Trends in the traditional cardiothoracic surgery resident operative experience for cardiac cases: An analysis of Accreditation Council for Graduate Medical Education case logs

Shah, Aakash; Siddiqui, Emaad; Holmes, Sari D.; Okoh, Alexis K.; Abdullah, Mohamed; Deatrick, Kristopher B.; Kaushal, Sunjay; Sambol, Justin T.

doi:10.1016/j.jtcvs.2020.11.168

Cited by 6 publications

(7 citation statements)

References 21 publications

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“…There are several variables that lead to increased confidence and competency in the operating room 49 . One key variable is operative volume 50 . Another is the opportunity to perform operations with skilled trainers 23 .…”

Section: Discussionmentioning

confidence: 99%

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Comanici

Salmasi

Schulte

et al. 2022

Journal of Cardiac Surgery

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Objectives We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. Methods EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety‐two results were obtained, 27 represented best evidence (2‐meta‐analyses, 1‐RCT, and 24 retrospective cohort studies). Results In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on‐pump vs. 3206 off‐pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty‐nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high‐risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in‐hospital or midterm mortality out to 5‐years. Discussion Trainees can perform cardiothoracic surgery in dedicated high‐volume units with outcomes comparable to those of fully trained surgeons.

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Section: Discussionmentioning

confidence: 99%

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Comanici

Salmasi

Schulte

et al. 2022

Journal of Cardiac Surgery

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“…Previous literature has shown that increased case volumes lead to an increased confidence level among graduating trainees. 1 Although there are many factors that create a great surgeon, operative volume will always be a key factor. As such, trends of overall case volume among trainees are important to understand.…”

Section: Keyan Mobli MD and Ikenna Okereke Mdmentioning

confidence: 99%

“…Shah and colleagues 1 have examined the case logs for cardiothoracic resident physicians in 2-and 3-year programs (excluding I-6 integrated programs) over the last 4 years to assess for trends in case volume. These logs counted both cases in which the resident acted as primary surgeon for the essential components of the case and as the assistant surgeon.…”

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confidence: 99%

Commentary: Cardiothoracic surgery training is more than calculus class

Dearani

2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Improvements in medical therapies and endovascular approaches have led to a greater proportion of coronary and valvular disease being treated without traditional surgical approaches. 2,3 Despite this increase, the manuscript by Shah and colleagues 4 showed that cardiothoracic surgery residents have performed more cases over the last 4 years. There was a more significant increase in the number of general thoracic cases performed than cardiac cases.…”

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confidence: 99%