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Notes from the Thoracic Surgery Directors Association
REPORT
Notes from the Thoracic Surgery Directors Association The Thoracic Surgery Directors Association (TSDA) met in San Antonio, TX, on January 21, 1984. Reports were given by Dr. R. W. M. Frater of the Curriculum Committee, Dr. Alexander Geha of the Manpower Committee, and Dr. Harvey W. Bender, Jr., of the Consultation Committee. Dr. Frater mentioned that members of the faculty at the University of British Columbia, Vancouver, had expressed interest in providing the nucleus for the ”selected readings” project; more information will be forthcoming. He also noted that in some of its recent communications, the American Board of Thoracic Surgery had placed increasing emphasis on training in the techniques of cardiopulmonary bypass among residents. Specific mechanisms of increased emphasis in this regard were discussed, such as the possibility of expanding the annual perfusionists meeting in San Diego to include appropriate topics for resident staff, the possibility of a separate meeting held annually on this subject, and the propriety of allowing commercial sponsorship for such a program. These matters were to be taken under advisement by Dr. Frater’s committee and brought back before the membership at a later date. Dr. Geha assumed the chairmanship of the Manpower Committee and will be working in close cooperation with the Joint Manpower Committee of The Society of Thoracic Surgeons and the American Association for Thoracic Surgery. He will be an ex oficio member of that committee, while Dr. Benson Wilcox, TSDA presidentelect, will be an official committee member. Speaking as a representative of the American Board of Thoracic Surgery, Dr. Harold V. Liddle asked for and was assured of TSDA support in preparation of the forthcoming in-training examination. TSDA members wishing to contribute questions may do so by mailing them directly to Dr. Liddle in care of Ms. Louise Sper at the American Board of Thoracic Surgery, 14640 E Seven Mile Rd, Detroit, MI 48205. This year’s in-training examination was held on April 7, 1984; therefore, questions submitted will be for future examinations. In the six months prior to this meeting, Dr. James Pluth had mailed a questionnaire to the TSDA membership to elicit a response regarding a possible matching plan for thoracic surgical programs. Although most directors were not in favor of a formal match, approximately half favored a uniform time of resident selection among programs. In the active discussion period that followed Dr. Pluth’s presentation, there were many more positive than negative comments about a potential matching plan. This might indicate that the initial negative response was a preconceived one and that as more information about “matching” becomes available, more merit might be seen in such a plan. In this regard, Dr. John Graettinger of the National Intern and Resident 305
Matching Plan was invited to briefly present some data to the TSDA at the May, 1984, meeting. The report of the American Association for Thoracic Surgery Liaison Committee on Thoracic Surgery was presented from several points of view. Dr. Richard Peters emphasized that general thoracic surgery, like cardiac surgery, requires specialized training in order to develop the specialized skills necessary for competence. He specifically mentioned the necessity of competence in preoperative evaluation and preparation of patients for thoracic surgical procedures, the conduct of the operations themselves, and the specialized postoperative care needed for the general thoracic surgical patient. In his opinion, it is important for the thoracic surgeon to maintain control in the postoperative care of these patients rather than abdicating this responsibility to the anesthesiologist, internist, or intensive care specialist. Representing the American Board of Thoracic Surgery, Dr. Donald Mulder emphasized that the absolute number of noncardiac procedures done by residents, not merely the noncardiackardiac ratio, has decreased over the past several years. He mentioned that it is the responsibility of the program director to ensure that the resident has adequate exposure to all areas of our specialty. He emphasized that the number of pediatric thoracic and esophageal patients seems to be decreasing most dramatically. He also remarked on the need for training in perfusion technique with regard to cardiac surgical procedures and echoed Dr. Peters’s remarks on the importance of training in postoperative care. Dr.F. Henry Ellis represented the Residency Review Committee. He outlined the policies of this committee and redefined what both the committee and the American Board of Thoracic Surgery consider to be ”residents’ cases.” Of special note was the need for the resident to have participated significantly in the preoperative evaluation and decision-makingprocess as well as the performance of a major portion of the operative procedure itself, and to have had a meaningful role in the postoperative care of the patient. If residents from a particular program repeatedly do poorly on the American Board of Thoracic Surgery examination or are often turned down in application for the examination because of “inadequate experience,” the program might be red-flagged by the Residency Review Committee so that these issues may be addressed at the committee’s next site visit. In addition, the Residency Review Committee is looking for each program to identify specific time, personnel, and space devoted to noncardiac thoracic surgery.
William A . Gay, Jr., M . D . Secretay-Treasurer
Notes from the Thoracic Surgery Directors Association The Thoracic Surgery Directors Association (TSDA) met in San Antonio, TX, on January 21, 1984. Reports were given by Dr. R. W. M. Frater of the Curriculum Committee, Dr. Alexander Geha of the Manpower Committee, and Dr. Harvey W. Bender, Jr., of the Consultation Committee. Dr. Frater mentioned that members of the faculty at the University of British Columbia, Vancouver, had expressed interest in providing the nucleus for the ”selected readings” project; more information will be forthcoming. He also noted that in some of its recent communications, the American Board of Thoracic Surgery had placed increasing emphasis on training in the techniques of cardiopulmonary bypass among residents. Specific mechanisms of increased emphasis in this regard were discussed, such as the possibility of expanding the annual perfusionists meeting in San Diego to include appropriate topics for resident staff, the possibility of a separate meeting held annually on this subject, and the propriety of allowing commercial sponsorship for such a program. These matters were to be taken under advisement by Dr. Frater’s committee and brought back before the membership at a later date. Dr. Geha assumed the chairmanship of the Manpower Committee and will be working in close cooperation with the Joint Manpower Committee of The Society of Thoracic Surgeons and the American Association for Thoracic Surgery. He will be an ex oficio member of that committee, while Dr. Benson Wilcox, TSDA presidentelect, will be an official committee member. Speaking as a representative of the American Board of Thoracic Surgery, Dr. Harold V. Liddle asked for and was assured of TSDA support in preparation of the forthcoming in-training examination. TSDA members wishing to contribute questions may do so by mailing them directly to Dr. Liddle in care of Ms. Louise Sper at the American Board of Thoracic Surgery, 14640 E Seven Mile Rd, Detroit, MI 48205. This year’s in-training examination was held on April 7, 1984; therefore, questions submitted will be for future examinations. In the six months prior to this meeting, Dr. James Pluth had mailed a questionnaire to the TSDA membership to elicit a response regarding a possible matching plan for thoracic surgical programs. Although most directors were not in favor of a formal match, approximately half favored a uniform time of resident selection among programs. In the active discussion period that followed Dr. Pluth’s presentation, there were many more positive than negative comments about a potential matching plan. This might indicate that the initial negative response was a preconceived one and that as more information about “matching” becomes available, more merit might be seen in such a plan. In this regard, Dr. John Graettinger of the National Intern and Resident 305
Matching Plan was invited to briefly present some data to the TSDA at the May, 1984, meeting. The report of the American Association for Thoracic Surgery Liaison Committee on Thoracic Surgery was presented from several points of view. Dr. Richard Peters emphasized that general thoracic surgery, like cardiac surgery, requires specialized training in order to develop the specialized skills necessary for competence. He specifically mentioned the necessity of competence in preoperative evaluation and preparation of patients for thoracic surgical procedures, the conduct of the operations themselves, and the specialized postoperative care needed for the general thoracic surgical patient. In his opinion, it is important for the thoracic surgeon to maintain control in the postoperative care of these patients rather than abdicating this responsibility to the anesthesiologist, internist, or intensive care specialist. Representing the American Board of Thoracic Surgery, Dr. Donald Mulder emphasized that the absolute number of noncardiac procedures done by residents, not merely the noncardiackardiac ratio, has decreased over the past several years. He mentioned that it is the responsibility of the program director to ensure that the resident has adequate exposure to all areas of our specialty. He emphasized that the number of pediatric thoracic and esophageal patients seems to be decreasing most dramatically. He also remarked on the need for training in perfusion technique with regard to cardiac surgical procedures and echoed Dr. Peters’s remarks on the importance of training in postoperative care. Dr.F. Henry Ellis represented the Residency Review Committee. He outlined the policies of this committee and redefined what both the committee and the American Board of Thoracic Surgery consider to be ”residents’ cases.” Of special note was the need for the resident to have participated significantly in the preoperative evaluation and decision-makingprocess as well as the performance of a major portion of the operative procedure itself, and to have had a meaningful role in the postoperative care of the patient. If residents from a particular program repeatedly do poorly on the American Board of Thoracic Surgery examination or are often turned down in application for the examination because of “inadequate experience,” the program might be red-flagged by the Residency Review Committee so that these issues may be addressed at the committee’s next site visit. In addition, the Residency Review Committee is looking for each program to identify specific time, personnel, and space devoted to noncardiac thoracic surgery.
William A . Gay, Jr., M . D . Secretay-Treasurer