The cardiothoracic surgery trainee experience during the coronavirus disease 2019 (COVID-19) pandemic: Global insights and opportunities for ongoing engagement

Early effect of the COVID-19 pandemic on the North American cardiothoracic surgery job market

Background

The present study aims to report the early effect of the coronavirus disease 2019 (COVID-19) pandemic on the cardiothoracic surgery job market in North America.

Methods

The Cardiothoracic Surgery Network (CTSNet) job market database was queried, and patterns from January to May for 2019 versus January to May 2020 were compared for trends in job postings and job seekers.

Results

Our study is comprised of 395 cardiothoracic surgery job postings, of which 98% were positions located in North America and 63% were academic. The negative impact of the pandemic on the cardiothoracic surgery job market was greatest in the cardiothoracic/cardiovascular combined subspecialty, followed by congenital and adult cardiac surgery, whereas general thoracic surgery experienced an increase in proportion of jobs available. Despite an increase in views per job posted in 2020 vs. 2019 (532 vs. 290), employer views of job seeker curriculum vitae declined over the same time period in 2020 (January, 380 views/month to May, 3 views/month) compared to 2019 (January, 100 views/month to May, 54 views/month).

Conclusions

An analysis of job postings from CTSNet suggests a decline in job availability in the North American cardiothoracic surgical job market following declaration of the pandemic with acknowledgement that there is month to month variability and a supply-demand mismatch. The COVID-19 pandemic has had an unprecedented impact on our field, and the ultimate consequences remain unknown.

Considerations for a Holistic Model in Evaluating Medical Students for Cardiothoracic Surgical Residency

Program directors are tasked with selecting whom they think will be the best fit for residency and the next leaders of the field. While numerical metrics have played a vital role in this process, recent changes to student evaluation are reducing the availability of these metrics. This poses unique challenges for both applicants and program directors. Here we discuss how this will likely shift the focus on other parts of the application and the consequences (good and bad) of doing so.

Multi-Institutional Evaluation of a Debate-Style Journal Club for Cardiothoracic Surgery Trainees

BACKGROUND

Traditional journal clubs address individual articles and are limited in terms of breadth and depth of content covered. The present study describes the outcomes of a novel debate-style journal club in a multi-institutional setting.

METHODS

Participating institutions were recruited through the Thoracic Education Cooperative Group (TECoG). The distributed curriculum included instructions, debate scenarios, suggested article lists, moderator slides, debate scoresheets, exams, and feedback surveys.

RESULTS

Six institutions participated in the study (2015-2019), consisting of a total of 10 years' worth of cumulative debates. Cardiothoracic surgery trainees participated in 10 monthly debates over each academic year. Trainee performance on the written examination in the realm of evidence-based medicine and critical appraisal improved over the course of the academic year (beginning 55.2% vs end 76.3%, p=0.040). Importantly, written examination after debates revealed a significant improvement in scores on questions relating to topics that were debated as compared to those that were not (+27.1% vs +2.5%, p=0.006), emphasizing the importance of the debates as compared to other sources of knowledge gain. Surveys completed by trainees and faculty overall favored the debate-style journal club as compared to the traditional journal club in gaining familiarity with seminal literature in the field, improving upon oral presentation skills, and applying published literature to questions encountered clinically.

CONCLUSIONS

In this multi-institutional prospective study, we demonstrate that the novel debate-style cardiothoracic surgery journal club is an effective educational intervention for cardiothoracic surgical trainees to acquire, retain, and gain practice in applying literature-based evidence to case-based scenarios.

Remote Simulator Training of Coronary Artery Bypass Grafting during the COVID-19 Pandemic

Objectives

The coronavirus disease 2019 (COVID-19) pandemic presents in-person exposure risk during surgical education. We aimed to validate the feasibility of fully remote faculty-supervised surgical training sessions focused on coronary artery bypass grafting using a synthetic simulator and online video-chat software.

Methods

This observational study organized 24 sessions of 2-hour remote training. Each session involved three trainees, one faculty, and one host. A total of 70 trainees and 24 faculties were enrolled. The participants joined the remote sessions via online video-chat, and performed focused training in coronary artery anastomosis using a commercially available simulator. A survey was conducted to validate the feasibility of the remote sessions. Performance improvement of the trainees who repeatedly participated (n = 13) were analyzed comparing initial and final scores of various performance indicators.

Results

All trainees and faculties were satisfied with the efficacy of the remote session. Additionally, most trainees (79%) and faculties (95%) agreed that the remote training sessions were equivalent to conventional on-site training seminars. A significant improvement between initial and last sessions was observed in the scoring components of near side (3.4 ± 1.0 vs. 4.1 ± 0.9; P = 0.02), far side (3.3 ± 0.8 vs. 3.9 ± 0.8; P = 0.03), external appearance (3.5 ± 0.8 vs. 4.2 ± 0.7; P = 0.01), and internal appearance (2.8 ± 0.9 vs. 4.0 ± 0.9; P = 0.004).

Conclusions

Faculty-supervised remote surgical training sessions were executed with satisfactory results. This methodology may have important implications for surgical education during the COVID-19 pandemic.

COVID-19 and cardiothoracic surgery: Effects on training and workforce utilization in a global pandemic

Background

The COVID‐19 pandemic has disrupted all aspects of healthcare, including cardiothoracic surgery (CTS). We sought to determine the pandemic's impact on CTS trainees' educational experiences.

Methods

A survey was developed and distributed to members of the Thoracic Surgery Residents Association and other international CTS trainees. Trainees were asked to evaluate their cumulative experiences and share their overall perceptions of how CTS training had been impacted during the earliest months of the COVID‐19 pandemic (i.e., since March 01, 2020). Surveys were distributed and responses were recorded June 25–August 05, 2020. In total, 748 surveys were distributed and 166 responses were received (overall response rate 22.2%). Of these, 126 of 166 responses (75.9%) met inclusion criteria for final analysis.

Results

Final responses analyzed included 45 of 126 (35.7%) United States (US) and 81 of 126 (64.3%) international trainees, including 101 of 126 (80.2%) senior and 25 of 126 (19.8%) junior trainees. Most respondents (76/126, 43.2%) lost over 1 week in the hospital due to the pandemic. Juniors (12/25, 48.0%) were more likely than seniors (20/101, 19.8%) to be reassigned to COVID‐19‐specific units (p < .01). Half of trainees (63/126) reported their case volumes were reduced by over 50%. US trainees (42/45, 93.3%) were more likely than international trainees (58/81, 71.6%) to report reduced operative case volumes (p < .01). Most trainees (104/126, 83%) believed their overall clinical acumen was not adversely impacted by the pandemic.

Conclusions

CTS trainees in the United States and abroad have been significantly impacted by the COVID‐19 pandemic, with time lost in the hospital, decreased operative experiences, less time on CTS services, and frequent reassignment to COVID‐19‐specific care settings.