title: A Decade of Change: Training and Career Paths of Cardiothoracic Surgery Residents 2003 to 2014.
abstract: BACKGROUND
  During the past decade, cardiothoracic surgery (CTS) education has undergone tremendous change with the advent of new technologies and the implementation of integrated programs, to name a few. The goal of this study was to assess how residents' career paths, training, and perceptions changed during this period.
  
  
  METHODS
  The 2006 to 2014 surveys accompanying the Thoracic Surgery Residents Association/Thoracic Surgery Directors' Association in-training examination taken by CTS residents were analyzed, along with a 2003 survey of graduating CTS residents. Of 2,563 residents surveyed, 2,434 (95%) responded.
  
  
  RESULTS
  During the decade, fewer residents were interested in mixed adult cardiac/thoracic practice (20% in 2014 vs 52% in 2003, p = 0.004), more planned on additional training (10% in 2003 vs 41% to 47% from 2011 to 2014), and the frequent use of simulation increased from 1% in 2009 to 24% in 2012 (p < 0.001). More residents recommended CTS to potential trainees (79% in 2014 vs 65% in 2010, p = 0.007). Job offers increased from a low of 12% in 2008 with three or more offers to 34% in 2014. Debt increased from 0% with more than $200,000 in 2003 to 40% in 2013 (p < 0.001). Compared with residents in traditional programs, more integrated residents in 2014 were interested in adult cardiac surgery (53% vs 31%) and congenital surgery (22% vs 7%), fewer were interested in general thoracic surgery (5% vs 31%, p < 0.001), and more planned on additional training (66% vs 36%, p < 0.001).
  
  
  CONCLUSIONS
  With the evolution in CTS over the last decade, residents' training and career paths have changed substantially, with increased specialization and simulation accompanied by increased resident satisfaction and an improved job market.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, Columbia University, New York, New York.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Stephens
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Odell
authors.affiliation: Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
authors.forename: William
authors.initials: W
authors.lastname: Stein
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Walter F
authors.initials: WF
authors.lastname: DeNino
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Aftab
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Berfield
authors.affiliation: Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Eilers
authors.affiliation: Division of General Thoracic Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Shawn
authors.initials: S
authors.lastname: Groth
authors.affiliation: Pinnacle Health CardioVascular Institute, Harrisburg, Pennsylvania.
authors.forename: John F
authors.initials: JF
authors.lastname: Lazar
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Robich
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Asad A
authors.initials: AA
authors.lastname: Shah
authors.affiliation: Division of Cardiac Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Smith
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Division of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Cameron
authors.initials: C
authors.lastname: Stock
authors.affiliation: Pinnacle Health CardioVascular Institute, Harrisburg, Pennsylvania.
authors.forename: Vakhtang
authors.initials: V
authors.lastname: Tchantchaleishvili
authors.affiliation: Department of Surgery, Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Mery
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa, Iowa City, Iowa.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Turek
authors.affiliation: Division of Cardiothoracic Surgery, University of Mississippi, Oxford, Mississippi.
authors.forename: Jorge
authors.initials: J
authors.lastname: Salazar
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Memorial Hermann-Texas Medical Center, Houston, Texas. Electronic address: tom.c.nguyen@gmail.com.
authors.forename: Tom C
authors.initials: TC
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D002321:Career Choice; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000191:economics; D007588:Job Satisfaction; D008297:Male; D066231:Surgeons / Q000191:economics; D013903:Thoracic Surgery / Q000193:education*