title: Characterizing the Operative Experience of Cardiac Surgical Trainees: What Are Residents Really Doing in the Operating Room?
abstract: BACKGROUND
  The present study aimed to describe and compare the operative experience of cardiothoracic surgical residents for basic and advanced cardiac surgical procedures.
  
  
  METHODS
  Data were obtained from the 2015 Thoracic Surgery Directors Association Survey administered to all thoracic surgical residents taking the yearly In-Service Training Examination (n = 356). Residents were asked whether they routinely served as the operative surgeon on various cardiac operations and operative tasks. Results were stratified by postgraduate year (PGY), residency type, and primary career interest.
  
  
  RESULTS
  The survey response rate was 100%. Considering all training pathways, only 2 of 13 cardiac operations surveyed were routinely performed by graduating chief residents as the operative surgeon: coronary artery bypass grafting (CABG; 92%) and aortic valve replacement (AVR; 88%). Off-pump CABG, minimally invasive mitral valve operation, and transcatheter aortic interventions were infrequently (<30% of the time) performed by graduating residents as the operative surgeon. These results were similar when residents with a career interest in general thoracic surgery were excluded from the analysis. For the operative progression of integrated 6-year (I-6) residents, most began to routinely cannulate for cardiopulmonary bypass, perform proximal coronary anastomoses, and harvest the mammary artery during PGY3. The majority (>50%) of I-6 residents performed CABG as the operative surgeon by PGY4.
  
  
  CONCLUSIONS
  There is pronounced heterogeneity in the cardiac operative experience of cardiothoracic surgical residents in the United States, with only CABG and AVR routinely performed by graduating residents as the operative surgeon. This heterogeneity may lead to insufficient training in certain procedures for many graduates.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: asad.shah@duke.edu.
authors.forename: Asad A
authors.initials: AA
authors.lastname: Shah
authors.affiliation: Department of Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Aftab
authors.affiliation: Department of Surgery, University of Rochester, Rochester, New York.
authors.forename: Vakhtang
authors.initials: V
authors.lastname: Tchantchaleishvili
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.affiliation: Department of Surgery, Columbia University, New York, New York.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Stephens
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Walters
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Walter F
authors.initials: WF
authors.lastname: DeNino
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: David D
authors.initials: DD
authors.lastname: Odell
authors.affiliation: Department of Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael
authors.initials: M
authors.lastname: Robich
authors.affiliation: Department of Surgery, Harvard University, Boston, Massachusetts.
authors.forename: Marisa
authors.initials: M
authors.lastname: Cevasco
authors.affiliation: Department of 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: Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Gillaspie
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Andrew
authors.initials: A
authors.lastname: Goldstone
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Tarek
authors.initials: T
authors.lastname: Malas
authors.affiliation: Department of Surgery, University of Texas, Houston, Texas.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Rice
authors.affiliation: Department of Surgery, University of Colorado, Aurora, Colorado.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Shelstad
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Andersen
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000193:education*; D002321:Career Choice; D002983:Clinical Competence; D001026:Coronary Artery Bypass / Q000193:education; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000193:education; D006801:Humans; D007396:Internship and Residency; D008297:Male; D017009:Professional Autonomy; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery / Q000193:education*; D014481:United States