A Cardiac Surgery Mini-Elective Increases Specialty Knowledge Acquisition Among Pre-Clinical Medical Students.

BACKGROUND: The introduction of integrated thoracic surgery residency programs has led to increased recruitment efforts of medical students to pursue a career in cardiac surgery. With little representation of cardiac surgery in medical school curriculum, we assessed a cardiac surgery mini-elective's efficacy in improving perceived knowledge among medical students. METHODS: Preclinical medical students were offered the opportunity to participate in a cardiac surgery mini-elective, which consisted of five 2-hour sessions. These sessions consisted of didactic and simulation components and covered topics including cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), aortic disease, aortic valve replacement (AVR), transplant and left ventricular assist devices (LVAD), and coronary artery bypass grafting (CABG). Students completed pre- and post-session surveys describing their perceived knowledge in these topics. RESULTS: Overall, 22 students completed at least one session of the mini-elective. Fourteen (73.7%) of the students were male. Fifteen (68.2%) students completed at least three out of five sessions. The post-session survey responses showed significantly higher perceived knowledge compared with pre-session responses for all survey prompts of all five sessions. The CPB/ECMO and aortic disease sessions showed the greatest increase in post-session familiarity and perceived knowledge after the session (P < 0.001) compared with the CABG, AVR, and transplant/LVAD sessions (P < 0.05). CONCLUSIONS: Beyond developing interest in cardiac surgery, these data indicate that a well-planned didactic and surgical simulation program may build confidence in students' knowledge of various cardiac surgical topics. Further studies will need to address how this increase in perceived ability lasts over time and impacts career selection.

Implementation of a protocol to increase the academic productivity of cardiothoracic surgery resident physicians.

OBJECTIVE: Academic productivity during cardiothoracic surgery residency training is an important program metric, but is highly variable due to multiple factors. This study evaluated the influence of implementing a protocol to increase resident physicians' academic productivity in cardiac surgery. METHODS: A comprehensive protocol for cardiac surgery was implemented at our institution that included active pairing of residents with academically productive faculty, regular research meetings, centralized data storage and analysis with a core team of biostatisticians, a formal peer-review protocol for analytic requests, and project prioritization and feedback. We compared cardiothoracic surgery residents' academic productivity before implementation (July 2015-June 2017) versus after implementation (July 2017-June 2019). Academic productivity was measured by peer-reviewed articles, abstract presentations (oral or poster) at national cardiothoracic surgery meetings, and textbook chapters. RESULTS: Thirty-four resident physicians (from traditional and integrated programs) trained at our institution during the study. A total of 122 peer-reviewed articles were produced over the course of the study: 74 (60.7%) cardiac- and 48 (39.3%) thoracic-focused. The number of cardiac-focused resident-produced articles increased from 10 preimplementation to 64 postimplementation (0.61 vs 2.03 articles per resident; P < .01). Abstract oral or poster presentations also increased, from 11 to 40 (0.61 vs 1.33 abstracts per resident; P = .01). Textbook chapters increased from 4 to 15 following the intervention (0.22 vs 0.5 chapters per resident; P = .01). CONCLUSIONS: Implementation of a dedicated protocol to facilitate faculty mentoring of resident research and streamline the data access, analysis, and publication process substantially improved cardiothoracic surgery residents' academic productivity.

Thoracic Surgery In-Training Exam Predicts Written But Not Oral Board Pass Rates: A 15-Year Single-Center Analysis.

The purpose of the Thoracic Surgery Director's Association In-Training Exam (ITE) is to gauge competency and progression of thoracic surgery residents and to prepare residents for the American Board of Thoracic Surgery (ABTS) examinations. We sought to identify the relationship between traditional resident ITE scores and success at passing the written or oral portion of the ABTS examinations. ITE and ABTS examination records from 2003 to 2019 were examined for all 2-year traditional cardiothoracic surgery residents at a single institution. Paired t tests were carried out between residents on their first- and second-year ITE. Bivariate logistic regression was performed on each of the second ITE component with written or oral board passing rate as the outcome of interest. Sixty residents completed training and took both written and oral boards. First attempt board pass rates were 90% for written and 75% for oral board examination. There was a significant improvement in test scores for each resident between the first the second ITE (P< 0.001 for all scores). Both increasing overall raw (odds ratio 1.26, P = 0.022) and scaled (odds ratio 1.08, P = 0.006) ITE scores were associated with passing the written boards on first attempt. There were no associations identified for oral board passing rates. Traditional residents improved ITE scores from first to second attempt. Increasing ITE scores were associated with improved written but not oral ABTS component pass rates. The ITE serves prepare residents for the ABTS qualifying (written) exam and assists programs with gauging resident readiness for taking this exam.

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.

Medical student perceptions of a career in cardiothoracic surgery: Results of an institutional survey.

OBJECTIVES: Recruiting medical students to cardiothoracic surgery is critical given new training paradigms and projected cardiothoracic surgeon shortages. This study characterizes current perceptions and exposure to cardiothoracic surgery among all levels of medical students. METHODS: Currently active medical students at all levels at a US allopathic medical school were sent an invitation to complete an online survey. Baseline demographics, medical specialty interest, interest and exposure to cardiac surgery specifically, and awareness of procedures performed by cardiothoracic surgeons were evaluated. Five-point Likert scales were used to evaluate attitudes toward facets of the field of cardiothoracic surgery. Only complete surveys over the 4-week enrollment period were used for analysis. RESULTS: There were 126 surveys (22%) completed during the study period. Interest in cardiothoracic surgery at any point was indicated by 37% of students, but only 13% indicated an interest at the time of the survey. Interest among first-year students was greater than all other classes (30% vs <15%, P = .02). Lifestyle factors and personal attributes of cardiothoracic surgeons were noted as negative factors influencing cardiothoracic surgery perception, whereas intellectual challenge and clinical impact were cited as positive factors. Increasing interaction with faculty/residents and simulation experiences were factors noted to increase interest in the field. CONCLUSIONS: Although medical students report early interest in cardiothoracic surgery because of intellectual stimulation and patient care attributes, lack of early exposure and perceived poor lifestyle negatively affect interest in the field. Early interaction between students and cardiothoracic faculty/trainees along with early exposure opportunities may increase recruitment.

Evaluation of a simulation-based mini-elective on medical student interest in cardiac surgery.

BACKGROUND: Integrated cardiothoracic (CT) surgery training programs are an increasingly popular pathway to train CT surgeons. Identifying and engaging medical students early is important to generate interest and ensure highly qualified applicants are aware of opportunities provided by a career in CT surgery. METHODS: An optional CT surgery "mini-elective" was developed for preclinical medical students consisting of five 2-hour sessions covering major procedures in cardiac surgery. Each session had an inital 1 hour lecture immediatly followed by a hands on simulation component. Sessions were taught by CT surgery faculty and residents. A precourse and postcourse survey was administered to identify interest in and awareness of the field of CT surgery. RESULTS: There were 22 students enrolled in the course who provided precourse surveys, while 21 provided postcourse surveys. CT surgery was a career consideration for 95.4% of students who took the mini-elective. nine percent of the students who had either scrubbed or observed a CT case precourse, increased to 33.3% postcourse (P = .11). With regards to mentorship, 23.8% felt they could easily find a mentor in CT surgery precourse, increasing to 66.7% postcourse (P = .01). Eighty-one percent of students reported that the mini-elective significantly increased their CT knowledge over the standard cardiovascular curriculum, and 100% of those completing the course were "extremely satisfied" with the experience. CONCLUSIONS: A CT surgery mini-elective increased awareness and interest in the field among preclinical medical students. Longitudinal exposure and mentorship provided in programs such as this will be key to the continued recruitment of high-quality medical students to the field.