 728). Of the respondents, 76% reported being "satisfied" or "very satisfied" with their program. Faculty willingness to teach in the operating room was ranked as the most valuable aspect of a training program, and strict adherence to the 80-h work week ranked as least valuable. Most respondents believed that a resident performing at least 75% of a case was acceptable for low-complexity procedures (92% of residents, 77% of attending physicians) and at least 25% for high-complexity procedures (91% of residents, 73% of attending physicians). However, residents wanted to perform more of the operations than the attending physicians considered necessary (P < 0.05). Finally, 63% of respondents (73% of residents, 56% of attending physicians) indicated that the increasing scrutiny of outcomes has adversely affected training. Other differences between the residents' and attending physicians' perceptions regarded the importance of participation in preoperative and postoperative care, what constitutes "scut work," and the value of auxiliary staff. CONCLUSIONS: Reconciling residents' expectations with the realities of duty-hour restrictions and high-stakes procedures will require the development of novel educational approaches to improve resident learning.
Assuntos
Cirurgia Torácica/educação , Adulto , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Satisfação no Emprego , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Percepção , Inquéritos e Questionários , Cirurgia Torácica/estatística & dados numéricosRESUMO
George Heuer undertook his medical education and residency training in surgery at Johns Hopkins. He then joined the surgical faculty under Halsted. He became Chair of Surgery at the University of Cincinnati in 1922, where he developed the second formal surgical training program modeled on Halsted's principles. Subsequently, he became Chair of Surgery at Cornell where he founded another surgical residency. His training programs stressed broad and thorough experience, and he championed increasing resident responsibility and independence. The demonstrated efficacy of his surgical residencies assisted greatly in the formation of subsequent resident training programs across this country.
Assuntos
Educação Médica/história , Cirurgia Geral/educação , História do Século XX , Humanos , Estados UnidosRESUMO
Aortic valve calcification is the most common form of valvular heart disease, but the mechanisms of calcific aortic valve disease (CAVD) are unknown. NOTCH1 mutations are associated with aortic valve malformations and adult-onset calcification in families with inherited disease. The Notch signaling pathway is critical for multiple cell differentiation processes, but its role in the development of CAVD is not well understood. The aim of this study was to investigate the molecular changes that occur with inhibition of Notch signaling in the aortic valve. Notch signaling pathway members are expressed in adult aortic valve cusps, and examination of diseased human aortic valves revealed decreased expression of NOTCH1 in areas of calcium deposition. To identify downstream mediators of Notch1, we examined gene expression changes that occur with chemical inhibition of Notch signaling in rat aortic valve interstitial cells (AVICs). We found significant downregulation of Sox9 along with several cartilage-specific genes that were direct targets of the transcription factor, Sox9. Loss of Sox9 expression has been published to be associated with aortic valve calcification. Utilizing an in vitro porcine aortic valve calcification model system, inhibition of Notch activity resulted in accelerated calcification while stimulation of Notch signaling attenuated the calcific process. Finally, the addition of Sox9 was able to prevent the calcification of porcine AVICs that occurs with Notch inhibition. In conclusion, loss of Notch signaling contributes to aortic valve calcification via a Sox9-dependent mechanism.
Assuntos
Valva Aórtica/metabolismo , Calcinose/metabolismo , Doenças das Valvas Cardíacas/metabolismo , Receptor Notch1/metabolismo , Idoso , Idoso de 80 Anos ou mais , Animais , Valva Aórtica/patologia , Células COS , Calcinose/patologia , Proteínas de Ciclo Celular/metabolismo , Chlorocebus aethiops , Proteínas da Matriz Extracelular/metabolismo , Regulação da Expressão Gênica , Doenças das Valvas Cardíacas/patologia , Humanos , Pessoa de Meia-Idade , Transporte Proteico , Ratos , Fatores de Transcrição SOX9/metabolismo , Transdução de Sinais , Suínos , Transcrição GênicaRESUMO
OBJECTIVE: With cardiothoracic education going through a critical phase of reevaluation and adaptation, we investigated perceptions of Veterans Affairs hospitals in cardiothoracic training. METHODS: A content-validated survey was distributed electronically to 676 cardiothoracic surgery residents, recent cardiothoracic graduates (on or after June 2006), cardiothoracic surgery chairpersons, program directors, associate program directors, and section heads. The Cardiothoracic Surgery Network was used to identify target recipients and their e-mail addresses. RESULTS: Forty-three percent of the target recipients (292/676) completed the survey. Of those who were residents, 59% (65/111) rotated at a Veterans Affairs hospital during their cardiothoracic training; this rotation accounted for 25% or more of the total training period for 19% of them (21/111). A Veterans Affairs appointment was held by 42% of program directors/chairpersons (20/48) and 24% of graduates, associate program directors, and section heads (31/129). An affiliation with a Veterans Affairs hospital was rated as somewhat to very beneficial by 93% of the responders (273/292), and the cardiothoracic training received at Veterans Affairs facilities was rated as good to excellent by 73% of the responders (213/292). Sixty-nine percent of respondents (201/292) reported the operating room environment at Veterans Affairs hospitals to be at least as conducive to learning as that at the affiliate teaching hospital, and 76% (223/292) indicated that residents get more autonomy and hands-on experience at Veterans Affairs institutions. In addition, 64% of responders (188/292) reported that they would seek or recommend a Veterans Affairs job. Responses were positive toward the Veterans Affairs system regardless of whether the responder had any Veterans Affairs affiliation (ie, appointment as staff or rotation as resident); however, a Veterans Affairs affiliation was associated with a higher rate of positive responses regarding Veterans Affairs hospitals. CONCLUSIONS: These findings suggest that Veterans Affairs hospitals are perceived as providing valuable experience in cardiothoracic training. The results warrant additional studies to further define the educational role of Veterans Affairs hospitals and help shape existing and future collaboration between cardiothoracic residency programs and the Veterans Affairs.
Assuntos
Atitude do Pessoal de Saúde , Procedimentos Cirúrgicos Cardiovasculares/educação , Educação de Pós-Graduação em Medicina , Conhecimentos, Atitudes e Prática em Saúde , Hospitais de Veteranos , Internato e Residência , Percepção , Procedimentos Cirúrgicos Torácicos/educação , Adulto , Escolha da Profissão , Currículo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Estados UnidosRESUMO
During embryogenesis the heart valves develop from undifferentiated mesenchymal endocardial cushions (EC), and activated interstitial cells of adult diseased valves share characteristics of embryonic valve progenitors. Twist1, a class II basic-helix-loop-helix (bHLH) transcription factor, is expressed during early EC development and is down-regulated later during valve remodeling. The requirements for Twist1 down-regulation in the remodeling valves and the consequences of prolonged Twist1 activity were examined in transgenic mice with persistent expression of Twist1 in developing and mature valves. Persistent Twist1 expression in the remodeling valves leads to increased valve cell proliferation, increased expression of Tbx20, and increased extracellular matrix (ECM) gene expression, characteristic of early valve progenitors. Among the ECM genes predominant in the EC, Col2a1 was identified as a direct transcriptional target of Twist1. Increased Twist1 expression also leads to dysregulation of fibrillar collagen and periostin expression, as well as enlarged hypercellular valve leaflets prior to birth. In human diseased aortic valves, increased Twist1 expression and cell proliferation are observed adjacent to nodules of calcification. Overall, these data implicate Twist1 as a critical regulator of valve development and suggest that Twist1 influences ECM production and cell proliferation during disease.
Assuntos
Matriz Extracelular/genética , Regulação da Expressão Gênica no Desenvolvimento , Doenças das Valvas Cardíacas/genética , Valvas Cardíacas/embriologia , Valvas Cardíacas/patologia , Proteínas Nucleares/genética , Proteínas Nucleares/metabolismo , Proteína 1 Relacionada a Twist/genética , Proteína 1 Relacionada a Twist/metabolismo , Animais , Animais Recém-Nascidos , Sequência de Bases , Biomarcadores/metabolismo , Calcinose/complicações , Calcinose/genética , Calcinose/patologia , Cardiomiopatias/complicações , Cardiomiopatias/genética , Cardiomiopatias/patologia , Proliferação de Células , Colágeno Tipo II/genética , Colágeno Tipo II/metabolismo , Matriz Extracelular/enzimologia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/patologia , Valvas Cardíacas/anormalidades , Valvas Cardíacas/metabolismo , Humanos , Íntrons/genética , Camundongos , Dados de Sequência Molecular , Morfogênese/genética , Ligação Proteica , Receptores Proteína Tirosina Quinases/metabolismo , Receptor TIE-2 , Sequências Reguladoras de Ácido Nucleico/genética , Proteínas com Domínio T/genética , Proteínas com Domínio T/metabolismoRESUMO
PURPOSE: This study was designed to assess the use of the intrathoracic vacuum-assisted management of persistent and infected pleural spaces. DESCRIPTION: Five patients with a persistent and infected pleural space after pulmonary resection underwent intrathoracic vacuum-assisted management to reduce the duration and frequency of dressing changes and to accelerate the formation of granulation tissue and the obliteration of the pleural space. Three patients also underwent a pleural space filling procedure. EVALUATION: Resolution of the infection or complete obliteration of the pleural space, or both, was in all patients achieved using fewer dressing changes than with traditional methods. No major complications related to the vacuum-assisted management were reported. CONCLUSIONS: The use of intrathoracic vacuum-assisted management of a persistent and infected pleural space after lung resection may reduce the duration and frequency of dressing changes necessary to allow spontaneous chest closure or a space filling procedure. Its use may decrease patient discomfort and contribute to a faster resolution of the infectious process.
Assuntos
Fístula Brônquica/cirurgia , Doenças Pleurais/cirurgia , Adulto , Fístula Brônquica/etiologia , Fístula Brônquica/microbiologia , Empiema Pleural/microbiologia , Empiema Pleural/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Doenças Pleurais/etiologia , Doenças Pleurais/microbiologia , Pneumonectomia/efeitos adversos , Pneumonia/complicações , ToracotomiaRESUMO
BACKGROUND: Concerns regarding ample employment opportunities for graduating cardiothoracic surgery residents may affect perceptions of the field and recruitment into residency programs. We present the results of the Thoracic Surgery Residents Association/Thoracic Surgery Directors Association (TSRA/TSDA) 2008 Resident Survey, and compare them with the 2007 TSRA/TSDA survey and the 2006 interim report of the Society of Thoracic Surgeons Task Force on Job Opportunities. METHODS: In April 2008, the TSRA/TSDA conducted an anonymous survey, linked to the cardiothoracic surgery resident online In-training Exam, with questions germane to resident job seeking and perceptions of the specialty. Results were compared with resident surveys from 2007 and 2006. RESULTS: Response rates for the 2008 and 2007 surveys were 100%, and 54.2% for 2006. Of graduating residents looking for employment, 61.6% had one or more job offers, compared with 64.6% and 83.5% from the 2007 and 2006 surveys, respectively. Of the respondents completing their job search, 24.5% entered private practice and 26.3% academia, compared with 12.1% and 30.1%, respectively, in the 2007 survey. Overall, 57.7% of all respondents had more than $50,000 education-related debt, compared with 54.2% of 2007 respondents. However, 71.5% of all 2008 respondents would recommend cardiothoracic surgery to a potential trainee, compared with 63.7% and 46.0% from 2007 and 2006 survey respondents, respectively. CONCLUSIONS: The 2008 survey suggests that although the majority of respondents found employment on completing residency, the percentage is less than 65%, reinforcing a need for formal networking programs or changes in residency training. Despite continued limited employment opportunities, resident impressions of cardiothoracic surgery have improved from 2006 to 2008.