Diminishing Basic Science Research Experience Among United States Cardiothoracic Surgery Trainees.

INTRODUCTION: There is growing concern regarding the attrition of surgeon-scientists. To understand the decline of basic science research (BSR), it is essential to examine trends in research conducted by trainees. We hypothesized that, over recent decades, cardiothoracic (CT) surgery trainees have published fewer BSR articles. MATERIALS AND METHODS: CT surgeons at United States training institutions in 2020 who completed training in the past three decades, excluding international trainees, were analyzed (1991-2000: n = 148; 2001-2010: n = 228; 2011-2020: n = 247). Publication records were obtained from Scopus. Articles with medical subject heading terms involving molecular/cellular or animal research were classified as BSR using the National Institutes of Health iCite Translation module. Data were analyzed using Fisher's exact test or the Wilcoxon rank-sum test. RESULTS: While the proportion of surgeons who published a first-author paper during training remained stable over the past two decades (178/228 [78.1%] versus 189/247 [76.5%], P = 0.7427), the proportion who published a first-author BSR paper decreased significantly (135/228 [59.2%] versus 96/247 [38.9%], P < 0.0001). Among surgeons who published a first-author paper in training, the total papers published by each trainee did not change over the past two decades (3.5 versus 3.3 first-author papers per 10 y of training, P = 0.8819). However, the number of BSR papers published during training decreased significantly (1.7 versus 0.8 first-author papers per 10 y of training, P < 0.0001). CONCLUSIONS: CT surgery trainees are publishing fewer BSR papers. Additional efforts are needed to increase exposure of trainees to BSR and reaffirm that BSR is a valuable and worthwhile pursuit for academic surgeons.

Characteristics of Integrated Thoracic Surgery Residency Matriculants: A Survey of Program Directors.

BACKGROUND: The 6-year Integrated Thoracic Surgery (I-6) residency programs have evolved over the past decade. Despite the rising number of programs, there are minimal data published about the criteria utilized by program directors to select candidates. We analyze the characteristics and qualities of successful matriculants using the American Association of Medical College's (AAMC) data reports and survey responses from program directors. METHODS: Using a survey administered through the RedCap service, program directors were asked to rate the importance of a variety of factors in their evaluations of candidates. The AAMC data reports from 2018 to 2020 provided information on the mean matriculant research productivity, United States Medical Licensing Examination (USMLE) step 1 scores, and step 2 clinical knowledge (CK) scores. RESULTS: Responses were received from 19 of 33 I-6 programs (58%). Program directors consistently rated interview performance as a very important factor in their evaluation of applicants. Matching into the specialty is becoming more competitive, with mean USMLE step 1, step 2 CK, and research productivity increasing over the past few years; matriculants had mean step 1 and step 2 CK scores of 247.3 and 254.2, respectively, in the 2020 match. CONCLUSIONS: Thoracic surgery program directors place high value on applicant interview performance, letters of recommendation, and professionalism. Program directors agree that a forthcoming pass/fail USMLE step 1 score report will lead to closer scrutiny of other factors during the decision-making process and may cause future evaluation of applicants to be heavily reliant on letters of recommendation and medical school pedigree.

Electrophysiologic Conservation of Epicardial Conduction Dynamics After Myocardial Infarction and Natural Heart Regeneration in Newborn Piglets.

Newborn mammals, including piglets, exhibit natural heart regeneration after myocardial infarction (MI) on postnatal day 1 (P1), but this ability is lost by postnatal day 7 (P7). The electrophysiologic properties of this naturally regenerated myocardium have not been examined. We hypothesized that epicardial conduction is preserved after P1 MI in piglets. Yorkshire-Landrace piglets underwent left anterior descending coronary artery ligation at age P1 (n = 6) or P7 (n = 7), After 7 weeks, cardiac magnetic resonance imaging was performed with late gadolinium enhancement for analysis of fibrosis. Epicardial conduction mapping was performed using custom 3D-printed high-resolution mapping arrays. Age- and weight-matched healthy pigs served as controls (n = 6). At the study endpoint, left ventricular (LV) ejection fraction was similar for controls and P1 pigs (46.4 ± 3.0% vs. 40.3 ± 4.9%, p = 0.132), but significantly depressed for P7 pigs (30.2 ± 6.6%, p < 0.001 vs. control). The percentage of LV myocardial volume consisting of fibrotic scar was 1.0 ± 0.4% in controls, 9.9 ± 4.4% in P1 pigs (p = 0.002 vs. control), and 17.3 ± 4.6% in P7 pigs (p < 0.001 vs. control, p = 0.007 vs. P1). Isochrone activation maps and apex activation time were similar between controls and P1 pigs (9.4 ± 1.6 vs. 7.8 ± 0.9 ms, p = 0.649), but significantly prolonged in P7 pigs (21.3 ± 5.1 ms, p < 0.001 vs. control, p < 0.001 vs. P1). Conduction velocity was similar between controls and P1 pigs (1.0 ± 0.2 vs. 1.1 ± 0.4 mm/ms, p = 0.852), but slower in P7 pigs (0.7 ± 0.2 mm/ms, p = 0.129 vs. control, p = 0.052 vs. P1). Overall, our data suggest that epicardial conduction dynamics are conserved in the setting of natural heart regeneration in piglets after P1 MI.