The impact of ACGME Congenital Cardiac Surgery Fellowship on Training and Practice
Nicholas Oh1, David Blitzer2, Alvise Guariento3, *Tara Karamlou1
1Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States, 2Department of Cardiothoracic Surgery, Columbia University, New York City, New York, United States, 3Department of Cardiothoracic Surgery, University of Padova, Padova, Italy
In 2007, congenital cardiac surgery became a recognized fellowship by the American Council of Graduate Medical Education (ACGME), with the goal of providing structured education and operative requirements for training congenital cardiac surgeons. Recently, ACGME-trained congenital surgeons have decreased percentages of congenital cardiac cases post-training and less retention within the congenital cardiac surgery field. Given the dissatisfaction with current training models, the ACGME has now transitioned from a one-year to a mandatory two-year fellowship. It is critical that a current benchmark be established from which the new training pathway can be evaluated. Thus, the objective of this study is to provide this benchmark by surveying the variation in training pathways and assessing characteristics attributing to career success of current training paradigms.
A survey-based study in which different questionnaires were distributed to program directors, current fellows, and graduates of the ACGME accredited congenital cardiac surgery training programs. Data collection included multiple choice and open-ended questions. Participant identities remained anonymous. Survey questions focused on aspects of didactic education, operative training, mentorship, and employment characteristics. Results were analyzed using summary statistics, subgroup, and multivariable analyses, when appropriate.
The survey yielded responses from 13 of 14 (93%) ACGME accredited programs. Regarding institutional case volumes, 2 of 13 (15%) programs reported 150 to 299 congenital cardiac cases per year, 5 of 13 (38%) reported 300-500 cases per year, 6 of 13 (46%) reported 500+ cases per year. 11 of 13 (85%) programs had a formalized educational curriculum, and 4 of 13 (31%) have a formalized mentorship. Most program directors agree (67%) that the ACGME should change training to a mandatory two-years, citing higher case volumes, exposure to non-surgical rotations. Most agree that training programs need to commit to training fellows and balance the rising expectation from public and peers with graduated responsibility of the trainee. Responses from ACGME graduates show that the obstacles faced during the first five years of practice are the lack of mentorship and support. Some graduates felt supported but did not have the opportunity to expand or build their congenital practice. Most graduates (78%) agree that training should be two years.
Wide variation exists in the current congenital cardiac training pathways. Despite higher case volumes in nearly 50% of training programs and involvement of mostly senior surgeons in training programs, current graduates are still perceived as needing additional mentorship and training. Interestingly, graduates indicate that a barrier to their practice is the lack of mentorship and support.
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