Weathering the Storm: How Can Thoracic Surgery Training Programs Meet The New Challenges in the Era of Emerging Non-Invasive Technologies?
Sunil M. Prasad1, Malek G. Massad1, Edgar G. Chedrawy1, Norman J. Snow1, Joannie T. Yeh1, Himalaya Lele1, Ahmed Tarakji1, Hersh S. Maniar2, William A. Gay2; 1University of Illinois, Chicago, IL; 2Washington University, St. Louis, MO
Comment on this Abstract
Objective: Recent introduction of new technologies such as drug eluting stents, endografts, robotics and non-surgical treatment of lung and chest pathology has shifted common procedures from the ABTS index case requirements and to non-cardiothoracic specialists. We examined case volume in cardiothoracic surgery over the last five years to identify changes and direct future training algorithms with objective, verifiable training data.
Methods: Program and resident data between 2002 to 2006 were obtained from the NRMP and ABTS. These data were combined in a database and statistically analyzed. Data is presented as MEAN±SD.
Results: During this period, 606 residents qualified for the written ABTS exam. 82.7% (501/606) of residents graduated from 2 year (2Y) programs and 17.3% (105/606) from 3 year programs (3Y) (p<0.01). More residents trained at a 2 resident/year (2R) program (252) than 1 resident/year (1R) (191) or 3 resident/year (3R) (163) program (p<0.01). The most common program was a 2Y, 2R (203) followed by 2Y, 1R (151). Total thoracic cases per resident were higher in 1R (180±68) and 3R (191±84) programs than 2R (168±59) (p<0.01). Total cardiothoracic cases were higher in 3R than 2R or 1R programs (612±135,571±153,573±165;respectively) (p<0.05). Myocardial revascularizations (REVASC) were significantly higher in 1R programs than 2R and 3R (130±62;122±48;120±60; respectively)(p<0.01). Including all programs, there was a significant decrease in REVASC (p<0.01), an increase in acquired valvular cases (p<0.05), and no change in total thoracic, congenital, or cardiac cases over the last five years (p>0.1)(Table). 3Y programs had significantly higher volumes than 2Y (p<0.001) in every requirement (Table). 93.3 % (98/105) of 3Y residents and only 71.7% (359/501) of 2Y residents had over 80 REVASC cases. 85.7 % (90/105) of 3Y residents and only 64.5% (323/501) of 2Y residents had over 100 chest, lung, pleura cases.
Conclusion: In an era of dynamic changes due to new technologies, training programs have so far weathered the storm by maintaining overall case volume and expanding the diversity of cases. This study clearly documents the significant advantage in case volume of 3Y programs, and suggests changing current training to a minimum of 3 years. Furthermore, optimization of resident case volume could be achieved by reorganizing programs to high volume 3R centers and changing low volume 2R programs to a 1R program.
| Pulmonary Resections | EsophagealResections | Total Thoracic | Total Congenital | Acquired Valve | MyocardialRevascularization | Total Cardiothoracic |
| 2 Year Programs | 77 ± 30 * | 13 ± 10 * | 167 ± 61 * | 60± 30 * | 53± 33* | 115± 47 * | 546± 123 * |
| 3 Year Programs | 110± 52 * | 21± 15 * | 228± 88 * | 88± 56 * | 80± 37* | 168± 72* | 759± 162 * |
| | | | | | | |
| All Programs 2002 | 79± 28 | 14± 9 | 169± 55 | 64± 29 | 50± 28 * | 134± 52 * | 573± 131 |
| All Programs 2003 | 82± 37 | 15± 11 | 176± 71 | 72± 44 | 55± 32 | 136± 51 | 594± 144 |
| All Programs 2004 | 82± 31 | 14± 12 | 177± 60 | 66± 44 | 62± 40 | 123± 63 | 588± 153 |
| All Programs 2005 | 85± 47 | 16± 15 | 184± 85 | 62± 37 | 62± 37 | 124± 60 | 593± 187 |
| All Programs 2006 | 84± 34 | 14± 10 | 178± 69 | 60± 31 | 57± 35 * | 110± 50 * | 565± 137 |
* = p <0.01
Back to 88th Annual Meeting
Back to Program Outline
