1. J R Sadaba & J Kluin The Challenge of Training Cardio- thoracic Surgeons in the XXI Century Towards an “Integrated European Training Programme“ Junior Committee EACTS

2. At the doors of the XXI century, Cardio- thoracic Surgery is confronting new challenges. The way the specialty has been traditionally taught might not be the adequate one to prepare surgeons to face these challenges…

3. Increasing Importance of Training Cardio-thoracic Surgeons in Europe Increasing Importance of Training Cardio-thoracic Surgeons in Europe 4 reasons 4 reasons 5 initiatives 5 initiatives

4. Reason 1: Increased Public Expectations Reason 1: Increased Public Expectations Improvement in surgical outcome Improvement in surgical outcome Results readily available to public Results readily available to public “Risk paradox” (sicker patients, better results) “Risk paradox” (sicker patients, better results) Sensationalism in health related news Sensationalism in health related news Patients see themselves as consumers Patients see themselves as consumers

5. Reason 2: Increased Accountability Reason 2: Increased Accountability Hospital and individual surgeon’s results are widely available Hospital and individual surgeon’s results are widely available Patients are more knowledgeable about their condition Patients are more knowledgeable about their condition

6. Reason 3: New Technologies – Higher Demand on Training Reason 3: New Technologies – Higher Demand on Training Surgical techniques Surgical techniques Basic science Basic science

7. Reason 4: Restriction on Training Time (Absolute and Relative) Reason 4: Restriction on Training Time (Absolute and Relative) European Working Time Directive European Working Time Directive < 48h/week < 48h/week >11h rest/24h >11h rest/24h > 20 min rest/6h > 20 min rest/6h > 6h continuous rest/24h > 6h continuous rest/24h > 4 weeks leave/year > 4 weeks leave/year

8. The imbalance between the demands imposed on future Cardio-thoracic Surgeons and the facilities available for training is obvious. Never before has there been such a need to create properly structured training programmes in Cardio-thoracic Surgery…

9. Initiative 1: European School of Cardio-thoracic Surgery in Bergamo Initiative 1: European School of Cardio-thoracic Surgery in Bergamo 3 annual Cardiac courses 3 annual Cardiac courses 3 annual Thoracic courses 3 annual Thoracic courses http://www.eacts.org/doc/6898

10. http://mmcts.ctsnetjournals.org/ Initiative 2: Multimedia Manual of Cardio-thoracic Surgery Initiative 2: Multimedia Manual of Cardio-thoracic Surgery Premier online manual of cardiovascular and thoracic surgical procedures Premier online manual of cardiovascular and thoracic surgical procedures

11. Initiative 3: International Symposium on Training in Cardio-thoracic Surgery Initiative 3: International Symposium on Training in Cardio-thoracic Surgery Sharing new teaching strategies Sharing new teaching strategies Exploring new learning resources Exploring new learning resources

12. Initiative 4: Development of an Integrated European Training Programme Initiative 4: Development of an Integrated European Training Programme Constructed from establised national programmes Constructed from establised national programmes Guidelines and targets of competency Guidelines and targets of competency Externally assessed Externally assessed

13. Initiative 5: Accreditation of Training Centres Initiative 5: Accreditation of Training Centres European Cardiovascular and Thoracic European Cardiovascular and Thoracic Surgery Institute of Accreditation

14. With the implementation of these and other initiatives we may be able to develop a new teaching culture which hopefully will be sufficient to train Cardio-thoracic surgeons capable of facing the challenges of the XXI century.