- Email: [email protected]
Evaluation of Cardiothoracic Surgery Residency and Fellowship Program Websites
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Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Association for Academic Surgery
Evaluation of Cardiothoracic Surgery Residency and Fellowship Program Websites Vanessa M. Miller, MD,a Luz A. Padilla, MD, MSPH,a,b Alissa Schuh, MD,c David Mauchley, MD,a David Cleveland, MD,a Zviadi Aburjania, MD,a and Robert Dabal, MDa,* a
Cardiovascular Division, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama c School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama b
article info
abstract
Article history:
Background: The internet is a valuable resource for residency and fellowship applicants
Received 7 December 2018
when deciding where to apply or interview, yet program websites have shown critical
Received in revised form
deficiencies in accessibility and content. No analysis of cardiothoracic surgery program
19 July 2019
websites has been performed.
Accepted 12 September 2019
Methods: Online databases and Google were used to identify integrated, 4 þ 3, and tradi-
Available online xxx
tional cardiothoracic surgery residency and fellowship programs. The accessibility of websites from each of these sources was assessed and the presence or absence of content
Keywords:
that may be relevant to applicants was evaluated by two reviewers.
Cardiothoracic surgery programs
Results: Eighty-nine active programs were identified and 86 had functional websites.
Website
Website content and accessibility were overall suboptimal in all 86 of these programs.
Content
Google was the most reliable means of accessing a program’s website. Fifty percent of
Accessibility
integrated program websites and 60% of traditional fellowship websites contained less than half of the content assessed. Information on 4 þ 3 programs was extremely limited. Conclusions: Despite the value that a program’s website could provide to applicants when making decisions during the application process, cardiothoracic surgery residency and fellowship websites remain difficult to access and are not uniformly providing information that may be important. Improving cardiothoracic website accessibility and content may have implications for attracting the most competitive applicants while limiting the financial and scheduling demands associated with the interview process. Creation of a current database containing standardized information relevant to applicants may improve applicants’ ability to form an impression of a program before scheduling an interview. ª 2019 Elsevier Inc. All rights reserved.
Meeting presentation: The 14th Annual Academic Surgical Congress in Houston, Texas e February 7, 2019. * Corresponding author. Cardiothoracic Division, Department of Surgery, 1700 6th Avenue South, WIC 9100, Birmingham, AL, 35233. Tel.: þ205 638-3172; fax: þ205-996-6551. E-mail address: [email protected] (R. Dabal). 0022-4804/$ e see front matter ª 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2019.09.009
miller et al evaluating ct program websites
Introduction Recent trends in general surgery training indicate that greater than 80% of trainees intend to pursue fellowship after the completion of residency.1 When applying for fellowship in the current era, applicants are inclined to perform an internet search of programs within their desired specialty; therefore, their first impression of a program is often based on the program’s website. Previous studies have indicated that applicants place significant weight on a program’s website when determining whether to apply to or interview at that program and are frequently dissatisfied with the quality of websites viewed.2-4 Numerous studies assessing the importance, accessibility, and content of residency and fellowship program websites have found that programs’ websites are a fundamental resource for trainees during the application process, yet most existing websites are critically lacking in content areas deemed relevant or important to prospective applicants.2,3,5-10 Furthermore, society web pages that applicants use to identify available training programs often provide indirect or nonfunctional links to program home pages, which limits website accessibility.3,5,8-10 Knowledge about the adequacy of residency and fellowship websites is important because access to thorough, accurate online information may allow applicants to make informed decisions about whether they would be a good “fit” for a program before applying or interviewing. Attending numerous interviews to find the ideal program may also have valuable implications related to resident finances and time missed from training. A study by Watson et al. reported that greater than 50% of general surgery residents miss more than a week of training for interviews and program directors report this absence to be significantly disruptive to their programs.4 This same study reported that most residents spend more than $4000 on fellowship interviews, yet 61.7% of respondents felt they could have eliminated certain programs from their interview list had websites been more informative. Despite the vast amount of literature that exists on this topic in other specialties, no analysis of the content or accessibility of cardiothoracic (CT) surgery training websites has been performed. Cardiothoracic surgical training is unique in that three distinct pathways exist including a 6-year integrated (I-6) residency directly after medical school, a “4 þ 3” residency involving 4 years of standard general surgery training followed by 3 years of traditional CT fellowship, and a traditional 2-3 year fellowship after 5 years of general surgery. Our study aims to determine in all tracks: (1) the accessibility of CT surgery residency and fellowship websites, and (2) the online presence of information that may be relevant to prospective applicants.
Materials and methods Several sources maintain a list of the U.S. CT surgery residencies and fellowships that applicants may reference. Such lists are accessed online through the respective websites for the Electronic Residency Application Service (ERAS),11 the Fellowship and Residency Electronic Interactive Database
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Access (FREIDA),12 the Accreditation Council for Graduate Medical Education (ACGME),13 and the Thoracic Surgery Directors Association (TSDA).14-16 All applicants to I-6 programs and traditional fellowships are required to submit their applications through ERAS except 4 þ 3 programs, so this list was obtained from TSDA. A list of programs was obtained from each source during May of 2018. Programs that were listed as participating in ERAS were included in our analysis. Programs were considered inactive if they were listed as “not participating” or “no longer accepting applications” or if they were listed on another database (FREIDA, ACGME, TSDA) but not on ERAS. Accessibility of active programs’ websites were evaluated through ERAS, FREIDA, ACGME, and TSDA by determining which programs provided functioning weblinks on these databases. Links were classified as functioning if they did not produce an error message and linked to any website at all, even if that website was unaffiliated with the program. Links were further stratified according to whether they linked directly to the homepage for the program, the cardiothoracic surgery department, the general surgery department, or the main hospital. An “other” option was created for programs with functional links that did not redirect to any of the aforementioned home pages. Accessibility of active program websites was also evaluated through a Google search performed using “program name þ cardiothoracic surgery residency” for integrated programs or “program name þ cardiothoracic surgery fellowship” for traditional fellowships or “program name” þ “4 þ 3 cardiothoracic surgery residency” for 4 þ 3 programs. The search was conducted on a public browser with no Google account logged in and cookies were regularly deleted to avoid personalized results. If the search for traditional and integrated programs produced a result referencing CT surgery training anywhere on the first page of results, we considered the Google link “present”. The functionality and directness of the link was then classified as described previously. For 4 þ 3 program searches, we clicked on the search result that referenced cardiothoracic surgery training and then navigated the website for reference to the 4 þ 3 training pathway, as we found that these programs tended not to have their own website because these residents eventually become part of the traditional fellowship program. Two independent evaluators assessed CT surgery residency and fellowship websites for content; 98% agreement was observed. These 46 total data points were based on previous studies that identified factors deemed important or relevant to residency and fellowship applicants.3,5-7 Variables were noted as present or absent with no judgment made on the quality of this information, as we felt this would introduce substantial subjectivity into our results. Variables were deemed present if the information could be found through any number of clicks starting from the residency or fellowship program’s homepage. Match data for each of these pathways was obtained from the National Residency Match Program. I-6 applicants apply during their last year of medical school and if matched, begin training the following year. Applicants to traditional fellowships apply during their second to last year of general surgery
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Fig e Breakdown of CT surgery programs according to program structure and match participation.
training and therefore if matched, must complete another full year of general surgery before starting their CT training. The most recent match data available for I-6 and traditional fellowship tracks was for appointment year 2019.17,18 For the statistical analysis, frequencies and percentages were calculated and used to describe all data. All statistical analyses were carried out using SAS 9.4 (SAS Institute Inc NC). No Institutional Review Board approval was required for this study.
Results There are a total of 114 CT surgery programs, of which 26 are active I-6 programs and 63 are active traditional fellowships, offering 37 and 90 positions for appointment year 2019, respectively. One inactive I-6 program and 12 inactive traditional fellowships were still listed on at least one other database (FREIDA, ACGME, or TSDA) (Figure). Most training programs were located in the South and Northeast (Table 1). For appointment year 2019, all 26 (100%) I-6 programs fully matched (Figure). Of the active fellowship programs analyzed, only 1 program had a spot go unfilled (98% match rate) (Figure). Table 2 outlines the accessibility of program web pages from various sources. All 26 I-6 programs were found to have a website that could be accessed directly with a Google search. Only 21 (81%) integrated programs provided a link from ERAS and 19 (91%) of these links were functional. However, only 6 (32%) of the 19 functional hyperlinks directed to the program’s web page, with a majority redirecting somewhere else. Likewise, on FREIDA, ACGME, and TSDA, many programs were found to lack links, with only 24 (92%), 21 (81%), and 9 (39%) of
the 26 programs in these respective databases providing links. Of the programs that did provide links, most were functional (23 [96%], 19 [91%], and 8 [89%] for FREIDA, ACGME, and TSDA, respectively) but again, only a minority linked directly to the program’s homepage. Of the 63 active fellowship programs identified, only 60 were found to have a website. All 60 of these websites were ultimately accessible using a Google search. On FREIDA,
Table 1 e Comparison of cardiothoracic integrated and fellowship programs. Program characteristic
I6 N (%) 26 (30)
Fellowships N (%) 60 (70)
Region* Northeast
8 (31)
16 (27)
South
8 (31)
20 (33)
Midwest
6 (23)
13 (22)
West
4 (15)
11 (18)
Number of positions in the program 0
0
1 (2)
1
16 (62)
34 (60)
2
10 (38)
18 (32)
3
0
2 (3)
4
0
2 (3)
Number filled Unfilled Filled *
0
1 (2)
26 (100)
59 (98)
Based on US Census Bureau classification.
2 (3) Direct link data variables number and percent are calculated based on functional link total. *
0 0
0 -
0
1 (12) 9 (19)
4 (9) 1 (5)
1 (5) 8 (19)
10 (23) 2 (11)
1 (5) 7 (15) 2 (9) Link directs to a website without error
8 (17) 2 (9) Hospital page
3 (5)
54 (90)
1 (2) 0 2 (25) 4 (9) 5 (26) 4 (9) 3 (16) 3 (6) 5 (22) General surgery page
0
26 (100) -
2 (25)
3 (38) 13 (28)
16 (35) 6 (32)
6 (32) 8 (19)
13 (30) 8 (42)
5 (26) 12 (26)
17 (36) 10 (43)
4 (17) Program website
*Direct link to
CT department home page
60 (100) 26 (100) 8 (89) 46 (82) 19 (91) 43 (75) 19 (91) 23 (96) Of links present number of functional links
47 (84)
60 (100)
60 (95) 26 (100)
26 (100) -
23 (89)
9 (39) 56 (89)
63 (100) 26 (100)
21 (81) 57 (91)
63 (100) 26 (100)
21 (81) 56 (89) Link present
63 (100) 26 (100)
24 (92)
Listed on
Fellowship Fellowship Fellowship I6
Fellowship
I6
Fellowship
I6
ERAS, N (%) ACGME, N (%) FREIDA, N (%) Website characteristic
Table 2 e Website accessibility of cardiothoracic (CT) integrated and fellowship program websites.
I6
TSDA, N (%)
I6
Google, N (%)
miller et al evaluating ct program websites
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ACGME, and ERAS, links were provided by 56 (89%), 57 (91%), and 56 (89%) programs with 47 (84%), 43 (75%), and 46 (82%) functional links, respectively. Of these functional links, only 12 (26%), 8 (19%), and 13 (28%) linked directly to the fellowship web page. TSDA did not provide a list or links for any traditional fellowships, in stark contrast to the list of integrated programs provided on TSDA.org. Instead, TSDA redirected applicants to the ACGME website for a list of traditional fellowships. Website content varied greatly for integrated and traditional training programs and is described in Table 3. Program description, current research in the department, rotation schedule, research opportunities, and salary were the most commonly provided information by I-6 programs. Program description, current research in the department, didactics/ educational conferences, rotation schedule, and research opportunities were the most commonly provided information on fellowship websites. The least common information presented for both type of programs was board pass rate (0% I-6 versus 5% traditional fellowship) and call expectations (0% I-6 versus 8% traditional fellowship). The average number of data points contained per website was 23 for I-6 programs and 20 for traditional fellowships. No website contained all data points. The maximum number of data points contained for an I-6 website was 35 and the minimum was 11. For a traditional fellowship website, the maximum number of data points was 36 and the minimum was 6. Fifty percent of I-6 websites and 60% of traditional fellowship websites contained less than half of the content assessed. Information related to past and current trainees and staff within the programs also varied greatly (Table 4). Most websites listed program coordinator and program director names. Email was the most common contact information listed for a program coordinator, whereas program director email was provided less frequently. All I-6 websites and almost all (97%) traditional fellowship websites provided a list of faculty with photos but an email address for faculty was provided on only 42% of I-6 websites and 40% of fellowship websites. In general, a list of current residents/fellows was less common than a list of faculty, but a list of current trainees was more commonly provided by I-6 programs (77% versus 48%). Contact info for trainees was provided even less often than it was for faculty and was listed on only 27% of I-6 websites and 7% of fellowship websites. Only 1 of 26 I-6 websites listed the last update for the web page; this one update was performed within the past year. Only 4 of the 60 traditional fellowships listed the last web page update and of these 4 websites, only 2 had been updated within the past year. The remaining websites in our study did not specify when they had been updated (Table 3). The only list of 4 þ 3 training programs we could locate was on TSDA.16 There was no indication of when this list had last been updated to verify its accuracy. Eleven 4 þ 3 programs were listed on TSDA but this list is known to be incomplete given that the 4 þ 3 program offered by the authors’ home institution was not listed on this site, meaning at least 12 programs exist. Of these twelve 4 þ 3 programs, only 8 (67%) referenced this training pathway on the institution’s website and only 6 (50%) provided information on the timing and process of applying. Further analysis was not carried out for
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Table 3 e Website and relevant application content for cardiothoracic integrated and fellowship programs.
Table 4 e Contact information available on cardiothoracic integrated and fellowship program websites.
Website data
Website data
I6 programs N (%) 26 (30)
Fellowships N (%) 60 (70)
The website contains
I6 programs N (%) 26 (30)
Fellowships N (%) 60 (70)
Program coordinator
Program description
26 (100)
58 (97)
Name
23 (89)
45 (75)
Current research in the department
24 (92)
45 (75)
Email
22 (85)
41 (68)
Number
19 (73)
40 (67)
Salary
19 (73)
34 (57)
Mailing address
14 (54)
24 (40)
Application requirements
17 (65)
34 (57)
Mentions the type of cases the program performs
17 (65)
34 (57)
Name
20 (77)
52 (87)
Number
16 (62)
34 (57)
Mail
16 (62)
28 (47)
Email
12 (46)
19 (32)
List
26 (100)
58 (97)
Photos
26 (100)
58 (97)
Biography or blurb
25 (96)
48 (80)
Publications
20 (77)
39 (65)
Email
11 (42)
24 (40)
List
20 (77)
29 (48)
Medical school or residency
17 (65)
19 (32)
Photos
16 (62)
21 (35)
Interview dates
9 (35)
14 (23)
Number of cases logged
2 (8)
9 (15)
Board pass rate
0 (0)
3 (5)
Rotation schedule
21 (81)
42 (70)
Vacation time
17 (65)
30 (50)
Work hour requirements
5 (19)
14 (23)
Clinic expectations
1 (4)
21 (35)
0
5 (8)
18 (69)
43 (72)
Work time expectations
Call expectations Professional development Didactics/educational conferences Research opportunities
20 (77)
38 (63)
Research expectations
15 (58)
24 (40)
Simulation experience Journal Club information
10 (39)
19 (32)
5 (19)
20 (33)
National meeting attendance and sponsorship
6 (23)
17 (28)
Program director message
4 (15)
11 (18)
Teaching responsibilities
1 (4)
6 (10)
12 (46)
37 (63)
7 (27)
33 (55)
1 (4)
4 (7)
1
2
Relocation information City information Housing information Website up to date Last web page update indicated Last update done less than 1 year ago
4 þ 3 programs because 4 þ 3 residents ultimately cross over into the traditional CT fellowship program at their institution and much of the data we would have collected would have been a duplicate of the traditional fellowship data already presented in this article.
Comment In today’s era, the Internet is a main source of information for applicants when making the decision to apply to, interview at, or rank a program.2,3 Despite the fact that it is more important than ever for programs to maintain current, thorough, and easily accessible websites, it seems most specialties including
Program director
Faculty
Current trainees
Biography or blurb
8 (31)
5 (8)
Contact information
7 (27)
4 (7)
Publications
5 (19)
1 (2)
List
7 (27)
18 (30)
Job location
7 (27)
15 (25)
Alumni
cardiothoracic surgery are not meeting these benchmarks. As imperative as it seems for programs to design a comprehensive website, we found that 3 traditional fellowship programs had no website at all. Furthermore, our data highlight many deficiencies in the content and accessibility of existing cardiothoracic surgery training program websites (Tables 2-4), which is consistent with findings across a variety of other medical specialties.2,3,5-10 Despite the presence of numerous national databases such as FREIDA, ACGME, ERAS, and TSDA, which maintain lists of cardiothoracic surgery residency and fellowship programs, Google was the best tool for easily accessing a program’s website. Although 100% of I-6 websites could be found and directly accessed through Google, many were inaccessible with no link provided on the aforementioned databases. In instances where a link was provided, the majority directed to a page other than the program’s website regardless of the database used. Google was also the best tool for locating traditional fellowship websites. Like I-6 programs, many traditional fellowships were inaccessible from national databases or only indirectly accessible. Another issue we encountered was that these national databases still listed programs that were no longer participating in the match (Figure). This problem was more common for traditional
miller et al evaluating ct program websites
fellowships, most likely because many programs that used to offer traditional fellowship have now transformed into I-6 programs. This may create substantial confusion for the traditional fellowship applicant. With the rising cost of medical debt, improving the content of CT residency and fellowship websites could also potentially lessen the financial and scheduling demands associated with the application and interview process. A study by Watson et al. indicated that 57.7% of general surgery residents miss more than 1 week of training for fellowship interviews with some residents needing more than 20 days off. The same study revealed that 62.3% of these residents spent over $4000 on interviews, but some reported spending over $10,000.4 There are multiple factors beyond websites that influence an applicant’s decision to apply to or interview at a program, such as a program’s reputation and advice from a mentor, but applicants could potentially apply and interview less broadly by targeting programs that fit their needs if CT websites were better designed. Although a website may not influence an applicant’s final ranking of a program, it may still be a valuable tool in making a more cost-effective and selective interview process for institutions and applicants. For example, the current structure of the interview process often forces applicants to choose between two programs with conflicting interview dates. Website data maybe the only objective data that applicants have to help them make an informed decision about how they would fit at that program before booking travel accommodations to one interview and canceling the other. Difficulty locating a program’s website or pertinent application information may deter competitive applicants from visiting that program, which should motivate programs to update their database listings yearly and to include current and detailed information on their websites regardless of the fact that most programs fill all their spots. Applicants would save time and money and avoid coverage issues at work if they were able to pare down the number of interviews they attend, and their ability to assess their fit at a program in part by using the program’s website may aid this process. This study was focused on assessing the presence of information that may be relevant to applicants based on previous studies in other specialties. Many of these studies evaluated the presence of contact information such as email addresses and phone numbers for various members of the program which led us to collect the data presented in Table 4. While it is possible that applicants seek out and value such information, programs may feel uncomfortable disseminating this information on a public forum. Applicants may view the ease of obtaining contact information as a sign of a program’s accessibility and openness to communication; however, programs may rightfully worry about outside individuals such as patients locating and abusing this information. Applicants also have the potential to abuse this information and overwhelm the program with frivolous communication during the busy interview season. Ultimately it will be at the discretion of each individual program to balance applicant desires with appropriate levels of privacy. In the future, a survey sent to applicants may help clarify how highly applicants actually value contact information beyond that of the program coordinator.
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Our study identified a significant lack of information regarding the 4 þ 3 training programs. To our knowledge, there is currently no universal list of such programs that is confirmed up to date. Although most (67%) known 4 þ 3 programs do mention this training pathway on their website, additional information was sparse. Only 50% of these programs mentioned how to apply to their 4 þ 3 track and we noted that some programs expect applicants to apply during fourth year of medical school whereas others take applications only from internal PGY-2 or PGY-3 general surgery residents. Medical students interested in cardiothoracic surgery may choose to dual apply to I-6 residency and general surgery residency to increase their odds of matching, and may be prone to targeting general surgery programs that offer a 4 þ 3 pathway. Likewise, medical students who are not competitive enough to match into an I-6 program may also target 4 þ 3 programs. There are multiple reasons why applicants may target a 4 þ 3 program regardless of whether they are competitive or not. There are some applicants who are very interested in cardiothoracic surgery but may not feel ready to commit to an integrated residency quite yet in order to explore other fields of general surgery. For personal reasons, some applicants who are vested in CT surgery still value a general surgery background. Other applicants with weaker applications may also later go on to prove their tenacity during their general surgery residency and become worthy of a 4 þ 3 spot. All these reasons shed a need for more information about which institutions have the 4 þ 3 option available. Another reason for the lack of information regarding the 4 þ 3 track may be that many recruit from within their general surgery program and must adjust their traditional fellowship positions available each year to account for internal recruits. It is imperative that we formulate an accurate database that lists all active 4 þ 3 programs along with the timing of the application process to benefit students who are interested in pursuing this pathway. To facilitate an improvement in program websites, we suggest creation of a new database, or modification of an existing one, that includes similar data assessed by our study or new validated factors. Two organizations that maintain websites with resources targeted specifically for medical students, residents, and fellows interested in CT surgery are the TSDA and Thoracic Surgery Residents Association (TSRA). We believe that either of these websites would be an excellent centralized source for collecting much of the program information analyzed in this study. Ideally, this database would contain a comprehensive list of only the active programs within each of the 3 tracks. Programs should be required to respond to a yearly survey updating all their information. This information would be transcribed into the database such that applicants could click on a program name and easily obtain a list of answers to their most common questions all on one page without having to navigate a confusing website. By responding to a yearly survey arranged by one of the aforementioned sources, individual programs would no longer be burdened by the web design process required to create a highquality website, although they could certainly continue to devote these resources if desired. Programs may find it helpful for the survey response to be a collaboration between a senior level resident or fellow “liaison” and the program coordinator to provide accurate details about information a program
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coordinator may not know, such as call expectations and research experiences, and administrative information that a trainee may not know, such as boards pass rate. This study had several limitations. The study only assessed the presence of certain variables and not the quality of information provided in order to remain as objective as possible. Most websites did not indicate when they had been updated, making it difficult to discern whether the data collected was current or accurate despite its presence. There were several variables recorded as absent for I-6 websites that may be related to nonexistence of the information rather than incomplete website maintenance. For example, many I-6 programs have not graduated any residents yet, which would make information such as boards pass rate or alumni locations nonapplicable as opposed to “missing”. A second major limitation of the study is that the list of website variables was compiled by relying on previous literature. CT surgery applicants were not surveyed to identify and rank which website information they find most important in the application process and therefore it is possible that some of the information evaluated in this study may not be crucial to include on the program website. In the future, a validated survey of CT surgery trainees will be necessary to determine which website information is truly most valuable for decision-making. In conclusion, improving cardiothoracic website accessibility and content may have implications for attracting the most competitive applicants, limiting the financial and scheduling demands placed on applicants, decreasing the number of training days missed for interviews, and increasing satisfaction with the match results. There is an obvious need to create a list of standardized content that is relevant to applicants on all training program websites to have a more effective match process.
Acknowledgment The authors would like to thank the Pediatric and Congenital Heart Center of Alabama for their support of this project. This research was financially supported by the Department of Cardiothoracic Surgery, United States.
Disclosure The authors report no conflicts of interest.
references
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2. Gaeta TJ, Birkhahn RH, Lamont D, Banga N, Bove JJ. Aspects of residency programs’ websites important to student applicants. Acad Emerg Med. 2005;12:89e92. 3. Chu LF, Young CA, Zamora AK, et al. Self-reported information needs of anesthesia residency applicants and analysis of applicant-related web sites resources at 131 United States training programs. Anesth Analg. 2011;112:430e439. 4. Watson SL, Hollis RH, Oladeji L, Xu S, Porterfield JR, Ponce BA. The burden of the fellowship interview process on general surgery residents and programs. J Surg Educ. 2017;74:167e172. 5. Charalel RA, Pua BB, Galla N, Trehan SK, Madoff DC. Interventional radiology fellowship website content: what is the relevance to potential applicants. Clin Imaging. 2016;40:1070e1074. 6. Huang BY, Hicks TD, Haidar GM, Pounds LL, Davies MG. An evaluation of the availability, accessibility, and quality of online content of vascular surgery training program websites for residency and fellowship applicants. J Vasc Surg. 2017;66:1892e1901. 7. Hashmi A, Policherla R, Campbell H, Khan FA, Schumaier A, Al-Mufarrej F. How informative are the plastic surgery residency websites to prospective applicants? J Surg Educ. 2017;74:74e78. 8. Hinds RM, Klifto CS, Naik AA, Sapienza A, Capo JT. Hand society and matching program web sites provide poor access to information regarding hand surgery fellowship. J Hand Microsurg. 2016;8:91e95. 9. Yayac M, Javandal M, Mulcahey MK. Accredited orthopaedic sports medicine fellowship websites: an updated assessment of accessibility and content. Orthop J Sports Med. 2017;5:1e6. 10. Hinds RM, Danna NR, Capo JT, Mroczek KJ. Foot and ankle fellowship websites: an assessment of accessibility and quality. Foot Ankle Spec. 2017;10:302e307. 11. ERAS 2018 participating programs and specialties. Available at: https://services.aamc.org/eras/erasstats/par/index.cfm. Accessed May 1, 2018. 12. Search FREIDA online, the AMA residency & fellowship database. Available at: https://www.ama-assn.org/life-career/ search-freida-online-ama-residency-fellowship-database. Accessed May 1, 2018. 13. List of programs by specialty. Available at: https://apps. acgme.org/ads/Public/Reports/Report/1. Accessed May 1, 2018. 14. Integrated Thoracic surgery residency programs. Available at: http://www.tsda.org/the-tsda/ct-residency-programs/ integrated-residency-progams. Accessed May 1, 2018. 15. Traditional Thoracic surgery residency programs. Available at: http://www.tsda.org/the-tsda/ct-residency-programs/ traditional-thoracic-surgery-residency-programs. Accessed May 1, 2018. 16. 4/3 Thoracic surgery residency programs. Available at: http:// www.tsda.org/the-tsda/ct-residency-programs/43-thoracicsurgery-residency-programs. Accessed May 1, 2018. 17. Results and data 2019 main residency match. Available at: http://www.nrmp.org/main-residency-match-data/. Accessed July 5, 2019. 18. Results and data specialties matching Service. Available at: http://www.nrmp.org/fellowship-match-data/. Accessed July 5, 2019.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Association for Academic Surgery
Evaluation of Cardiothoracic Surgery Residency and Fellowship Program Websites Vanessa M. Miller, MD,a Luz A. Padilla, MD, MSPH,a,b Alissa Schuh, MD,c David Mauchley, MD,a David Cleveland, MD,a Zviadi Aburjania, MD,a and Robert Dabal, MDa,* a
Cardiovascular Division, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama c School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama b
article info
abstract
Article history:
Background: The internet is a valuable resource for residency and fellowship applicants
Received 7 December 2018
when deciding where to apply or interview, yet program websites have shown critical
Received in revised form
deficiencies in accessibility and content. No analysis of cardiothoracic surgery program
19 July 2019
websites has been performed.
Accepted 12 September 2019
Methods: Online databases and Google were used to identify integrated, 4 þ 3, and tradi-
Available online xxx
tional cardiothoracic surgery residency and fellowship programs. The accessibility of websites from each of these sources was assessed and the presence or absence of content
Keywords:
that may be relevant to applicants was evaluated by two reviewers.
Cardiothoracic surgery programs
Results: Eighty-nine active programs were identified and 86 had functional websites.
Website
Website content and accessibility were overall suboptimal in all 86 of these programs.
Content
Google was the most reliable means of accessing a program’s website. Fifty percent of
Accessibility
integrated program websites and 60% of traditional fellowship websites contained less than half of the content assessed. Information on 4 þ 3 programs was extremely limited. Conclusions: Despite the value that a program’s website could provide to applicants when making decisions during the application process, cardiothoracic surgery residency and fellowship websites remain difficult to access and are not uniformly providing information that may be important. Improving cardiothoracic website accessibility and content may have implications for attracting the most competitive applicants while limiting the financial and scheduling demands associated with the interview process. Creation of a current database containing standardized information relevant to applicants may improve applicants’ ability to form an impression of a program before scheduling an interview. ª 2019 Elsevier Inc. All rights reserved.
Meeting presentation: The 14th Annual Academic Surgical Congress in Houston, Texas e February 7, 2019. * Corresponding author. Cardiothoracic Division, Department of Surgery, 1700 6th Avenue South, WIC 9100, Birmingham, AL, 35233. Tel.: þ205 638-3172; fax: þ205-996-6551. E-mail address: [email protected] (R. Dabal). 0022-4804/$ e see front matter ª 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2019.09.009
miller et al evaluating ct program websites
Introduction Recent trends in general surgery training indicate that greater than 80% of trainees intend to pursue fellowship after the completion of residency.1 When applying for fellowship in the current era, applicants are inclined to perform an internet search of programs within their desired specialty; therefore, their first impression of a program is often based on the program’s website. Previous studies have indicated that applicants place significant weight on a program’s website when determining whether to apply to or interview at that program and are frequently dissatisfied with the quality of websites viewed.2-4 Numerous studies assessing the importance, accessibility, and content of residency and fellowship program websites have found that programs’ websites are a fundamental resource for trainees during the application process, yet most existing websites are critically lacking in content areas deemed relevant or important to prospective applicants.2,3,5-10 Furthermore, society web pages that applicants use to identify available training programs often provide indirect or nonfunctional links to program home pages, which limits website accessibility.3,5,8-10 Knowledge about the adequacy of residency and fellowship websites is important because access to thorough, accurate online information may allow applicants to make informed decisions about whether they would be a good “fit” for a program before applying or interviewing. Attending numerous interviews to find the ideal program may also have valuable implications related to resident finances and time missed from training. A study by Watson et al. reported that greater than 50% of general surgery residents miss more than a week of training for interviews and program directors report this absence to be significantly disruptive to their programs.4 This same study reported that most residents spend more than $4000 on fellowship interviews, yet 61.7% of respondents felt they could have eliminated certain programs from their interview list had websites been more informative. Despite the vast amount of literature that exists on this topic in other specialties, no analysis of the content or accessibility of cardiothoracic (CT) surgery training websites has been performed. Cardiothoracic surgical training is unique in that three distinct pathways exist including a 6-year integrated (I-6) residency directly after medical school, a “4 þ 3” residency involving 4 years of standard general surgery training followed by 3 years of traditional CT fellowship, and a traditional 2-3 year fellowship after 5 years of general surgery. Our study aims to determine in all tracks: (1) the accessibility of CT surgery residency and fellowship websites, and (2) the online presence of information that may be relevant to prospective applicants.
Materials and methods Several sources maintain a list of the U.S. CT surgery residencies and fellowships that applicants may reference. Such lists are accessed online through the respective websites for the Electronic Residency Application Service (ERAS),11 the Fellowship and Residency Electronic Interactive Database
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Access (FREIDA),12 the Accreditation Council for Graduate Medical Education (ACGME),13 and the Thoracic Surgery Directors Association (TSDA).14-16 All applicants to I-6 programs and traditional fellowships are required to submit their applications through ERAS except 4 þ 3 programs, so this list was obtained from TSDA. A list of programs was obtained from each source during May of 2018. Programs that were listed as participating in ERAS were included in our analysis. Programs were considered inactive if they were listed as “not participating” or “no longer accepting applications” or if they were listed on another database (FREIDA, ACGME, TSDA) but not on ERAS. Accessibility of active programs’ websites were evaluated through ERAS, FREIDA, ACGME, and TSDA by determining which programs provided functioning weblinks on these databases. Links were classified as functioning if they did not produce an error message and linked to any website at all, even if that website was unaffiliated with the program. Links were further stratified according to whether they linked directly to the homepage for the program, the cardiothoracic surgery department, the general surgery department, or the main hospital. An “other” option was created for programs with functional links that did not redirect to any of the aforementioned home pages. Accessibility of active program websites was also evaluated through a Google search performed using “program name þ cardiothoracic surgery residency” for integrated programs or “program name þ cardiothoracic surgery fellowship” for traditional fellowships or “program name” þ “4 þ 3 cardiothoracic surgery residency” for 4 þ 3 programs. The search was conducted on a public browser with no Google account logged in and cookies were regularly deleted to avoid personalized results. If the search for traditional and integrated programs produced a result referencing CT surgery training anywhere on the first page of results, we considered the Google link “present”. The functionality and directness of the link was then classified as described previously. For 4 þ 3 program searches, we clicked on the search result that referenced cardiothoracic surgery training and then navigated the website for reference to the 4 þ 3 training pathway, as we found that these programs tended not to have their own website because these residents eventually become part of the traditional fellowship program. Two independent evaluators assessed CT surgery residency and fellowship websites for content; 98% agreement was observed. These 46 total data points were based on previous studies that identified factors deemed important or relevant to residency and fellowship applicants.3,5-7 Variables were noted as present or absent with no judgment made on the quality of this information, as we felt this would introduce substantial subjectivity into our results. Variables were deemed present if the information could be found through any number of clicks starting from the residency or fellowship program’s homepage. Match data for each of these pathways was obtained from the National Residency Match Program. I-6 applicants apply during their last year of medical school and if matched, begin training the following year. Applicants to traditional fellowships apply during their second to last year of general surgery
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Fig e Breakdown of CT surgery programs according to program structure and match participation.
training and therefore if matched, must complete another full year of general surgery before starting their CT training. The most recent match data available for I-6 and traditional fellowship tracks was for appointment year 2019.17,18 For the statistical analysis, frequencies and percentages were calculated and used to describe all data. All statistical analyses were carried out using SAS 9.4 (SAS Institute Inc NC). No Institutional Review Board approval was required for this study.
Results There are a total of 114 CT surgery programs, of which 26 are active I-6 programs and 63 are active traditional fellowships, offering 37 and 90 positions for appointment year 2019, respectively. One inactive I-6 program and 12 inactive traditional fellowships were still listed on at least one other database (FREIDA, ACGME, or TSDA) (Figure). Most training programs were located in the South and Northeast (Table 1). For appointment year 2019, all 26 (100%) I-6 programs fully matched (Figure). Of the active fellowship programs analyzed, only 1 program had a spot go unfilled (98% match rate) (Figure). Table 2 outlines the accessibility of program web pages from various sources. All 26 I-6 programs were found to have a website that could be accessed directly with a Google search. Only 21 (81%) integrated programs provided a link from ERAS and 19 (91%) of these links were functional. However, only 6 (32%) of the 19 functional hyperlinks directed to the program’s web page, with a majority redirecting somewhere else. Likewise, on FREIDA, ACGME, and TSDA, many programs were found to lack links, with only 24 (92%), 21 (81%), and 9 (39%) of
the 26 programs in these respective databases providing links. Of the programs that did provide links, most were functional (23 [96%], 19 [91%], and 8 [89%] for FREIDA, ACGME, and TSDA, respectively) but again, only a minority linked directly to the program’s homepage. Of the 63 active fellowship programs identified, only 60 were found to have a website. All 60 of these websites were ultimately accessible using a Google search. On FREIDA,
Table 1 e Comparison of cardiothoracic integrated and fellowship programs. Program characteristic
I6 N (%) 26 (30)
Fellowships N (%) 60 (70)
Region* Northeast
8 (31)
16 (27)
South
8 (31)
20 (33)
Midwest
6 (23)
13 (22)
West
4 (15)
11 (18)
Number of positions in the program 0
0
1 (2)
1
16 (62)
34 (60)
2
10 (38)
18 (32)
3
0
2 (3)
4
0
2 (3)
Number filled Unfilled Filled *
0
1 (2)
26 (100)
59 (98)
Based on US Census Bureau classification.
2 (3) Direct link data variables number and percent are calculated based on functional link total. *
0 0
0 -
0
1 (12) 9 (19)
4 (9) 1 (5)
1 (5) 8 (19)
10 (23) 2 (11)
1 (5) 7 (15) 2 (9) Link directs to a website without error
8 (17) 2 (9) Hospital page
3 (5)
54 (90)
1 (2) 0 2 (25) 4 (9) 5 (26) 4 (9) 3 (16) 3 (6) 5 (22) General surgery page
0
26 (100) -
2 (25)
3 (38) 13 (28)
16 (35) 6 (32)
6 (32) 8 (19)
13 (30) 8 (42)
5 (26) 12 (26)
17 (36) 10 (43)
4 (17) Program website
*Direct link to
CT department home page
60 (100) 26 (100) 8 (89) 46 (82) 19 (91) 43 (75) 19 (91) 23 (96) Of links present number of functional links
47 (84)
60 (100)
60 (95) 26 (100)
26 (100) -
23 (89)
9 (39) 56 (89)
63 (100) 26 (100)
21 (81) 57 (91)
63 (100) 26 (100)
21 (81) 56 (89) Link present
63 (100) 26 (100)
24 (92)
Listed on
Fellowship Fellowship Fellowship I6
Fellowship
I6
Fellowship
I6
ERAS, N (%) ACGME, N (%) FREIDA, N (%) Website characteristic
Table 2 e Website accessibility of cardiothoracic (CT) integrated and fellowship program websites.
I6
TSDA, N (%)
I6
Google, N (%)
miller et al evaluating ct program websites
203
ACGME, and ERAS, links were provided by 56 (89%), 57 (91%), and 56 (89%) programs with 47 (84%), 43 (75%), and 46 (82%) functional links, respectively. Of these functional links, only 12 (26%), 8 (19%), and 13 (28%) linked directly to the fellowship web page. TSDA did not provide a list or links for any traditional fellowships, in stark contrast to the list of integrated programs provided on TSDA.org. Instead, TSDA redirected applicants to the ACGME website for a list of traditional fellowships. Website content varied greatly for integrated and traditional training programs and is described in Table 3. Program description, current research in the department, rotation schedule, research opportunities, and salary were the most commonly provided information by I-6 programs. Program description, current research in the department, didactics/ educational conferences, rotation schedule, and research opportunities were the most commonly provided information on fellowship websites. The least common information presented for both type of programs was board pass rate (0% I-6 versus 5% traditional fellowship) and call expectations (0% I-6 versus 8% traditional fellowship). The average number of data points contained per website was 23 for I-6 programs and 20 for traditional fellowships. No website contained all data points. The maximum number of data points contained for an I-6 website was 35 and the minimum was 11. For a traditional fellowship website, the maximum number of data points was 36 and the minimum was 6. Fifty percent of I-6 websites and 60% of traditional fellowship websites contained less than half of the content assessed. Information related to past and current trainees and staff within the programs also varied greatly (Table 4). Most websites listed program coordinator and program director names. Email was the most common contact information listed for a program coordinator, whereas program director email was provided less frequently. All I-6 websites and almost all (97%) traditional fellowship websites provided a list of faculty with photos but an email address for faculty was provided on only 42% of I-6 websites and 40% of fellowship websites. In general, a list of current residents/fellows was less common than a list of faculty, but a list of current trainees was more commonly provided by I-6 programs (77% versus 48%). Contact info for trainees was provided even less often than it was for faculty and was listed on only 27% of I-6 websites and 7% of fellowship websites. Only 1 of 26 I-6 websites listed the last update for the web page; this one update was performed within the past year. Only 4 of the 60 traditional fellowships listed the last web page update and of these 4 websites, only 2 had been updated within the past year. The remaining websites in our study did not specify when they had been updated (Table 3). The only list of 4 þ 3 training programs we could locate was on TSDA.16 There was no indication of when this list had last been updated to verify its accuracy. Eleven 4 þ 3 programs were listed on TSDA but this list is known to be incomplete given that the 4 þ 3 program offered by the authors’ home institution was not listed on this site, meaning at least 12 programs exist. Of these twelve 4 þ 3 programs, only 8 (67%) referenced this training pathway on the institution’s website and only 6 (50%) provided information on the timing and process of applying. Further analysis was not carried out for
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Table 3 e Website and relevant application content for cardiothoracic integrated and fellowship programs.
Table 4 e Contact information available on cardiothoracic integrated and fellowship program websites.
Website data
Website data
I6 programs N (%) 26 (30)
Fellowships N (%) 60 (70)
The website contains
I6 programs N (%) 26 (30)
Fellowships N (%) 60 (70)
Program coordinator
Program description
26 (100)
58 (97)
Name
23 (89)
45 (75)
Current research in the department
24 (92)
45 (75)
22 (85)
41 (68)
Number
19 (73)
40 (67)
Salary
19 (73)
34 (57)
Mailing address
14 (54)
24 (40)
Application requirements
17 (65)
34 (57)
Mentions the type of cases the program performs
17 (65)
34 (57)
Name
20 (77)
52 (87)
Number
16 (62)
34 (57)
16 (62)
28 (47)
12 (46)
19 (32)
List
26 (100)
58 (97)
Photos
26 (100)
58 (97)
Biography or blurb
25 (96)
48 (80)
Publications
20 (77)
39 (65)
11 (42)
24 (40)
List
20 (77)
29 (48)
Medical school or residency
17 (65)
19 (32)
Photos
16 (62)
21 (35)
Interview dates
9 (35)
14 (23)
Number of cases logged
2 (8)
9 (15)
Board pass rate
0 (0)
3 (5)
Rotation schedule
21 (81)
42 (70)
Vacation time
17 (65)
30 (50)
Work hour requirements
5 (19)
14 (23)
Clinic expectations
1 (4)
21 (35)
0
5 (8)
18 (69)
43 (72)
Work time expectations
Call expectations Professional development Didactics/educational conferences Research opportunities
20 (77)
38 (63)
Research expectations
15 (58)
24 (40)
Simulation experience Journal Club information
10 (39)
19 (32)
5 (19)
20 (33)
National meeting attendance and sponsorship
6 (23)
17 (28)
Program director message
4 (15)
11 (18)
Teaching responsibilities
1 (4)
6 (10)
12 (46)
37 (63)
7 (27)
33 (55)
1 (4)
4 (7)
1
2
Relocation information City information Housing information Website up to date Last web page update indicated Last update done less than 1 year ago
4 þ 3 programs because 4 þ 3 residents ultimately cross over into the traditional CT fellowship program at their institution and much of the data we would have collected would have been a duplicate of the traditional fellowship data already presented in this article.
Comment In today’s era, the Internet is a main source of information for applicants when making the decision to apply to, interview at, or rank a program.2,3 Despite the fact that it is more important than ever for programs to maintain current, thorough, and easily accessible websites, it seems most specialties including
Program director
Faculty
Current trainees
Biography or blurb
8 (31)
5 (8)
Contact information
7 (27)
4 (7)
Publications
5 (19)
1 (2)
List
7 (27)
18 (30)
Job location
7 (27)
15 (25)
Alumni
cardiothoracic surgery are not meeting these benchmarks. As imperative as it seems for programs to design a comprehensive website, we found that 3 traditional fellowship programs had no website at all. Furthermore, our data highlight many deficiencies in the content and accessibility of existing cardiothoracic surgery training program websites (Tables 2-4), which is consistent with findings across a variety of other medical specialties.2,3,5-10 Despite the presence of numerous national databases such as FREIDA, ACGME, ERAS, and TSDA, which maintain lists of cardiothoracic surgery residency and fellowship programs, Google was the best tool for easily accessing a program’s website. Although 100% of I-6 websites could be found and directly accessed through Google, many were inaccessible with no link provided on the aforementioned databases. In instances where a link was provided, the majority directed to a page other than the program’s website regardless of the database used. Google was also the best tool for locating traditional fellowship websites. Like I-6 programs, many traditional fellowships were inaccessible from national databases or only indirectly accessible. Another issue we encountered was that these national databases still listed programs that were no longer participating in the match (Figure). This problem was more common for traditional
miller et al evaluating ct program websites
fellowships, most likely because many programs that used to offer traditional fellowship have now transformed into I-6 programs. This may create substantial confusion for the traditional fellowship applicant. With the rising cost of medical debt, improving the content of CT residency and fellowship websites could also potentially lessen the financial and scheduling demands associated with the application and interview process. A study by Watson et al. indicated that 57.7% of general surgery residents miss more than 1 week of training for fellowship interviews with some residents needing more than 20 days off. The same study revealed that 62.3% of these residents spent over $4000 on interviews, but some reported spending over $10,000.4 There are multiple factors beyond websites that influence an applicant’s decision to apply to or interview at a program, such as a program’s reputation and advice from a mentor, but applicants could potentially apply and interview less broadly by targeting programs that fit their needs if CT websites were better designed. Although a website may not influence an applicant’s final ranking of a program, it may still be a valuable tool in making a more cost-effective and selective interview process for institutions and applicants. For example, the current structure of the interview process often forces applicants to choose between two programs with conflicting interview dates. Website data maybe the only objective data that applicants have to help them make an informed decision about how they would fit at that program before booking travel accommodations to one interview and canceling the other. Difficulty locating a program’s website or pertinent application information may deter competitive applicants from visiting that program, which should motivate programs to update their database listings yearly and to include current and detailed information on their websites regardless of the fact that most programs fill all their spots. Applicants would save time and money and avoid coverage issues at work if they were able to pare down the number of interviews they attend, and their ability to assess their fit at a program in part by using the program’s website may aid this process. This study was focused on assessing the presence of information that may be relevant to applicants based on previous studies in other specialties. Many of these studies evaluated the presence of contact information such as email addresses and phone numbers for various members of the program which led us to collect the data presented in Table 4. While it is possible that applicants seek out and value such information, programs may feel uncomfortable disseminating this information on a public forum. Applicants may view the ease of obtaining contact information as a sign of a program’s accessibility and openness to communication; however, programs may rightfully worry about outside individuals such as patients locating and abusing this information. Applicants also have the potential to abuse this information and overwhelm the program with frivolous communication during the busy interview season. Ultimately it will be at the discretion of each individual program to balance applicant desires with appropriate levels of privacy. In the future, a survey sent to applicants may help clarify how highly applicants actually value contact information beyond that of the program coordinator.
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Our study identified a significant lack of information regarding the 4 þ 3 training programs. To our knowledge, there is currently no universal list of such programs that is confirmed up to date. Although most (67%) known 4 þ 3 programs do mention this training pathway on their website, additional information was sparse. Only 50% of these programs mentioned how to apply to their 4 þ 3 track and we noted that some programs expect applicants to apply during fourth year of medical school whereas others take applications only from internal PGY-2 or PGY-3 general surgery residents. Medical students interested in cardiothoracic surgery may choose to dual apply to I-6 residency and general surgery residency to increase their odds of matching, and may be prone to targeting general surgery programs that offer a 4 þ 3 pathway. Likewise, medical students who are not competitive enough to match into an I-6 program may also target 4 þ 3 programs. There are multiple reasons why applicants may target a 4 þ 3 program regardless of whether they are competitive or not. There are some applicants who are very interested in cardiothoracic surgery but may not feel ready to commit to an integrated residency quite yet in order to explore other fields of general surgery. For personal reasons, some applicants who are vested in CT surgery still value a general surgery background. Other applicants with weaker applications may also later go on to prove their tenacity during their general surgery residency and become worthy of a 4 þ 3 spot. All these reasons shed a need for more information about which institutions have the 4 þ 3 option available. Another reason for the lack of information regarding the 4 þ 3 track may be that many recruit from within their general surgery program and must adjust their traditional fellowship positions available each year to account for internal recruits. It is imperative that we formulate an accurate database that lists all active 4 þ 3 programs along with the timing of the application process to benefit students who are interested in pursuing this pathway. To facilitate an improvement in program websites, we suggest creation of a new database, or modification of an existing one, that includes similar data assessed by our study or new validated factors. Two organizations that maintain websites with resources targeted specifically for medical students, residents, and fellows interested in CT surgery are the TSDA and Thoracic Surgery Residents Association (TSRA). We believe that either of these websites would be an excellent centralized source for collecting much of the program information analyzed in this study. Ideally, this database would contain a comprehensive list of only the active programs within each of the 3 tracks. Programs should be required to respond to a yearly survey updating all their information. This information would be transcribed into the database such that applicants could click on a program name and easily obtain a list of answers to their most common questions all on one page without having to navigate a confusing website. By responding to a yearly survey arranged by one of the aforementioned sources, individual programs would no longer be burdened by the web design process required to create a highquality website, although they could certainly continue to devote these resources if desired. Programs may find it helpful for the survey response to be a collaboration between a senior level resident or fellow “liaison” and the program coordinator to provide accurate details about information a program
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coordinator may not know, such as call expectations and research experiences, and administrative information that a trainee may not know, such as boards pass rate. This study had several limitations. The study only assessed the presence of certain variables and not the quality of information provided in order to remain as objective as possible. Most websites did not indicate when they had been updated, making it difficult to discern whether the data collected was current or accurate despite its presence. There were several variables recorded as absent for I-6 websites that may be related to nonexistence of the information rather than incomplete website maintenance. For example, many I-6 programs have not graduated any residents yet, which would make information such as boards pass rate or alumni locations nonapplicable as opposed to “missing”. A second major limitation of the study is that the list of website variables was compiled by relying on previous literature. CT surgery applicants were not surveyed to identify and rank which website information they find most important in the application process and therefore it is possible that some of the information evaluated in this study may not be crucial to include on the program website. In the future, a validated survey of CT surgery trainees will be necessary to determine which website information is truly most valuable for decision-making. In conclusion, improving cardiothoracic website accessibility and content may have implications for attracting the most competitive applicants, limiting the financial and scheduling demands placed on applicants, decreasing the number of training days missed for interviews, and increasing satisfaction with the match results. There is an obvious need to create a list of standardized content that is relevant to applicants on all training program websites to have a more effective match process.
Acknowledgment The authors would like to thank the Pediatric and Congenital Heart Center of Alabama for their support of this project. This research was financially supported by the Department of Cardiothoracic Surgery, United States.
Disclosure The authors report no conflicts of interest.
references
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