Thoracic surgery education

Iam extremely honored to have been chosen to give this first J. Kent Trinkle Lecture in Thoracic Surgery Education for the Southern Thoracic Surgical Association. I am a little intimidated by having it placed between the honored guest address by Dr Shumway, and Dr Baumgardner’s presidential address. This should, however, assure me a captive audience. I should mention that my parents would be particularly proud of me being invited to give this lecture, which is clearly more oriented to education and philosophy than to science, because they were both teachers and were responsible for me choosing a career in academic surgery. I had the privilege of knowing and working with Kent Trinkle for a long time, most recently during his tenure on the American Board of Thoracic Surgery (ABTS). The ABTS provides the opportunity for a small group of thoracic surgeons to get to know each other extremely well, and Kent and I became close friends. Kent was the source of more bad jokes than any person I have ever known. In San Antonio, these are known as “Trinkleisms.” Kent was a strong resident advocate and committed in every sense to thoracic surgery education, to this organization which he served as President, and to the future of our specialty. His death has deprived us of the opportunity to continue to benefit from his wisdom. For a number of years, a presentation has been given at this meeting by a program director from one of our residency programs. This presentation has usually included a description of that program, and at least a few words about that program’s philosophy of thoracic surgery education. Previous presentations have been made by Ben Wilcox [1], Irv Kron [2], Kent Trinkle [3], and our current and incoming Presidents, Bill Baumgartner [4], and Don Watson. In keeping with their precedent, I would like to first tell you a little about the thoracic surgery residency at the Medical University of South Carolina (MUSC). The MUSC is the oldest medical school in the southeast. It was founded in 1824, and has been in continuous operation since that time. It is a free standing health sciences university with students in the schools of medicine, dentistry, nursing, pharmacy, health related professions, and graduate studies. It is located in the peninsula portion of downtown Charleston. In 1948, cardiac surgery was introduced to Charleston when Horace Smithy, a graduate of the University of Virginia School of Medicine and the general surgery residency program in Charleston, utilized a valvulotome to successfully open a stenotic mitral valve in a young lady from Akron, Ohio, who was dying of heart failure secondary to rheumatic mitral stenosis [5]. This was one of the first successful operations on the mitral valve. Tragically Dr Smithy himself died of the same disease later that same year at the age of 34. Eddie Parker, who served this association as president in 1959, subsequently developed the first heart surgery program in South Carolina in Charleston, and we mourned Eddie’s passing last December at the age of 88. Bill Lee was recruited in 1964 to develop a formal residency program in cardiothoracic surgery at MUSC. This program was approved and accredited in 1967, and has been in continuous operation since that time. When Bill died in an automobile accident in 1978, Eddie Parker returned from private practice to run the program until I was recruited in 1979. It has indeed been an honor to be able to return to my home state to help continue the tradition of this program. At that time, it was a two-year program with two residents in each year, or what is referred to by the Residency Review Committee (RRC), as a 2-2 program. In 1987 we made a conscious decision to change our program from a 2-year to a 3-year program, and to voluntarily decrease the number of residents trained each year from two to one (1-1-1). We believed that additional time would be beneficial in educating the modern thoracic surgeon, and at the same time were concerned about the number of thoracic surgeons being trained. Since my arrival in 1979, 25 residents have completed the program. This map shows where they are currently located (Fig 1). They are in both academic and private practice, and are scattered throughout the country. Only recently have several chosen to remain in South Carolina. Just as is true with all of your residents, ours have been uniformly successful in passing the boards, have been successful in academic and private practice, and accordingly have made our faculty look quite good in the process. We are justifiably proud of all of them. Like most institutions, our faculty has evolved over the years. Currently it includes Scott Bradley, Jack Crumbley, Jim Zellner, Carolyn Reed, John Kratz, Bob Sade, Frank Spinale, and myself. With two exceptions, all have been recruited to MUSC from other institutions. Our faculty has been heavily involved in the Southern Thoracic Surgical Association, and both Eddie Parker and Bob Sade have served as President and Carolyn Reed currently serves as Secretary. As a part of the overall effort of our division, we have been fortunate to develop a very solid basic science research effort under the leadership of Frank Spinale. Presented at the Forty-sixth Annual Meeting of the Southern Thoracic Surgical Association, San Juan, Puerto Rico, Nov 4–6, 1999.