AATS: American Association for Thoracic Surgery.
Watch the AATS Leadership Video
 
Quantitative Assessment of Technical Proficiency of Residents in Cardiac Surgery
Hiroo Takayama, Yoshifumi Naka, Mehmet C. Oz, Allan S. Stewart, Mathew R. Williams, Craig R. Smith, Micheal Argenziano; Columbia University, New York, NY
READER COMMENTS
Objective: Board certification in cardiothoracic surgery requires that trainees perform of a minimum of 150 adult cardiac operations as “surgeon.” The aims of this study were to identify objective variables that correlated with residents’ technical competence, and to determine the minimum number of operative cases required for residents to achieve acceptable proficiency.
Methods: The operative records of patients operated on by 12 consecutive residents and fellows at our institution between 1/2002 and 6/2008 were retrospectively reviewed. This analysis included only cases done as “surgeon” by residents in their final 9 months of training or during a 6 month post-residency fellowship.
Results: Over the 6.5 year study period, a total of 2919 cases were analyzed. This included 1146 isolated CABG, 944 aortic valve procedures (239 AVR+CABG, 220 isolated AVR for AS, 110 AVR for AI, 375 other), 454 mitral valve procedures, 278 heart transplants, 185 aortic operations, and 205 other procedures. Isolated AVR for AS (n=220) was selected for further analysis due to its standardized operative technique and volume. The following variables were evaluated for suitability as a surrogate of surgical skill: aortic cross-clamp time (XCL), cardiopulmonary bypass time, mortality, morbidity, PRBC transfusion requirement, hospital and ICU length of stay. Among these, only XCL was significantly correlated to the operating resident’s level of experience, with a progressive decrease in XCL (figure). Comparison of this data to the XCL for isolated AVR for AS performed by a senior attending surgeon during the same period (57.2 ± 8 min) suggests that a minimum of 200 cases would be required to achieve similar proficiency.
Conclusion: XCL time for isolated AVR for AS is correlated to a resident's surgical experience, and may be a reasonable surrogate of technical competence. Utilizing this metric, it appears that more than 150 cases are required for residents to approach the proficiency of an attending cardiac surgeon.

Back to 2009 Annual Meeting
Back to Program Outline
Back to Main Program
Policies | Find a Surgeon | About | Contact
We Model Excellence
Copyright © American Association for Thoracic Surgery. All rights reserved.
Read the Privacy Policy.
IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.