Cardiothoracic Surgery Training Is Intense, But It Helps Patients

Overview

By Richard H. Feins, MD

Article

Cardiothoracic surgery requires some of the longest and most comprehensive training in all of medicine. Typically, cardiothoracic surgeons undergo 7 to 12 years of training after graduating from medical school.  This training is overseen by the Accreditation Council for Graduate Medical Education (ACGME) through the Residency Review Committee for Thoracic Surgery (RRC-TS).

Training the residents is the responsibility of the 95 cardiothoracic residency programs in the United States. Each residency program is run by an experienced cardiothoracic educator called a program director.  Program directors are part of a national organization called the Thoracic Surgery Directors Association (TSDA). TSDA oversees the curriculum necessary to meet the requirements set forth by the RRC-TS.  At the conclusion of cardiothoracic surgery training, all residents have to pass written and oral examinations given by the American Board of Thoracic Surgery (ABTS). ABTS ensures that all cardiothoracic surgeons meet established levels of competency.

My specialty training in cardiothoracic surgery involved the surgical treatment of all diseases of the chest, with four areas of emphasis: adult cardiac surgery, general thoracic surgery, congenital heart surgery, and critical care. This represents training in some of the most complex operations in all of surgery, which is what I love about the specialty.

During the course of the training, I learned how to perform surgery in a highly supervised environment with some truly great surgeons and exceptional teachers. The data are quite clear that patients undergoing surgery in an academic training center have outcomes that are as good as those seen in non-academic centers. The reason for this is that not only are we providing excellent assistance in the operating room, but we are also readily available at any time should a problem come up. In addition, data show that if a new procedure is introduced in an academic medical center, the risk for additional complications or deaths is near zero.  

Simulation training

During a career of almost 40 years as a cardiothoracic surgical educator, I am most proud of the leadership role our specialty has taken in simulation-based training.

Courtesy of the University of Washington in Seattle

Cardiothoracic surgery has embraced the concept that training someone to be a true master surgeon requires multiple repetitions of a task using a set curriculum. This can only be done in the simulation environment. Following the lead of military training, flight training, and elite sports and performance arts training, cardiothoracic surgery has developed surgical simulators that so closely resemble the real thing that they achieve “suspension of disbelief” or the state in which we almost cannot tell the difference between operating in a simulator and a real operation.

Courtesy of the University of Washington in Seattle

Simulation Boot Camp

In 2008, I helped TSDA establish the first-ever national Resident Simulation Boot Camp. Now in its 10th year, Boot Camp brings together cardiothoracic residents and faculty from all over the country for intensive training in areas, such as cardiopulmonary bypass, blood vessel anastomosis, lung resection, lung cancer diagnostic procedures, and heart valve repair and replacement. In addition, we just completed an extensive 3-year study of simulation-based training in cardiac surgery—sponsored by the Agency for Healthcare Research and Quality—demonstrating conclusively that residents who were trained using simulation achieved perfect or near perfect performances in all major procedures of cardiac surgery. This curriculum is now being rolled out throughout the country.

Importance of a board-certified thoracic surgeon

I think it is important that every patient has the best trained surgeon possible. That starts with your surgeon being board certified by the ABTS. I was honored to chair ABTS from 2007 to 2009. Particularly in lung surgery, board certification and full thoracic training are not required to perform the operation. But I can tell you, and there is plenty of data to support this, the results are better if the operation is done by a board-certified thoracic surgeon. If you need cardiothoracic surgery, you owe it to yourself to have an ABTS board-certified surgeon perform your operation.

I am very proud of the training I received. I am very proud that training gave me the skills that allowed me to serve my patients and offer them the best treatment possible. Cardiothoracic surgery training is long, hard, and very intense. Even so, and despite being 35 years old before I even started practice, I never felt the training to be a sacrifice; in the end, it provided me with the skills I needed to do something I love doing.