Clear majorities of the respondents from active (83%) and mature (71%) I-6 programs did not believe that the reduced general surgical experience would disadvantage I-6 graduates in future career placement. 8600 Rockville Pike

What do you believe are the largest disadvantages of an I-6 residency program? Also, most I-6 residents appear to have had significant medical school rotational experiences in CT surgery. Supplemental material is available online. However, we believed that maintaining anonymity would encourage objective assessments and criticisms. Grand Rounds and didactic conference are held here weekly. Third, given that the first I-6 residents graduated in 2013, the survey sample was skewed toward experience with trainees in their early years (ie, PGY1, PGY2, PGY3). However, we were not able to garner sufficient responses for any meaningful conclusions.

The Yale University Human Investigation Committee approved the design and conduct of the present study. Translational Research. Foster effective interdisciplinary collaborative relationships. A sample block schedule is included below: Through its open-minded approach to life, business and ideas, the Columbus region has cultivated an environment of unique communities, companies, institutions and entertainment. Do you think that trainees in your I-6 program will be better prepared to adopt new technological advances in CT surgery than traditionally trained residents?

Justin.Feezell@osumc.edu, Copyright 2022 The Ohio State University College of Medicine. PMID 33012713. During the third year, residents will participate in a year-long high fidelity cardiac surgery simulation curriculum taught by one of the adult cardiac surgeons. October 2019. J Community Health 43(1): 27-32.

It does not discriminate with regard to sex, race, age, religion, color, national origin, disability, or veteran status.

An official website of the United States government. Also, 67% of the responding directors of active programs would have chosen an I-6 program for their own training had the choice been available. Data represented as percentages of surveyed directors of 12 active and 7 mature integrated residency programs (newly accredited programs not included). HHS Vulnerability Disclosure, Help In contrast, some concerns about the I-6 format have arisen, including perceptions that these programs are too cardiac focused, uncertainty regarding the willingness of CT surgical faculty to train junior residents (particularly in the operating room), the heterogeneity of the curriculum among different programs, vulnerability to midcourse resident attrition, and concerns related to the lack of maturity and clinical experience otherwise obtained in traditional 5-year general surgical training programs.2,4. National Library of Medicine

[Epub ahead of print]. Generally speaking, how would you compare your I-6 residents to residents in your past/present traditional residency program in clinical aptitude for diagnosing and treating CT disease processes? Participation was voluntary, and the anonymity of all respondents was preserved.

However, the exposure to nontraditional rotations in cardiovascular and pulmonary medicine might provide more opportunity for collaboration and new domains of investigation.

How do you anticipate your I-6 residency graduates will compare to your past/present traditional residency graduates with regard to interest in academics (eg, teaching, research)? government site. Since the adoption of the I-6 CT surgical residency format by Stanford in 2007, steady growth has occurred in the number of ACGME-approved I-6 programs in the United States, with 14 programs offered in the 2011 to 2012 match2 and 24 programs in the 2013 to 2014 match.

The Value of the Surgeon Do you think further training is required for I-6 graduates to perform less-invasive CT surgery (including robotics)?

Nahush.Mokadam@osumc.edu, Kaitlen Knight Residents present topics following the Society of Thoracic Surgeons and attend general surgery education sessions in program years 1-3. The survey was closed December 1, 2013. This superiority was also anticipated at graduation. Also, 67% of the responding directors from active I-6 programs would have chosen an I-6 program for their own training had the choice been available. Zhao JY, Romero Arenas MA. Do you believe most academic CT surgical faculty in the United States favor the I-6 CT residency format over traditional programs? Four newly accredited I-6 programs had not yet enrolled their first residents at the time of our survey.

Gastrostomy tube placement in neonates undergoing tracheostomy: An opportunity to coordinate care? These impressions were largely echoed in the responses from program directors of the newly accredited I-6 programs. An Enhanced Shared Decision Making Model to Address Willingness and Ability to Undergo Lung Cancer Screening and Follow-Up Treatment in Minority Underserved Populations. Program Manager It would not seem that the curricular requirements of I-6 programs, including a mandatory 24 months of general surgical rotation, would afford sufficient time to conduct high-quality independent research.

In a recent survey of I-6 program applicants, Tchantchaleishvili and colleagues1 reported that most candidates were young, high-achieving individuals oriented toward academic careers; however, the sample size was small (36 respondents, 45% response rate). However, their study was limited in that it only considered the duration of the different rotations rather than the content (eg, case volume, experiential milestones) and noted significant curricular heterogeneity among the programs.2. Increased exposure and dedication to CT surgery, increased exposure to nonsurgical specialties related to CT surgery, 4. However, more opportunities for sustained mentorship and the discipline and focus required in academic endeavors and the other high achievements ascribed to I-6 applicants could be factors. Therefore, we thought it would be useful to obtain an early snapshot of the perceptions of many of the format's architects by conducting the first nationwide survey of I-6 program directors. We would like to thank all integrated program directors who responded to our survey and Ms Suzanne Giannotti who provided assistance in coordinating our study. They are younger and potentially could withdraw, Accreditation Council for Graduate Medical Education. The recently implemented integrated 6-year (I-6) format represents a significant change in cardiothoracic surgical residency training.

Do you think the integrated multidisciplinary training of I-6 residency improves the overall comprehension of CT disease processes? J Thorac Oncol. Ahmed Aly, MD, first-year Cardiothoracic Surgery Integrated Resident, describes what he looks for in an integrated six-year cardiothoracic surgery residency program. We must also recognize that traditional CT residencies, including many highly regarded, time-tested programs still constitute the clear majority of training programs in the United States. Better and more engaged residents, more purpose built curriculum, more time of contact by CT faculty, 1. Perspective of Medical Education. Because competitive I-6 resident applicants appear to have greater numbers of research publications than traditional program applicants, it was not surprising that our surveyed program directors believed their I-6 residents currently possessed more interest in academic careers and foresaw that this would persist to graduation.

2020 Apr. 2020 Jan. Yeo JH, Shariati NM, Pelz GB, Dozier J, Rizk NP. We found that most I-6 program directors are optimistic that this new residency training scheme is moving toward achieving its primary goals, although significant concerns remain with respect to the challenges in training highly qualified, highly motivated, but relatively inexperienced, individuals. The ultimate success or failure of the new I-6 format will largely depend on whether it is perceived as achieving its primary objectives and being demonstratively superior to the tried and true traditional format. 10.1016/j.jss.2020.04.003. Whether this reflects a wait-and-see approach among most programs, the perceived disadvantages of the format, satisfaction with their own traditional programs, or the challenges in building a coalition of cardiologists, anesthesiologists, vascular surgeons, pulmonologists, and other groups not traditionally associated with CT residency training programs warrants additional elucidation beyond the scope of the present survey. First, given the limited number of ACGME-accredited I-6 programs in the United States, the sample size in the present study was small. If you had it to do over again, would you choose an I-6 CT surgical residency training program over a more traditional track?

PMID 32637637. Epub ahead of print. Finally, we recognized that many of our conclusions of residents' capabilities and qualifications were based on subjective opinion and impressions. Ward ST, Smith D, Andrei AC, Hicks GL, Jr, Shemin RJ, Calhoon JH, et al. Some had lingering concerns that the attenuated training period would not permit I-6 residents to acquire all the skills and maturity needed to independently practice CT surgery, that most CT surgical faculty currently do not have adequate training or experience to educate interns or junior residents, and no evidence is available that this new training paradigm will be more successful in producing well-trained CT surgeons. Do you believe that I-6 CT residency programs largely represent a reaction to declining interest among medical school graduates?

2014 Aug; 148(2): 40815.e1. The Surgical Blog: An Important Supplement to Traditional Scientific Because we had no true control group, the results were analyzed and are presented in a descriptive manner. Although the sample size of that group was quite small, the responses suggested optimism regarding the capabilities of the I-6 residents and features of the I-6 format compared with those of the traditional track. The free text responses of the most significant advantages and disadvantages of the I-6 format were useful, particularly in identifying concerns (Table 3). Do you believe that most academic CT surgical faculty in the United States favor the I-6 CT residency format over traditional programs? The greater challenges in training less mature and experienced trainees and vulnerability to attrition were noted as disadvantages of the I-6 format.

Applications are accepted from Sept. 1 through Nov. 15 each year. May 2020. Ward and colleagues2 compared the curricula between I-6 and traditional training programs. Although these parameters are not firmly established indicators for success as a surgical resident, they reflect positively on the assimilation and retention of information and interest in research. Furthermore, evidence has indicated that the qualifications of the I-6 applicants have generally been superior to those of the applicants to traditional CT surgical training programs. Most surveyed I-6 directors of active I-6 programs believed their residents currently possessed more diagnostic and technical aptitude and academic interest than their traditional resident counterparts (Figure 1). Practical milestones, in particular given the current heterogeneity of the I-6 curricula, would also seem prudent. Of these respondents, 12 (75%) represented active programs with currently enrolled residents, accounting for 69% of all I-6 residents in the United States (62 of 90). The Impact of Obesity on Outcomes in Geriatric Blunt Trauma.

To gain a more balanced perspective, however, we attempted to better understand why a few respondents did not answer positively to any of these questions. Foster continuing education to promote lifelong individual initiative and creative scholarship. Generally speaking, how would you compare your I-6 residents to residents in your past/present traditional residency program in interest in academics? Thus, we analyzed a subset of 7 of these more mature training programs and found that their responses generally paralleled those of the respondents from our main cohort of active I-6 programs. Zhao JY, Forsythe R, Langerman A, Melton GB, Schneider DF, Jackson GP. In which year did you initiate your I-6 CT surgical residency training program? Do you think I-6 residency graduates will be better trained than residents who graduate from traditional residency training pathways? High satisfaction rates with the I-6 format were prevalent among I-6 program directors. For example, it would have been useful to include questions to determine whether our respondents believed that I-6 residents were more likely to graduate as competent CT surgeons than their traditional program counterparts. This new format for CT surgical residency programs seeks (1) to attract a greater number of highly qualified trainees to the field and (2) to provide a more focused and multidisciplinary curriculum to produce CT surgeons better equipped to practice modern CT surgery. JCO Oncol Pract. We report the results of the first nationwide survey assessing I-6 program directors' impressions of this new format. The https:// ensures that you are connecting to the Our program has weekly protected time, where clinical activity is suspended and our educational conferences take place. The response rate was a robust 67%. Gasparri and colleagues4 at the Medical College of Wisconsin and Chikwe and colleagues3 reported a greater number of peer-reviewed publications and greater US Medical Licensing Examination scores among applicants invited to interview for their I-6 program compared with their traditional program applicants. The distribution of the programs' starting dates was as follows: 1 in 2007, 1 in 2008, 2 in 2009, 4 in 2010, 1 in 2011, 1 in 2012, 3 in 2013, and 4 in 2014.

Do you believe that the lack of full general surgery training confers future career disadvantages for CT surgeons trained using the I-6 pathway? This should be remembered when interpreting the comparisons drawn between I-6 and traditional training programs by our respondents. Generally speaking, how would you compare your I-6 residents to residents in your past/present traditional residency program in overall maturity? Youll need to provide your curriculum vitae, personal statement, letters of recommendation, and medical school transcript.

Acceptance into these programs has been highly competitive, with well over 100 applications received by most programs for 1 or 2 positions each year. Free text responses to our questions pertaining to the perceptions of the most significant advantages and disadvantages of the I-6 format are listed in Table 3. The Department of Surgery is an equal-opportunity employer. BMJ Case Reports.

Selected applicants will be invited for a personal interview. Develop professional leadership and management skills. These respondents were asked to anticipate their responses to the questions using their current knowledge and expectations of the new format. Greater period to study field of CT surgery, teach them techniques pertinent to our field, become specialist in cardiovascular medicine, 9.

Literature. Attracting superior candidates and training them ourselves, 12. Follow-up inquiries revealed that some were not convinced that the I-6 format carries evolutionary advantages over traditional formats. Do you think that your I-6 residents will be sufficiently trained to perform routine cardiac and thoracic operations independently by the time they graduate from your program? A 28-question web-based survey was distributed to program directors of all 24 Accreditation Council for Graduate Medical Education-accredited I-6 training programs in November 2013. Active programs, Programs with currently enrolled residents; Mature programs, programs initiated in 2010 or earlier (ie, with PGY4, PGY5, and PGY6 residents); New programs, newly accredited programs anticipating enrolling first residents in July 2014; I-6, integrated 6-year; CT, cardiothoracic. Third-year resident, Ammu Vijayakumar, MD, in the Cardiothoracic Surgery Integrated Residency program from The Ohio State University Wexner Medical Center, talks about the differences between the general surgery residency program and the integrated six-year cardiothoracic surgery residency program. Before GraphPad Prism software, version 6.0c (GraphPad Software, Inc, La Jolla, Calif) was used for basic statistical analysis and plotting of the data. Foreign medical graduates applying to the program must hold or be eligible for a valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) and a J-1 Visa and must have at least one year of experience in an accredited clinical training program in the United States. Erkmen CP, Randhawa S, Patterson F, Kim R, Weir M, Ma GX. Greater challenges in training less mature and less clinically and technically experienced trainees and vulnerability to attrition were noted as disadvantages of the I-6 format. about navigating our updated article layout. Compared with graduates of traditional residencies, most I-6 program directors with enrolled residents believed that their graduates will be better trained (67%), be better prepared for new technological advances (67%), and have superior comprehension of cardiothoracic disease processes (83%). To date, and without exception, every applicant to our I-6 program at Yale has expressed an interest and a desire in conducting research during their residency. aSection of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn, bSection of Cardiac Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY, cDivision of Thoracic Surgery, University of Texas Health Science Center, San Antonio, Tex, dDivision of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis, eDivision of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga, fDivision of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY, gDepartment of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, hDivision of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, iDivision of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill, jDivision of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, kDivision of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC. Nahush Mokadam, MD Clinical exposure and acquisition of skills during a 6-y period, 3. Finally, 4 respondents (25%) represented newly accredited programs anticipating enrolling their first residents in July 2014. Integrate principles of basic sciences with clinical experiences. The majority of training is provided at the Ohio State University Hospital main campus, where most faculty reside and have exposure to residents. Aly A *, Saito Y *, BoumaW, Imai A, Hwang H, Okamoto K, Pilla J, Eperjesi T, Pouch A, Yushkevich P, Gillespie M, Gorman III J, Gorman R. Heterogeneous Leaflet Adaptation and Subvalvular Dynamics in Ischemic Mitral Regurgitation. Six-year integrated CT surgery residency applicants: characteristics, expectations, and concerns. These findings were not surprising, given the intuitive necessity for I-6 program directors to actively advocate for these new training programs. Journal of Surgical Research.

It would also have been informative to identify the motivations behind each of our respondents' decision to pursue an I-6 format, thoughts on how to improve their respective programs, and whether they intended to maintain a parallel traditional training program. Lean Lobectomy: Streamlining Video-Assistant Lobectomy to Increase the Value of Lung Cancer Care.

Although the realization of these goals has yet to be definitively established, the early indicators have been promising. From our recent nationwide survey of the I-6 residents (data not yet published), it appears that more early and intense mentorship, technical training (eg, simulation laboratories), didactics, and nontraditional rotations in cardiovascular and pulmonary rotations could also have contributed to this finding. The data from our respondents suggest otherwise, indicating that their I-6 residents currently possess as much, if not more, aptitude in these areas. Provide CT Residents with the ability to function as teachers and consultants. The responses were checked for inconsistencies and errors, computed, and presented as frequencies according to the following groups: Active programs: I-6 programs with currently enrolled residents, Mature programs: I-6 programs instituted in 2010 or earlier, with residents at or beyond the postgraduate year (PGY)3 level, New programs: newly accredited programs anticipating enrolling their first residents in July 2014. This finding has been substantiated, given that most respondents based their impressions on residents in their first 3 years of training. However, a clear majority of our respondents believed their I-6 residents were as mature, if not more so, than their traditional residents, with a substantial proportion of these observing or anticipating greater degrees of maturity among their graduates. Tchantchaleishvili V, Barrus B, Knight PA, Jones CE, Watson TJ, Hicks GL. J Thorac Cardiovasc Surg. August 2020. The overarching goals of the new I-6 training strategy are to attract a greater number of highly qualified trainees to the field and develop a more focused and relevant curriculum to produce CT surgeons better equipped to practice modern CT surgery.

These concerns call for a need to establish prescribed pathways and methods with respect to specific clinical rotations, didactic teaching, and technical instruction (eg, simulation laboratories) with proven track records of success, particularly during the first 3 years of I-6 programs when relative inexperience and risk of resident attrition would seem particularly acute. The respondents were equivocal regarding whether they thought additional specialty training (eg, minimally invasive, heart failure, aortic) was necessary for their I-6 residents but favored additional training for graduates of traditional programs. Langer, T., Vijayakumar, A., Alvarez, P., Ruiz, C., Tsai, P., Adams, U., Powierza, C., Dallahan, G.B., Rahangdale, L. Transition to multiple mini interview (MMI) interviewing for medical school admissions. The .gov means its official. The Joint Council on Thoracic Surgical Education has been actively addressing some of these issues specific to I-6 curricula, including formation of an American Board of Surgery Case Requirement Task Force. The present survey has provided an important snapshot of I-6 program directors' impressions of the still nascent I-6 format, providing early indications regarding whether this format is achieving its goals of attracting more highly qualified trainees to the field and producing surgeons well versed in contemporary CT surgery. Do you think that I-6 residency graduates have an advantage over peer traditional residency training program graduates for new faculty positions? Nevertheless, the responding program directors accounted for approximately 69% of all I-6 residents nationwide in November 2013. Although the general perception has been that the I-6 format is moving toward achieving these objectives, current evidence has been limited and often anecdotal.

Informatician. Accessibility To date, largely anecdotal concerns have been raised that I-6 residents, generally recruited straight out of medical school, would experience significant difficulty assimilating the clinical and technical abilities relative to the fully trained general surgical residents in traditional programs. The responses from the program directors of the 4 newly accredited I-6 programs were tabulated and analyzed separately from the main group (Table 2), because these programs had not yet matriculated trainees at the time of the survey.

One question contained a field for a specific numeric response, and two questions permitted free text responses. Administrator, Divisions of Cardiac, Thoracic, and Vascular Surgery University of Texas Health Science Center at San Antonio, Comparisons between residents in I-6 and traditional training programs. Potential need for fellowship training, 3. Despite these perceptions, however, most I-6 program directors did not believe that the I-6 format was strongly favored over traditional programs by academic CT surgical faculty, because 41 US residency programs have not yet adopted the I-6 approach. Learn more The survey data were exported from the platform in a pure text file format (.CSV) and subjected to basic statistical analysis. and transmitted securely. Interaction with a multitude of specialties occurs regularly. 2021 Jun 3:S1043-0679(21)00263-X. Residents rotate on the adult cardiac surgery service at the Ross Heart Hospital, the thoracic surgical service at the James Cancer Hospital, and the congenital heart service at Nationwide Childrens Hospital in the first, third, and fifth years of the program.

Federal government websites often end in .gov or .mil. PatrickM. Journal of Medical Education and Curricular Development. Of these questions, 25 were multiple choice and used a Likert response scale. This six-year program accepts one resident each year in a categorical position. However, clear majorities of the directors from both active (75%) and mature (71%) I-6 programs believed that the I-6 format represents a natural evolution toward improved residency training rather than a response to declining interest among medical school graduates (Table 2). Bethesda, MD 20894, Web Policies The American Journal of Surgery. A clear majority of I-6 program directors believed that the I-6 format represents a natural evolution toward improved residency training rather than primarily a response to declining interest among medical school graduates. Do you think further training is required for I-6 graduates to perform surgical therapies for heart failure (eg, mechanical circulatory assist devices, cardiopulmonary transplantation)? How do you anticipate your I-6 residency graduates will compare to your past/present traditional residency graduates with regard to surgical technical aptitude? Since the first integrated 6-year (I-6) cardiothoracic (CT) surgical residency program was adopted at Stanford in 2007, the number of Accreditation Council for Graduate Medical Education (ACGME)-approved I-6 programs in the United States has steadily increased. Do you think trainees in your I-6 program will be better prepared to adopt new technological advances in CT surgery than traditionally trained residents? We are not used to training junior residents so their education might not be as good as we think without significant effort; no option to change to another specialty, 13. One reminder electronic mail message to the initial nonrespondents was sent, including invitations to other members of the faculty. To better assess the perceived advantages, disadvantages, and concerns with the I-6 format, particularly timely given the recent graduation of the first I-6 residents, we conducted the first nationwide survey of program directors in all US ACGME-accredited I-6 programs and report our results and interpretations.