title: Resident Perception of Technical Skills Education and Preparation for Independent Practice.
abstract: BACKGROUND
  Surgical skills are traditionally taught and practiced in the operating room. However, changes in health care policy and outcome-based evaluation have decreased trainee operative autonomy. We examined cardiothoracic residents' perceptions of operative experience and the role of simulation.
  
  
  METHODS
  The In-Training Examination (ITE) is taken each year by all residents. Completion of a 30-question preexamination survey is mandatory, ensuring a 100% response rate. Survey data related to operative experience, career preparedness, and surgical simulation were analyzed. Opinion questions were asked on a 5-point Likert scale. Respondents were grouped into three cohorts by training paradigm (2-year versus 3-year traditional programs and 6-year integrated programs).
  
  
  RESULTS
  In all, 314 respondents (122 2-year, 96 3-year, and 96 6-year integrated) completed the survey. Of the three groups, residents in 3-year programs had the highest levels of satisfaction. Advanced training was most common among residents in 6-year integrated programs (66%, versus 49% for 2-year and 26% for 3-year programs; p = 0.63). Desire to specialize drove further training (97%), with 2% stating further training was needed owing to inadequacy and 1% owing to a poor job market. In all assessed categories, the majority of residents believed that simulation did not completely replicate the educational value of an operative case.
  
  
  CONCLUSIONS
  Cardiothoracic residents largely feel well prepared for the transition to practice under the current educational paradigm. Although many residents seek advanced training, it seems driven by the desire for specialization. Residents view simulation as an adjunct to traditional intraoperative education, but not as a viable replacement. Further study is necessary to better understand how best to integrate simulation with operative experience.
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: dodell@northwestern.edu.
authors.forename: David D
authors.initials: DD
authors.lastname: Odell
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Macke
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiac Surgery, University of Rochester, Rochester, New York.
authors.forename: Vakhtang
authors.initials: V
authors.lastname: Tchantchaleishvili
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Loor
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Nelson
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiac Surgery, University of Rochester, Rochester, New York.
authors.forename: John F
authors.initials: JF
authors.lastname: LaZar
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wei
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Walter F
authors.initials: WF
authors.lastname: DeNino
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Berfield
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
authors.forename: William
authors.initials: W
authors.lastname: Stein
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Division of Cardiac Surgery, Swedish Medical Center, Seattle, Washington.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Youssef
authors.affiliation: Thoracic Surgery Resident's Association, Executive Committee, Chicago, Illinois; Department of Cardiothoracic and Vascular Surgery, University of Texas at Houston, Houston, Texas.
authors.forename: Tom C
authors.initials: TC
authors.lastname: Nguyen
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004502:Education, Medical, Continuing / Q000379:methods*; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D010465:Perception; D010820:Physicians / Q000523:psychology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery / Q000193:education*