Ten years into the Integrated Residency Era: A Majority of Thoracic Surgeons Favor the Traditional Pathway
Charles A Keilin1, Gurjit Sandhu2, Niki Matusko2, Rishindra M Reddy2
1University of Michigan Medical School, Ann Arbor, MI;2Michigan Medicine, Department of Surgery, Ann Arbor, MI
Objective: The first integrated thoracic surgery residents (I6) graduated in 2013. We aim to understand current opinions of academic thoracic faculty on the thoracic training models.
Methods: An anonymous web-based survey was developed and distributed to all academic thoracic surgeons in the United States. Respondents were asked about their current perceptions of the various training models. Descriptive statistics, Fisher exact test and qualitative content analysis of free text responses were used to analyze the data.
Results: The response rate was 15.4% (111/719). 56 faculty were from traditional only programs, 13 from I6 only, and 42 from programs with both I6 and traditional pathways. 11.7% (13/111) were female. 23.4% (26/111) of faculty believe the I6 is superior to the traditional model, 31.5% (35/111) believe they are the same and 45.0% (50/111) believe the traditional model is better. When comparing faculty who had an I6 program (55) versus those who did not (56), 32.7% (18/55) vs 14.3% (8/56) favored the I6, while 38.2% (21/55) vs 51.8% (29/56) favored traditional (p = 0.03), respectively. Also, 51.4% (57/111) of faculty said they would still apply into a traditional fellowship, with 27.9% (31/111) picking an I6 program and 20.7% (23/111) picking a 4+3 model. When comparing I6 to non-I6 faculty, 49.1% (27/55) vs 53.6% (30/56) would choose a traditional path, 43.6% (24/55) vs 12.5% (7/56) would choose an I6 program, while 7.3% (4/55) vs 33.9% (19/56) would choose a 4+3 model (p < 0.01), respectively. Of all faculty, 40.5% (45/111) believe the I6 is good for the specialty and 55.0% (61/111) think the I6 attracts higher achieving applicants, but 73.9% (82/111) and 80.2% (89/111) don't believe it is improving training or increasing the scholarly activity of residents, respectively. Comparing between I6 and non-I6 faculty, 50.9% (28/55) vs 30.4% (17/56) believe the I6 is good for the specialty (p = 0.03), and 60.0% (33/55) vs 87.5% (49/56) don't believe it is improving training (p < 0.01), respectively. 60.0% (33/55) of I6 faculty think the quality of the I6 curriculum is better than that of the traditional curriculum with only 53.8% (7/13) of those with only an I6 program at their institution believing this to be true (p = NS). 56.4% (31/55) of I6 faculty feel there is bias against their residents on general surgery service, which some believe leads to poor educational outcomes for I6 residents. 58.2% (32/55) of I6 faculty admitted that they have changed their teaching style to accommodate junior residents. When responses were stratified by age or rank of faculty, there were no significant differences in responses.
Conclusions: The I6 represents a major shift in the way thoracic surgeons are trained. However, there is a high degree of variability amongst faculty nationally regarding the quality and effectiveness of the I6 model with most preferring the traditional model.
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