Assessment of the well-being of significant others of cardiothoracic surgeons.

OBJECTIVES: We aimed to evaluate how the current working climate of cardiothoracic surgery and burnout experienced by cardiothoracic surgeons influences their spouses and significant others (SOs). METHODS: A 33-question well-being survey was developed by the American Association for Thoracic Surgery Wellness Committee and distributed by e-mail to the SOs of cardiothoracic surgeons and to all surgeon registrants of the 2020 and 2021 American Association for Thoracic Surgery Annual Meetings with a request to share it with their SO. The 5-item Likert-scale survey questions were dichotomized, and associations were determined by χ2 or independent samples t tests, as appropriate. RESULTS: Responses from 238 SOs were analyzed. Sixty-six percent reported that the stress on their cardiothoracic surgeon partner had a moderate to severe influence on their family, and 63% reported that their partner's work demands didn't leave enough time for family. Fifty-one percent reported that their partner rarely had time for intimacy, 27% reported poor work-life balance, and 23% reported that interactions at home were usually or always not good-natured. SOs were most affected when their partner was <5 years out from training, worked in private vs academic practice, and worked longer hours. Having children, particularly younger than age 19 years, and a lack of workplace support resources further diminished well-being. CONCLUSIONS: The current work culture of cardiothoracic surgeons adversely affects their SOs, and the risk for families is concerning. These data present a major area for exploration as we strive to understand and mitigate the factors that lead to burnout among cardiothoracic surgeons.

Dissuasion in women surgical trainees pursuing cardiothoracic surgery.

BACKGROUND: The reasons for persistent gender disparity in cardiothoracic surgery (CTS) are multifaceted. The objective of this paper is to understand if and why women surgical trainees are dissuaded from pursuing CTS. METHODS: A survey was sent to self-identified women participating in Women in Thoracic Surgery speed mentoring. Statistical analysis was performed to determine dissuasion rates. Open-ended responses describing examples of dissuasion were characterized and categorized. RESULTS: Of all participants, 76 â€‹% (163/215) reported dissuasion from a CTS career. Third- and fourth-year medical students experienced the highest rate by training (81 â€‹%, 48/59) and those interested in Congenital CTS experienced the highest rate based on subspecialty interest (94 â€‹%, 17/18). The most cited dissuasion examples included work/life balance, lifestyle with children, and gender. CONCLUSIONS: Most women surveyed had been dissuaded from pursuing a career in CTS. Examples of dissuasion provided are heavily associated with traditional gender roles, supporting the presence of continued gender bias in CTS.

Starting and Developing a Robotic Thoracic Surgery Program.

Robotic-assisted surgery has been widely adopted in the field of thoracic surgery as a safe, minimally invasive approach with distinct technical advantages. With increased utilization, it has become an integral part of training pathways for the next generation of thoracic surgeons. This review article highlights key steps in implementing a robotic thoracic surgery program at an academic center based on institutional experience and the available surgical literature.

The Thoracic Surgery Medical Student Association: Understanding the needs of medical students pursuing cardiothoracic surgery in the United States.

OBJECTIVE: Founded in 2020, the Thoracic Surgery Medical Student Association is the first national organization dedicated to supporting medical students interested in pursuing cardiothoracic surgery. Our inaugural survey aimed to describe their basic characteristics and needs. METHODS: An Institutional Review Board-approved, nonincentivized, anonymous electronic survey was distributed to any medical students enrolled in Liaison Committee on Medical Education-accredited medical schools through social media such as Twitter, national organizations (Association of Women Surgeons, Thoracic Surgery Resident Association), and medical school cardiothoracic surgery interest groups. Their basic characteristics, attitudes, and preferences regarding cardiothoracic surgery were recorded. RESULTS: Of the 167 students from 117 unique schools who completed the survey, 53% identified as White and 57% identified as female. Stages of training were well distributed: 16% first-year medical students, 33% second-year medical students, 16% third-year medical students, 21% fourth-year medical students, and 14% dual degree/research students. Most participants (57%) did not have (32%) or were not aware of having (25%) a thoracic surgery training program at their home institution. The majority (72%) of students reported not having a cardiothoracic surgery interest group at their home institution. The most desired areas of cardiothoracic were networking (31%) and mentorship (28%). CONCLUSIONS: There is a significant need to directly engage medical students who are interested in cardiothoracic surgery considering limited exposure at home institutions through a lack of cardiothoracic surgery interest groups and cardiothoracic residency programs. The Thoracic Surgery Medical Student Association is poised to address these areas with directed networking by connecting cardiothoracic surgery faculty and residents from other institutions with medical students interested in pursuing cardiothoracic surgery.

2020 Women in Thoracic Surgery Update on the Status of Women in Cardiothoracic Surgery.

BACKGROUND: Women in Thoracic Surgery (WTS) has previously reported on the status of women in cardiothoracic (CT) surgery. We sought to provide a 10-year update on women in CT surgery. METHODS: An anonymous research electronic data capture survey link was emailed to female diplomats of the American Board of Thoracic Surgery. Survey questions queried respondents regarding demographics, training, accolades, practice details, and career satisfaction. The survey link was open for 30 days. Results were compared with The Society of Thoracic Surgeons 2019 workforce survey. Descriptive analyses were performed using frequency and proportions. Comparisons were performed using Student's t tests, Fisher's exact tests, and χ2 tests. RESULTS: Of 354 female diplomats, 309 were contacted and 176 (57%) responded. The majority of respondents were aged 36 to 50 years (59%), white (67.4%), and had graduated from traditional-track programs (91.4%). Most respondents reported practicing in an urban (64%) and academic setting (73.1%). 36.4% and 23.9% reported a general thoracic and adult cardiac practice (22.7% mixed practice, 9.6% congenital). Fifty percent of respondents reported salaries between $400,000 and $700,000 annually; 37.7% reported salaries less than 90% of their male colleagues; 21.6% of respondents in academia are full professor; 53.4% reported having a leadership role. Whereas 74.1% would pursue a career in CT surgery again, only 27.3% agreed that CT surgery is a healthy and positive environment for women. CONCLUSIONS: The number of women in CT surgery has steadily increased. Although women are rising in academic rank and into leadership positions, salary disparities and the CT surgery work environment remain important issues in achieving a diverse work force.

Thoracic surgery program websites: Bridging the content gap for improved applicant recruitment.

OBJECTIVE: To evaluate the website content of all US thoracic training programs, assessing the available content to identify areas for improvement. METHODS: A total of 98 accredited thoracic surgery fellowship and integrated residency programs were evaluated for the presence of 25 important online content items. Two authors assessed each website and social media page individually, and a third author resolved <4% of the initial data disagreement. The total number of alumni represented for each program was also recorded, including a breakdown of what the alumni pursued. RESULTS: Of the 98 accredited programs, 91 (92.9%) had a website. All 26 integrated residencies had a website, compared with 65 of 72 fellowships (90.3%). The 91 websites contained a mean of 8.2 ± 3.0 out of the 25 online content variables evaluated (33.0%), with rotation information (n = 69; 75.8%), application information (n = 65; 71.4%), program coordinator contact (n = 60; 65.9%), hospital affiliation (n = 49; 53.8%), number of positions per year (n = 49; 53.8%), and faculty listing (n = 46; 50.5%) found on ≥50% of the program websites. Areas lacking were retention rate (0% reported), social media links (n = 3; 3.3%), written and oral exam pass rates (both n = 5; 5.5%), graduate placement (n = 11; 12%), call duties (n = 12; 13.2%), cases performed (n = 17; 18.7%), and salary/benefits (n = 25; 27.5%). CONCLUSIONS: This study identifies gaps in content for prospective thoracic surgery applicants. Important information such as retention rate, social media links, exam pass rates, outcomes of graduates, call duties, cases performed, and salary/benefits were lacking in program websites. The improvement of websites may represent a straightforward and low-cost intervention that programs can undertake to enhance the recruitment of prospective applicants.

Characteristics of Matriculants to Thoracic Surgery Residency Training Programs.

BACKGROUND: Thoracic surgery (TS) residency positions are in high demand. There is no study describing the nationwide attributes of successful matriculants in this specialty. We examined the characteristics of TS resident applicants and identified factors associated with acceptance. METHODS: Applicant data from 2014 to 2017 application cycles was extracted from the Electronic Residency Application System and stratified by matriculation status. Medical education, type of general surgery residency, and research achievements were analyzed. The number of peer-reviewed publications and the corresponding impact factor for the journals where they were published were quantified. RESULTS: There were 492 applicants and 358 matriculants. The overall population was primarily male (79.5%), white (55.1%), educated at United States allopathic medical schools (66.5%), and trained at university-based general surgery residencies (59.6%). Education at United States allopathic schools (odds ratio [OR], 2.54; P < .0001), being a member of the American Osteopathic Association (OR, 3.27; P = .021), general surgery residency affiliation with a TS residency (OR, 2.41; P = .0003) or National Cancer Institute designated Comprehensive Cancer Center (OR, 1.76; P = .0172), and being a first-time applicant (OR, 4.71, P < .0001) were independently associated with matriculation. Matriculants published a higher number of manuscripts than nonmatriculants (median of 3 vs 2, P < .0001) and more frequently published in higher impact journals (P < .0001). CONCLUSIONS: Our study includes objective and quantifiable data from recent application cycles and represents an in-depth examination of applicants to TS residency. The type of medical school and residency, as well as academic productivity, correlate with successful matriculation.

Resident perception of standardization and credentialing for high-risk bedside procedures in cardiothoracic surgery: Results from an institutional pilot study.

OBJECTIVES: Though clear-guidelines are set by the American Board of Thoracic Surgery (ABTS) for the operative cases that cardiothoracic surgery residents must perform to be board-eligible, no such recommendations exist to assess competency for the wide range of high-risk bedside procedures. Our department created and implemented a multidisciplinary course designed to standardize common high-risk bedside procedures and credential our trainees. The aim of this study was to survey the attitudes of residents towards and query the efficacy of such a course. METHODS: The course was designed with the goal of standardizing endotracheal intubation, arterial line insertion (radial and femoral), central venous line insertion, pigtail tube thoracostomy, thoracentesis and nasogastric tube placement. The course consisted of an online module followed by a 4-hour hands-on simulation session. Knowledge-based pre- and post-evaluations were administered as well as a Likert-based survey regarding multiple aspects of the residents' perceptions of the course and the procedures. RESULTS: Twenty-three (7 traditional and 16 integrated) cardiothoracic surgical residents participated in the course. Residents reported that 48% of the time, bedside procedures were historically taught by other trainees rather than by faculty. All residents endorsed increased standardization of all procedures after the course. Likewise, residents showed increased confidence in all procedures except for pigtail tube thoracostomy, thoracentesis as well as nasogastric tube placement. 43.5% of the participants demonstrated improvement in the pretest and posttest knowledge-based evaluations. CONCLUSION: Cardiothoracic residents have favorable attitudes towards standardization and credentialing for high-risk bedside procedures and utilizing such courses may help standardize procedural techniques.

The impact of COVID-19 on thoracic surgery residency programs in the US: A program director survey.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) has altered how the current generation of thoracic surgery residents are being trained. The aim of this survey was to determine how thoracic surgery program directors (PDs) are adapting to educating residents during the COVID-19 pandemic. METHODS: Thoracic surgery PDs of integrated, traditional (2 or 3 year), and combined 4 + 3 general/thoracic surgery training programs in the United States were surveyed between 17th April and 1st May 2020 during the peak of the COVID-19 pandemic in much of the United States. The 15-question electronic survey queried program status, changes to the baseline surgical practice, changes to didactic education, deployment/scheduling of residents, and effect of the pandemic on case logs and preparedness for resident graduation. RESULTS: All 23 institutions responding had ceased elective procedures, and most had switched to telemedicine clinic visits. Online virtual didactic sessions were implemented by 91% of programs, with most (69.6%) observing same or increased attendance. PDs reported that 82.7% of residents were on a non-standard schedule, with most being deployed in a 1 to 2 week on, 1 to 2 week off block schedule. Case volumes were affected for both junior and graduating trainees, but a majority of PDs report that graduating residents will graduate on time without perceived negative effect on first career/fellowship position. CONCLUSIONS: The COVID-19 pandemic has radically changed the educational approach of thoracic surgery programs. PDs are adapting educational delivery to optimize training and safety during the pandemic. Long-term effects remain uncertain and require additional study.

Cardiothoracic Surgery at the University of Alabama at Birmingham (UAB): A Legacy of Innovation, Education, and Contributions.

Cardiothoracic Surgery at the University of Alabama at Birmingham (UAB) represents a transformative enterprise whose origins lie in local practice and education in a Southern state with a challenging history, transformed by the visions of a few to become a dominant force in the historical fabric of regional, national, and international cardiothoracic surgery. Throughout its history, numerous individuals have participated in important innovations, education, and contributions to a consistent theme of surgical excellence. This review will recapitulate a sample of relevant historical events and the impact of the leaders of cardiothoracic surgery at UAB.

Learning curve associated with thoraco-laparoscopic esophagectomy for esophageal cancer patients in the prone position.

OBJECTIVE: To observe the surgical index at the different learning stages of thoraco-laparoscopic esophagectomy in the prone position for esophageal cancer and to investigate the learning curve of this surgical procedure. METHODS: Sixty thoraco-laparoscopic esophagectomies in the prone position for esophageal cancer conducted by the same group of surgeons between January 2014 and December 2015 were retrospectively analyzed. The surgeries were divided into 5 groups, A, B, C, D, and E, in chronological order. The duration of surgery, intraoperative blood loss, total number of lymph nodes removed, rate of the intraoperative conversion to open surgery, complication rate, and length of postoperative hospitalization were recorded and analyzed. RESULTS: The general information of the patients did not significantly differ among the 5 groups (P > 0.05). The duration of surgery, intraoperative blood loss, number of lymph node removed, rate of intraoperative conversion to open surgery, and number of injuries to the recurrent laryngeal nerve all significantly differed (P < 0.05). The rates of postoperative pulmonary infection, anastomotic fistula, pneumothorax, and hospitalization did not significantly differ (P > 0.05). CONCLUSION: Thoracic physicians with some endoscopic experience can meet the requirements of the thoraco-laparoscopic esophagectomy in the prone position for esophageal cancer after completing 24-30 surgeries.

The Society of Thoracic Surgeons Thoracic Surgery Practice and Access Task Force-2019 Workforce Report.

BACKGROUND: The Society of Thoracic Surgeons (STS) has intermittently surveyed its workforce, providing isolated accounts of the current state of thoracic surgical practice. METHODS: The 70-question survey instrument was received by 3834 STS surgeon members, and responses were gathered between September 16 and November 1, 2019. The return rate was 27.9%. RESULTS: The median age of the active United States (US) thoracic surgeons is 56 years. Women comprise 8.4% of the responders, constituting 6.2% of adult cardiac, 10.6% of congenital heart, and 12.6% of general thoracic surgeons. Most practicing US surgeons (83.5%) graduated from medical school in the US. Survey respondents had 7 (21.8%), 8 (25.0%), 9 (22.1%) or 10 (29.2%) or more years of post-MD training before entering practice. Educational debt was increased compared with previous years, as were salaries. Overall career satisfaction was 54.1% (very or extremely satisfied), and overall average hours per week worked decreased compared with past surveys. However, 55.7% of surgeons had symptoms of burnout and depression. STS Database participation was high (90.5%), with the most common reason for not participating being cost (32.6%). Operative volume over the past 12 months decreased for 23.7% of surgeons. Of those who responded, 46.9% plan to retire between the age of 66 and 69 years and a further 25.6% at age 70 or older. CONCLUSIONS: These data provide a current, detailed profile of the specialty. Ongoing challenges remain length of training and educational debt. Case volumes, scope of practice, and career satisfaction have remained relatively constant: however, symptoms of burnout or depression or both, are common.