Systematic survey of opinion regarding the thoracic surgery residency

Impact of a focused review course in cardiovascular and thoracic surgery on test performance

Background

Methods

Results

Conclusions

A personal experience of 2-year general thoracic surgery training programs in Japan and the United States

OBJECTIVES

The objective of the study is to review and compare two countries' thoracic surgery training programs.

METHODS

Retrospective review of the first author's prospectively maintained operative case logs in two countries was performed. Each training program was established in a teaching hospital for its country's board requirement. Preoperative diagnosis, operative procedures and postoperative diagnosis were reviewed. The case volume (overall and in each category) was also reviewed. The ratio of each category and overall case volume was compared between the two programs by Chi-square test. p value was considered significant if it is <0.05.

RESULTS

The overall case volumes were 169 cases in the Japanese institution and 456 cases in the United States' institution. The number ratio of each category's procedures and overall procedures was as follows: pleural cases, Japan 19.2 % versus the Unites States 20.6 % (p = 0.782), pulmonary cases, Japan 72.7 % versus the United States 36.8 % (p < 0.0001), mediastinal cases, Japan 8.1 % versus the United States 8.6 % (p = 0.678), diaphragm cases, Japan 0.62 % versus the United States 13.2 % (p = 0.0001), chest wall cases, Japan 1.2 % versus the United States 3.5 % (p = 0.0858), tracheobronchial cases, Japan 1.2 % versus the United States 1.8 % (p = 0.583). Regarding the approach, the ratios of each approach and overall cases are as follows: minimally invasive approach, Japan 78.3 % versus the United States 45.8 % (p < 0.0001), reoperative cases, Japan 0.62 % versus the United States 3.1 % (p = 0.0411).

CONCLUSIONS

Case variety is different between the two countries. Our findings suggest that thoracic surgery training in the United States may be beneficial for Japanese medical graduates.

Benson R. Wilcox--industry, genius, judgment

The 29th President of the Society of Thoracic Surgeons, Benson R. Wilcox, MD, died at his home in Fearington Village Center, NC, on May 11, 2010. In 2 weeks, he would have been 78 years old, and the focus of a birthday celebration for his wife, Patsy Davis, his 4 children, Adelaide, Sandra, Melissa, and Reid, 11 grandchildren, and many loved ones. With his death, caused by brain cancer, the University of North Carolina lost one of its most prolific and loyal sons, and the profession of thoracic surgery, one of its wisest leaders. Two facts are certain: Ben will be remembered forever by his students, residents, and colleagues, and our sky is, indeed, Carolina blue.

Improving the National Board of Medical Examiners internal Medicine Subject Exam for use in clerkship evaluation

OBJECTIVE

To provide a consensus opinion on modifying the National Board of Medical Examiners (NBME) Medicine Subject Exam (Shelf) to: 1) reflect the internal medicine clerkship curriculum, developed by the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM); 2) emphasize knowledge important for a clerkship student; and 3) obtain feedback about students' performances on the Shelf.

DESIGN

Two-round Delphi technique.

PARTICIPANTS

The CDIM Research and Evaluation Committee and CDIM members on NBME Step 2 Committees.

MEASUREMENTS

Using 1-5 Likert scales (5 = highest ratings), the group rated test question content for relevance to the SGIM-CDIM Curriculum Guide and importance for clerkship students' knowledge. The Shelf content is organized into 4 physician tasks and into 11 sections that are generally organ system based. Each iteration of the Shelf has 100 questions. Participants indicated a desired distribution of questions by physician task and section, topics critical for inclusion on each exam, and new topics to include. They specified the types of feedback clerkship directors desired on students' performances. Following the first round, participants viewed pooled results prior to submitting their second-round responses.

RESULTS

Of 15 individuals contacted, 12 (80%) participated in each round. The desired distribution by physician task was: diagnosis (43), treatment (23), mechanism of disease (20), and health maintenance (15). The sections with the most questions requested were the cardiovascular (17), respiratory (15), and gastroenterology (12) sections. The fewest were requested in aging/ethics (4) and neurology, dermatology, and immunology (5 each). Examples of low-rated content were Wilson's Disease, chancroid and tracheal rupture (all <2.0). Health maintenance in type 2 diabetes, hypertension, and cardiovascular disease all received 5.0 ratings. Participants desired feedback by: section (4.6) and physician task (3.9), on performances of the entire class (4.0), and for individual students (3.8).

CONCLUSION

Clerkship directors identified test content that was relevant to the curricular content and important for clerkship students to know, and they indicated a desired question distribution. They would most like feedback on their students' performance by organ system-based sections for the complete academic year. This collaborative effort could serve as a model for aligning national exams with course goals.

The Thoracic Surgery Residency Program at Chapel Hill

The success of the cardiothoracic surgery residency program in Chapel Hill is due to a number of contributing factors. The first important ingredient is the faculty. Their ability, stability, and dedication, with each faculty member developing an area of expertise, has contributed greatly to the success of our program. The second important aspect is the program design itself--all three years: the first to allow the resident time to reflect on educational priorities and do some innovative thinking; the second and third as chief resident on their respective services--for an entire, continuous year. The third and most important aspect of our program is the quality of the residents we have been able to attract--uniformly a splendid group of individuals who regularly gave more than they received and who continue to be a source of inspiration, hope, and pride for those of us who have been privileged to be their teachers.