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Thoracic Surgery Directors Association: 1993 in review
REPORT
Thoracic Surgery Directors Association: 1993 in Review During the past year, the Thoracic Surgery Directors Association (TSDA) continued its focus on issues concerning the education of thoracic surgery residents. The Oak Brook Joint Conference on graduate education in thoracic surgery (September 25-27, 1992, Oak Brook, Illinois) was the primary topic of discussion at the January 23, 1993, TSDA meeting in San Antonio, Texas. Summaries of each of the major topics discussed at the Oak Brook meeting were presented: Drs John Baldwin on Thoracic Surgery in 2010; William Gay on Thoracic Surgery Curriculum; Sidney Levitsky on Recruitment and Resident Selection; Martin McKneally on Professional, Personal, and Societal Factors Influencing Thoracic Surgery Graduate Education; and Harvey Bender on Certification and Accreditation. Each of these presentations was followed by a brief statement on its implications for thoracic surgery education by Drs Penfield Faber, John Benfield, Robert Mentzer, Stanton Nolan, and Robert Guyton, respectively. There was clear acknowledgment that the mandate before the TSDA is to improve the educational experience of our thoracic surgery residents. In this regard, TSDA President Martin McKneally reviewed discussions with the American Board of Thoracic Surgery at its October 1992 meeting in California in which the American Board of Thoracic Surgery expressed its support for the TSDA effort to begin to establish a formal thoracic surgery curriculum, including the goals and objectives of our resident education, methodology for achieving these, and means of evaluating the effectiveness of the process. The effort is to develop a document that defines the thoracic surgery curriculum similar to that which has been prepared by the Association of Academic Chairmen of Plastic Surgery. Doctor Andrew Wechsler was appointed Chairman of the TSDA Curriculum Committee and was charged with initiating this process. A Committee on Extramural Educational Programs, chaired by Dr Stanton Nolan, was established as a TSDA effort to provide guidelines for assessing the value of extramural educational programs being offered to thoracic surgery residents by industry. The proliferation of these courses, their ethical implications in view of the guidelines currently being developed for the appropriate interaction between industry and physicians, and the need to establish a listing of TSDA “approved” courses in advance of the academic year will be the charge of this committee. A TSDA database, completed each July by the Program Directors, has been established in the office of the Secretary of the TSDA (Dr Mark Orringer). Through this database, an updated roster of all thoracic surgery residents is maintained to any organizations wishing to communicate with them. Additional data from the July 1992 database questionnaire were reviewed. Some of the highlights of 0 1994 by the Society of Thoracic Surgeons
this information are as follows: Of the 92 Thoracic Surgery Residency Programs approved by the Residency Review Committee (RRC) in 1992, 90% are either a division or section within a department of surgery, whereas only 10% are separate departments; 74% are approved for 2 years, 23% for 3 years, and 2% for 2.5 years, and 59% of the programs now have separate general thoracic surgery rotations for the residents. The TSDA Secretary’s office also maintains a registry of available general thoracic surgery faculty positions and attempts to serve as a clearing house for filling unexpected vacancies in our residency programs with general surgery residents who have decided late to pursue careers in thoracic surgery. The Third TSDA Residents Research Award, supported by a grant from Medtronics, was presented to Robert Gates, MD, for his paper ”The gross and microvascular distribution of retrograde cardioplegia in explanted human hearts,” which resulted from his research in the Department of Cardiothoracic Surgery at the UCLA Medical Center under the direction of Hillel Laks, MD. The process whereby the American Board of Thoracic Surgery reviews a candidate’s operative case list and faculty evaluation forms in establishing a candidate’s eligibility for the certifying examination was discussed. Each year, a small number of thoracic surgery residents have been denied entry into the certifying examination process because their operative experience did not meet the minimal acceptable standards established by the ABTS in the areas of either esophageal, pulmonary, or congenital heart disease. It was emphasized that Program Directors have a responsibility to monitor the operative experience of their residents at varying intervals throughout their residency so that major areas of deficiency can be addressed before the resident completes his or her training. It is a false expectation that a resident will be permitted to take the certifying examination simply because he or she has completed two years of residency. The required intensity of operative experience and breadth of operations must be obtained. At the TSDA meeting held in Chicago, Illinois, on April 24, 1993, the results of the 1995 Thoracic Surgery National Resident Matching Program were reviewed. It is to be recalled that the TSDA has established a National Resident Matching Program to ensure a uniform and fair process of resident selection. A highly successful resident Match for candidates beginning thoracic surgery residency in 1995 took place in April 1993. Two hundred general surgery residents applied. Of these, 136 (68%) matched, whereas 64 (32%)were unmatched. Ninety-one of 92 eligible programs participated in the Match, providing 141 resident positions. Eighty-six (95%) of the programs filled their available positions through the Match, Ann Thorac Surg 1994;57:1367-8
0003-4975/94/$7.00
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REPORT THORACIC SURGERY DIRECTORS ASSOCIATION 1993 IN REVIEW
and 136 (96%) of the available positions were filled through the Match. Of the 136 matched applicants, 45 (32%) were the first choice of their programs, 26 (19%) were the second choice, and 17 (13%) were the third choice; 65% of the matched residents were either the first, second, or third choices of their programs. Conversely, 66 (49%) of the matched residents got their first choice, 25 (18%)their second choice, and 15 (11%)their third choice. In total, 77% of residents got either their first, second, or third choice of thoracic surgery residency programs. Election of the President-Elect and one of the Executive Committeemen took place at the April meeting. Doctor John Benfield became the new President-Elect by unanimous vote of the Directors, and Dr Gordon Olinger was similarly elected to replace Dr Stanton Nolan, whose term of office expired. Doctor Martin McKneally, as the outgoing President of the TSDA, passed on the gavel to Dr Gordon Murray, the new President. The TSDA Executive Committee for 1993-1995 will consist of Drs Gordon Murray, President; John Benfield, President-Elect; Mark Orringer, SecretaryRreasurer; Sidney Levitsky, Executive Committeeman; and Gordon Olinger, Executive Committeeman. Floyd D. Loop, MD, Chairman of the RRC for Thoracic Surgery, circulated a newsletter from the RRC to the Program Directors in August. It was emphasized that the primary responsibility of the RRC is to review residency programs for compliance with the Accreditation Council for Graduate Medical Education General and Special Requirements. It was noted that it is the responsibility of Program Directors to ensure the assignment of reasonable in-hospital duty hours so that residents are not required to perform excessively for long periods of duty. It is desirable that residents have on the average at least one day out of seven free of routine responsibility and be on call in the hospital no more than every third night. At the present time there are 93 accredited programs in thoracic surgery, 18 (19%)of which are three-year and the remainder two-year programs. The number of three-year programs has not changed since 1991. Any program seeking to extend its training beyond two years must at each RRC
Ann Thoi,ac Surg 1994;5>’: 1367-8
review provide educational justification for the add]tional year and indicate how that extra year enhances the educational program. When the RRC is notified by the American Board of Thoracic Surgery that candidates have failed to qualify for entry into the certification process because of inadequate case experience during residency, the RRC may dispatch special site reviewers to that program to determine the cause of the deficiency. Because the General Requirements indicate that ”there must be a single Program Director responsible for the Program,” Co-Program Directors are not permitted, but an Associate Program Director may be appointed. A survey of general surgery residents matching for thoracic surgery programs beginning in 1995 was conducted by the TSDA. Of 134 questionnaires mailed, 109 (81%)were returned. Of those responding, 102 (944’0)felt that the Match was effective in achieving its goal; 11(10%) felt that they had experienced undue pressure to commit outside of the Match; and 2 (1%)felt that more than one program violated the principles of the Match. The number of programs at which residents interviewed ranged from 1 to 26 (average, 8). The total cost of these interviews to the applicants ranged from $0 to $10,000 (average, $2,915). Thirty-eight (35%)of respondents preferred keeping the time of the Match as is (approximately two and one-half years before the start of thoracic surgery residency); 66 (61% preferred delaying the time of the Match process to one year before completion of general surgery residency (one year before the start of thoracic surgery residency); and 5 (4%) preferred an earlier Match than is cum-ently used. The majority of residents support the Match as a fair system for resident selection, but complaints center upon the cost of the Match to the residents (necessitated by interviewing at multiple programs) and the desirability of standardizing the application process. The TSDA E,xecutive Committee plans to discuss the results of this residents’ survey at the general meeting in 1994.
Mark B. Orringer, M D Secretay/Treasurer Thoracic Surgery Directors Association
Thoracic Surgery Directors Association: 1993 in Review During the past year, the Thoracic Surgery Directors Association (TSDA) continued its focus on issues concerning the education of thoracic surgery residents. The Oak Brook Joint Conference on graduate education in thoracic surgery (September 25-27, 1992, Oak Brook, Illinois) was the primary topic of discussion at the January 23, 1993, TSDA meeting in San Antonio, Texas. Summaries of each of the major topics discussed at the Oak Brook meeting were presented: Drs John Baldwin on Thoracic Surgery in 2010; William Gay on Thoracic Surgery Curriculum; Sidney Levitsky on Recruitment and Resident Selection; Martin McKneally on Professional, Personal, and Societal Factors Influencing Thoracic Surgery Graduate Education; and Harvey Bender on Certification and Accreditation. Each of these presentations was followed by a brief statement on its implications for thoracic surgery education by Drs Penfield Faber, John Benfield, Robert Mentzer, Stanton Nolan, and Robert Guyton, respectively. There was clear acknowledgment that the mandate before the TSDA is to improve the educational experience of our thoracic surgery residents. In this regard, TSDA President Martin McKneally reviewed discussions with the American Board of Thoracic Surgery at its October 1992 meeting in California in which the American Board of Thoracic Surgery expressed its support for the TSDA effort to begin to establish a formal thoracic surgery curriculum, including the goals and objectives of our resident education, methodology for achieving these, and means of evaluating the effectiveness of the process. The effort is to develop a document that defines the thoracic surgery curriculum similar to that which has been prepared by the Association of Academic Chairmen of Plastic Surgery. Doctor Andrew Wechsler was appointed Chairman of the TSDA Curriculum Committee and was charged with initiating this process. A Committee on Extramural Educational Programs, chaired by Dr Stanton Nolan, was established as a TSDA effort to provide guidelines for assessing the value of extramural educational programs being offered to thoracic surgery residents by industry. The proliferation of these courses, their ethical implications in view of the guidelines currently being developed for the appropriate interaction between industry and physicians, and the need to establish a listing of TSDA “approved” courses in advance of the academic year will be the charge of this committee. A TSDA database, completed each July by the Program Directors, has been established in the office of the Secretary of the TSDA (Dr Mark Orringer). Through this database, an updated roster of all thoracic surgery residents is maintained to any organizations wishing to communicate with them. Additional data from the July 1992 database questionnaire were reviewed. Some of the highlights of 0 1994 by the Society of Thoracic Surgeons
this information are as follows: Of the 92 Thoracic Surgery Residency Programs approved by the Residency Review Committee (RRC) in 1992, 90% are either a division or section within a department of surgery, whereas only 10% are separate departments; 74% are approved for 2 years, 23% for 3 years, and 2% for 2.5 years, and 59% of the programs now have separate general thoracic surgery rotations for the residents. The TSDA Secretary’s office also maintains a registry of available general thoracic surgery faculty positions and attempts to serve as a clearing house for filling unexpected vacancies in our residency programs with general surgery residents who have decided late to pursue careers in thoracic surgery. The Third TSDA Residents Research Award, supported by a grant from Medtronics, was presented to Robert Gates, MD, for his paper ”The gross and microvascular distribution of retrograde cardioplegia in explanted human hearts,” which resulted from his research in the Department of Cardiothoracic Surgery at the UCLA Medical Center under the direction of Hillel Laks, MD. The process whereby the American Board of Thoracic Surgery reviews a candidate’s operative case list and faculty evaluation forms in establishing a candidate’s eligibility for the certifying examination was discussed. Each year, a small number of thoracic surgery residents have been denied entry into the certifying examination process because their operative experience did not meet the minimal acceptable standards established by the ABTS in the areas of either esophageal, pulmonary, or congenital heart disease. It was emphasized that Program Directors have a responsibility to monitor the operative experience of their residents at varying intervals throughout their residency so that major areas of deficiency can be addressed before the resident completes his or her training. It is a false expectation that a resident will be permitted to take the certifying examination simply because he or she has completed two years of residency. The required intensity of operative experience and breadth of operations must be obtained. At the TSDA meeting held in Chicago, Illinois, on April 24, 1993, the results of the 1995 Thoracic Surgery National Resident Matching Program were reviewed. It is to be recalled that the TSDA has established a National Resident Matching Program to ensure a uniform and fair process of resident selection. A highly successful resident Match for candidates beginning thoracic surgery residency in 1995 took place in April 1993. Two hundred general surgery residents applied. Of these, 136 (68%) matched, whereas 64 (32%)were unmatched. Ninety-one of 92 eligible programs participated in the Match, providing 141 resident positions. Eighty-six (95%) of the programs filled their available positions through the Match, Ann Thorac Surg 1994;57:1367-8
0003-4975/94/$7.00
1368
REPORT THORACIC SURGERY DIRECTORS ASSOCIATION 1993 IN REVIEW
and 136 (96%) of the available positions were filled through the Match. Of the 136 matched applicants, 45 (32%) were the first choice of their programs, 26 (19%) were the second choice, and 17 (13%) were the third choice; 65% of the matched residents were either the first, second, or third choices of their programs. Conversely, 66 (49%) of the matched residents got their first choice, 25 (18%)their second choice, and 15 (11%)their third choice. In total, 77% of residents got either their first, second, or third choice of thoracic surgery residency programs. Election of the President-Elect and one of the Executive Committeemen took place at the April meeting. Doctor John Benfield became the new President-Elect by unanimous vote of the Directors, and Dr Gordon Olinger was similarly elected to replace Dr Stanton Nolan, whose term of office expired. Doctor Martin McKneally, as the outgoing President of the TSDA, passed on the gavel to Dr Gordon Murray, the new President. The TSDA Executive Committee for 1993-1995 will consist of Drs Gordon Murray, President; John Benfield, President-Elect; Mark Orringer, SecretaryRreasurer; Sidney Levitsky, Executive Committeeman; and Gordon Olinger, Executive Committeeman. Floyd D. Loop, MD, Chairman of the RRC for Thoracic Surgery, circulated a newsletter from the RRC to the Program Directors in August. It was emphasized that the primary responsibility of the RRC is to review residency programs for compliance with the Accreditation Council for Graduate Medical Education General and Special Requirements. It was noted that it is the responsibility of Program Directors to ensure the assignment of reasonable in-hospital duty hours so that residents are not required to perform excessively for long periods of duty. It is desirable that residents have on the average at least one day out of seven free of routine responsibility and be on call in the hospital no more than every third night. At the present time there are 93 accredited programs in thoracic surgery, 18 (19%)of which are three-year and the remainder two-year programs. The number of three-year programs has not changed since 1991. Any program seeking to extend its training beyond two years must at each RRC
Ann Thoi,ac Surg 1994;5>’: 1367-8
review provide educational justification for the add]tional year and indicate how that extra year enhances the educational program. When the RRC is notified by the American Board of Thoracic Surgery that candidates have failed to qualify for entry into the certification process because of inadequate case experience during residency, the RRC may dispatch special site reviewers to that program to determine the cause of the deficiency. Because the General Requirements indicate that ”there must be a single Program Director responsible for the Program,” Co-Program Directors are not permitted, but an Associate Program Director may be appointed. A survey of general surgery residents matching for thoracic surgery programs beginning in 1995 was conducted by the TSDA. Of 134 questionnaires mailed, 109 (81%)were returned. Of those responding, 102 (944’0)felt that the Match was effective in achieving its goal; 11(10%) felt that they had experienced undue pressure to commit outside of the Match; and 2 (1%)felt that more than one program violated the principles of the Match. The number of programs at which residents interviewed ranged from 1 to 26 (average, 8). The total cost of these interviews to the applicants ranged from $0 to $10,000 (average, $2,915). Thirty-eight (35%)of respondents preferred keeping the time of the Match as is (approximately two and one-half years before the start of thoracic surgery residency); 66 (61% preferred delaying the time of the Match process to one year before completion of general surgery residency (one year before the start of thoracic surgery residency); and 5 (4%) preferred an earlier Match than is cum-ently used. The majority of residents support the Match as a fair system for resident selection, but complaints center upon the cost of the Match to the residents (necessitated by interviewing at multiple programs) and the desirability of standardizing the application process. The TSDA E,xecutive Committee plans to discuss the results of this residents’ survey at the general meeting in 1994.
Mark B. Orringer, M D Secretay/Treasurer Thoracic Surgery Directors Association