Retooling Thoracic Surgery Education for the 21st Century

The field of education as a whole is in the midst of a revolution that will change the methods and techniques used to teach students at every level. I think that the development of the television and video recorder will pale in comparison with the communications technology being researched and advanced today at an exponential rate. The computer capability of nearby instantaneous communication with multiple parties in a variably structured format provides unlimited possibilities to instruction, education, and learning. These observations are not the result of my innate knowledge of this subject, but rather a gradual appreciation of the power of this new form of instructional media. Applying these novel and innovative techniques to our current thoracic surgical educational programs will be the challenge for the next century. Reviewing the history of our current educational system will provide the backdrop from which our future endeavors will be directed. Like most surgical residencies, thoracic surgical education had its roots with William Stewart Halsted. Before 1889, there was no formal training system in the United States. In that same year, Johns Hopkins Hospital was opened, and Dr Halsted was appointed Surgeon-in-Chief in 1890 [1]. Based on his experience with surgical programs in Germany, he introduced for the first time in the United States the concept of a surgical training program. His description of this program, entitled “The Training of the Surgeon,” appeared in the Bulletin of the Johns Hopkins Hospital in 1904 [2]. Doctor Halsted stated, “We need a system, and we shall surely have it, which will provide not only surgeons, but surgeons of the highest type, men who will stimulate the first youths of our country to study surgery and devote their energy and lives to raising the standard of surgical science.” The uniqueness of the Halsted training program is illustrated in this quote: “The assistants are expected in addition to their ward and operating room duties, to prosecute original investigations and to keep in close touch with the work in surgical pathology, bacteriology and, as far as possible, physiology.” This in essence set the standard for the current academic thoracic surgeon. Doctor Halsted’s residency training program design has remained a stable foundation with some modifications during the past 100 years. In the majority of programs, residency training occurs at the site of patient encounter. For thoracic surgeons, this occurs in the outpatient clinic, on the wards, and in the operating room, where detailed teaching of operative technique occurs. Due to constraints of time and the stress placed on the development of excellent technical skills, the overall education of the resident has lagged somewhat behind the training. Education has traditionally been provided in the form of teaching rounds, grand grounds, conferences, journal clubs, invited professorships, and independent reading. This successful format remains in place today. However, due to the response from various resident surveys and recommendations of conferences dedicated to thoracic resident education, improvements and refinement of teaching techniques including a core curriculum are indicated. Surgical education has not been a major subject of discussion or research until recently. As emphasized by Dr Kron in his 1996 presentation to the Forty-third Annual Meeting of the Southern Thoracic Surgical Association [3], there are few citations in the Index Medicus pertaining to thoracic surgical education. One of the first organized sessions dealing with resident education occurred in 1991, when Dr John A. Waldhausen organized a conference in Snowbird, Utah, to address a variety of thoracic surgical issues; one of which was cardiothoracic resident education. Although there were a variety of issues discussed by the planning group, including American Board of Surgery certification and specialization in residency training, considerable emphasis was placed on the “education” of the resident. One significant recommendation was the establishment of a core curriculum that would emphasize “basic knowledge of physiology and pathology as it pertains to the specialty of cardiothoracic surgery.” This conference reinforced the importance of education for our thoracic residents. It resulted in a specific and dedicated meeting dealing with the subject of graduate medical education in thoracic surgery. This meeting was held in Oak Brook, Illinois, in 1992 and was entitled “Joint Conference on Graduate Education in Thoracic Surgery” [4]. It was sponsored by the major thoracic surgical societies. In preparation for the conference, surveys were sent to a variety of individuals including a leadership group, young practicing thoracic surgeons, and thoracic residents who had completed at least one year of residency [5]. A variety of factual information regarding operative data, education, and lifestyle was obtained. A consistent theme in the majority of responses was that thoracic surgery faculty should have a greater involvement in all levels of the educational experience. “More Presented at the Forty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Naples, FL, Nov 6–8, 1997.