Global cardiothoracic surgery: outcomes from a survey on current worldwide training programmes

Abstract

Objectives: There are significant disparities in global access to cardiothoracic surgery. Training a diverse cohort of global cardiothoracic surgeons is a critical step. However, little is known about training pathways globally, and there is a lack of standardization in training.

Methods: The Global Thoracic Surgery Residents' Association developed a 25-item survey covering the five domains of country of origin, access to cardiothoracic surgical training, variations in training, barriers and facilitators to training, and future plans of cardiothoracic surgery trainees. The survey was disseminated electronically and over social media platforms.

Results: A total of 73 responses from trainees in 21 countries were received. Wide variations were found in training programmes, including length of training, operative autonomy, reliance on simulation, trainee supervision and minimum case requirements. Common barriers included discrimination, separation from family and inadequate supervision and volume. Facilitators included participation in global rotations and mentorship. The majority (78%) of trainees plan on additional training.

Conclusions: There is a lack of standardization of trainee experience with extreme variations in global cardiothoracic training programmes in terms of length of training, reliance on simulation, supervision, research opportunities and minimum case requirements. These variations are opportunities to think forward in terms of collectively working on standardization of trainee experience, developing innovative modalities to increase supervision of trainees and recognizing trainee interest in research. There is a clear demand for increased global collaboration and the transfer of knowledge and techniques in addition to trainee recognition of need for further training.

Keywords: cardiothoracic surgery; competency; global; training.

Graphical abstract

Figure 1:

Countries with training programmes represented by cardiothoracic surgery trainee survey responses. Base layer of the map obtained from open access website: mapchart.net

Figure 2:

Comparative analyses of trainee research opportunities, access to simulation, operative supervision, minimum cardiac and thoracic case requirements, and plans for further training by country of training income classification. **** denotes statistical significance

Figure 3:

Progression of operative autonomy by clinical year of training and county of training income classification. * denotes never done during training