Characterizing the Operative Experience of Cardiac Surgical Trainees: What Are Residents Really Doing in the Operating Room? Asad A. Shah, MD, Muhammad.

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Characterizing the Operative Experience of Cardiac Surgical Trainees: What Are Residents Really Doing in the Operating Room? Asad A. Shah, MD, Muhammad Aftab, MD, Vakhtang Tchantchaleishvili, MD, Damien J. LaPar, MD, MS, Elizabeth H. Stephens, MD, PhD, Dustin M. Walters, MD, Walter F. DeNino, MD, David D. Odell, MD, MMS, Michael Robich, MD, Marisa Cevasco, MD, Amanda L. Eilers, DO, Erin A. Gillaspie, MD, Andrew Goldstone, MD, Tarek Malas, MD, Robert D. Rice, MD, Ryan C. Shelstad, MD, Nicholas D. Andersen, MD The Annals of Thoracic Surgery Volume 101, Issue 6, Pages 2341-2349 (June 2016) DOI: 10.1016/j.athoracsur.2015.12.069 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Number of cardiac operation types routinely performed by graduating residents as the operative surgeon. Significant heterogeneity was appreciated with nearly a bell-shaped distribution, with some residents reporting zero operations performed routinely as the operative surgeon and some reporting all 13 surveyed operation types routinely performed as the operative surgeon. Mean ± standard deviation for the entire cohort was 6.4 ± 3.3 operation types performed as the operative surgeon. (# = number.) The Annals of Thoracic Surgery 2016 101, 2341-2349DOI: (10.1016/j.athoracsur.2015.12.069) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Comparison of total operation types routinely performed by graduating residents as operative surgeon between programs. (A) Graduating residents of I-6, 4+3, and 3-year fellowship programs reported performing similar numbers of operation types as the operative surgeon. However, graduates from 2-year fellowships reported performing substantially fewer operation types as the operative surgeon compared with I-6 and 4+3 residents. (B) After residents with a stated interest in general thoracic surgery were excluded, no differences remained between the program types. *p < 0.05 by analysis of variance. (I-6 = integrated 6-year residency; NS = not significant; 2-year = traditional 2-year cardiothoracic surgical residency; 3-year = traditional 3-year cardiothoracic surgical residency, including 2.5-year programs; 4+3 = combined 4 plus 3-year general/thoracic surgical residency.) The Annals of Thoracic Surgery 2016 101, 2341-2349DOI: (10.1016/j.athoracsur.2015.12.069) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Comparison of total operation types routinely performed by graduating residents by career interest and presence of advanced fellows. (A) Graduating residents with a career interest in general thoracic surgery routinely performed substantially fewer cardiac procedures as the operative surgeon. (B) The presence or absence of advanced fellows did not affect the number of cardiac operation types performed by all graduating residents. *p < 0.05 by t test. (NS = not significant.) The Annals of Thoracic Surgery 2016 101, 2341-2349DOI: (10.1016/j.athoracsur.2015.12.069) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Operative tasks performed by integrated 6-year residents at a given postgraduate year. (IMA = internal mammary artery; IQR = interquartile range; PGY = postgraduate year.) The Annals of Thoracic Surgery 2016 101, 2341-2349DOI: (10.1016/j.athoracsur.2015.12.069) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions