Global Differences in the Training, Practice, and Interrelationship of Cardiac and Thoracic Surgeons

doi:10.1016/j.athoracsur.2009.04.010

The Annals of Thoracic Surgery

Volume 88, Issue 2, August 2009, Pages 515-522.e5

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

https://doi.org/10.1016/j.athoracsur.2009.04.010 Get rights and content

Background

Training and certification for general thoracic surgeons varies enormously between countries. There is little knowledge about training and certification for general thoracic surgeons, and the relationship between thoracic surgery and cardiac surgery around the world.

Methods

A 38-item survey was designed to assess training, practice, demographics, and relationships of general thoracic and cardiac surgeons. Eighteen cardiothoracic societies representing surgeons on six continents were contacted, and 15 submitted the survey to their membership. The survey was advertised through CTSnet, and 928 surgeons from 105 countries were contacted directly in regions not covered by the professional societies.

Results

In all, 1,520 survey respondents were tabulated, representing 95 separate countries. Non-US respondents were younger, more commonly had practices exclusively in cardiac or thoracic surgery, less commonly obtained general surgery certification, less commonly performed esophageal surgery, and had shorter overall surgical training but longer specialized training in cardiothoracic surgery, although US respondents received greater length of cardiac surgery specific training (all p < 0.05). The US respondents thought that cardiac surgery training was more important for the practice of general thoracic surgery than did non-US respondents, and that it was important for thoracic surgeons and cardiac surgeons to be aligned in public policy and specialty advocacy.

Conclusions

Marked differences in training and certification across the world result in discrepancies in clinical practice, levels of collaboration between cardiac and thoracic surgeons, and culture and attitude differences that are relevant to the feasibility of alliances relating to public policy. These findings also provide important data to inform any decisions about changes in US cardiothoracic training. Greater international cooperation may diminish these differences in order to propagate improvements in cardiothoracic education, and improve patient access and outcomes through shared specialty advocacy.

Section snippets

Material and Methods

A 38-item survey (Appendix^⁎) was designed to assess training, practice, demographics, and relationships of general thoracic and cardiac surgeons. Survey questions included demographics, total and cardiothoracic (CT) specific length of training, board certification status, current and previous specialty practice, opinions on cardiac and thoracic inter-relationships, academic versus private practice, and number of peer-reviewed manuscripts in a 5-year period.

Eighteen cardiothoracic societies

Results

In all, 1,520 survey respondents were tabulated, representing 95 separate countries on six continents (Table 2). Of all respondents, 1,261 (83%) answered the question about country of practice, and there were 439 US respondents (35%) US and 822 non-US respondents (65%), respectively. The US respondents were older, 49% were aged more than 50 years compared with 28% of non-US surgeons (p < 0.001). Women made up a minority of cardiothoracic surgeons in both groups (6% in each). The survey appeared

Comment

The last 60 years have provided a revolution in cardiothoracic surgery, with technical advances allowing thoracic surgery to successfully treat an expanding array of intrathoracic pathology. These advances, when combined with the development of extracorporeal circulation, launched cardiac surgery, which quickly evolved to become the most visible subspecialty of cardiothoracic surgery. The ability to correct previously untreated valvular heart disease, and the development of coronary bypass

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Cited by (11)

Global perspectives on cardiothoracic, cardiovascular, and cardiac surgical training
2021, Journal of Thoracic and Cardiovascular Surgery
Various methods for cardiothoracic, cardiovascular, and cardiac surgical training exist across the globe, with the common goal of producing safe, independent surgeons. A comparative analysis of international training paradigms has not been undertaken, and our goal in doing so was to offer insights into how to best prepare future trainees and ensure the health of our specialty.
We performed a comparative analysis of available publications offering detailed descriptions of various cardiothoracic, cardiovascular, and cardiac surgical training paradigms. Corresponding authors from previous publications and other international collaborators were also reached directly for further data acquisition.
We report various approaches to common challenges surrounding (1) selection of trainees and plans for the future surgical workforce; (2) trainee assessments and certification of competency before independent practice; and (3) challenges related to a changing practice landscape.
Cardiothoracic surgery remains a dynamic and rewarding specialty. Current and future trainees face several challenges that transcend national borders. To foster collaboration and adoption of best practices, we highlight international strengths and weaknesses of various nations in terms of workforce selection, trainee operative experience and assessment, board certification, and preparation for future changes anticipated in cardiothoracic surgery.
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2011, Progress in Pediatric Cardiology
Citation Excerpt :
Malpractice claims are not randomly distributed within surgical subspecialties; some surgeons are associated with more claims than others [1–3]. Although several reports discuss differences in C–T surgery training that might affect outcomes [4–11] (and therefore may reflect claims experience), we could find no studies describing risk-related indicators or characteristics of pediatric C–T surgeons. Rather than wait for events and claims to accumulate, what is needed is a proxy for malpractice risk that provides more – and more timely – data than simply counting event reports and lawsuits.
Effective teamwork is critical to successful outcomes in pediatric cardiac surgery. Unfortunately, lapses in professional performance and conduct by those who treat pediatric cardiac patients pose threats to quality and safety. One hallmark of a profession is self regulation. Therefore, healthcare leaders need specific means for identifying and addressing those lapses and indicators of unsafe systems or individuals. This article describes an initial “near miss” event involving a pediatric cardiac surgeon. While fictional, the case represents a composite of events involving several pediatric cardiac surgeons who practice at different medical centers throughout the U.S.
Research shows that patient complaints are significantly associated with physicians' risk management activity and lawsuits. Research also demonstrates that a small subset of physicians and surgeons in various areas of practice are associated with disproportionate shares of patient complaints. Coded and aggregated patient complaint data therefore offer a metric for identifying and promoting behavior change. Analysis of the distribution of patient complaints associated with 41 pediatric cardiac surgeons is presented as a means for helping leaders show one surgeon how her/his risk status compares with peers'. The paper describes a specific plan and reliable process by which medical group/center colleagues and leaders may: 1) address lapses in professionalism and performance; 2) follow-up to promote professionalism, professional accountability, quality, and a safety culture; and 3) reduce risk.
A Pan-European training in cardio vascular or cardio thoracic surgery: Update and current challenges
2019, Cirugia Cardiovascular
A competency framework in cardiothoracic surgery for training and revalidation - an international comparison
2011, European Journal of Cardio-thoracic Surgery
Training, certification and practice of cardiac and thoracic surgeons in Europe: a comparison of the members of the European Association for Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons
2010, European Journal of Cardio-thoracic Surgery

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: The Appendix is available only online. To access it, please visit: http://ats.ctsnetjournals.org and search for the article by Wood, Vol. 88, pages 515–22.

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Original articleAdult cardiacGlobal Differences in the Training, Practice, and Interrelationship of Cardiac and Thoracic Surgeons

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

J Thorac Cardiovasc Surg

Ann Thorac Surg

Educating tomorrow's cardiac and thoracic surgeons: a Canadian initiative

Can J Surg

The practice of thoracic surgery in Canada

Can J Surg

General thoracic surgery as an independent specialty in Mexico

Rev Inst Nal Enf Resp Mex

Original article
Adult cardiac
Global Differences in the Training, Practice, and Interrelationship of Cardiac and Thoracic Surgeons