Connection through cardiothoracic surgery subspecialty collaboration: Strategies for Early Faculty Peer Network Development (2022)

Central MessageFor junior cardiothoracic surgery faculty, collaboration and community building across subspecialties (congenital, thoracic, and adult cardiac) is an effective strategy for early career peer support.PerspectiveEarly career faculty in cardiothoracic surgical subspecialties find themselves pursuing studying, writing, and research opportunities for independent professional development. Although current focus is on career development for trainees and individuals, junior faculty should establish a peer-support group across subspecialties as a strategy to collectively navigate successful career paths. For junior cardiothoracic surgery faculty, collaboration and community building across subspecialties (congenital, thoracic, and adult cardiac) is an effective strategy for early career peer support. Early career faculty in cardiothoracic surgical subspecialties find themselves pursuing studying, writing, and research opportunities for independent professional development. Although current focus is on career development for trainees and individuals, junior faculty should establish a peer-support group across subspecialties as a strategy to collectively navigate successful career paths. When starting your first job, being the only junior faculty member in a specific surgical department is common. Yet, this may be the first time you are without another person who possesses the same title as you: A co-(fill in the blank). Without peers, assuming an individual role within an unfamiliar, complex organization is predictably arduous. Additionally, structured safeguards embedded in residency/fellowship training programs are suddenly eliminated. Social loneliness can become a debilitating obstacle during this crucial period of major career transition.1Maddaus M. The resilience bank account: skills for optimal performance.Ann Thorac Surg. 2020; 109: 18-25Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Each unique individual's professional journey is embattled with constantly shifting priorities and struggle to preserve time to complete important, nonclinical tasks. Currently, faculty development resources are concentrated at trainee audiences2Brescia A.A. Lou X. Louis C. Blitzer D. Coyan G.N. Han J.J. et al.The Thoracic Surgery Residents Association: past contributions, current efforts, and future directions.J Thorac Cardiovasc Surg. 2021; 162: 917-927.e5Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar or topics related to individual-specific challenges.3Soceity of Thoracic SurgeonsSTS career development blog.https://www.sts.org/resources/career-resources/career-development-blogDate accessed: June 15, 2022Google Scholar However, navigating this complex environment doesn't have to be done in isolation. It can be practically approached by bolstering peer networks with other junior cardiothoracic surgery faculty members. Given standardized training paradigms, this cohort is a logical extension of peer support that replicates well into faculty life. As developing cardiothoracic surgeons, what are some collective strategies to promote connection early during career development? What are the potential benefits of having reciprocal support with accountability, growing skills together, and fostering mutual understanding at this new step in everyone's career? Effectively establishing a professional peer group will strengthen career resilience and promote productivity across cardiothoracic surgical subspecialties (eg, congenital, thoracic, or adult cardiac) by strategically addressing communal stresses outside the operating room when starting a demanding surgical career. When junior faculty are hired in their first cardiothoracic surgery jobs, the environment will range from openly hostile to friendly depending on the level of support, resource allocation, and institutional priority for individual faculty growth. Although younger surgeons may move from their first job, switching jobs may not improve the consistent pressures that junior surgeons universally face. Once surgeons have spent time identifying their own strengths and individual career aspirations, the next step is to obtain awareness with other junior cardiothoracic faculty to identify common challenges and overlapping individual goals. Younger surgeons may find peer support in developing clinical and operative practices early on; however, this is beyond the scope of this article. Instead, we will focus on specific areas of career development that junior faculty may find mutually challenging because these require dedicated time outside clinical responsibilities, include obtaining Board certification, writing, and/or research. An enormous task that all newly graduated trainees in cardiothoracic residency and fellowship have in their first few years as junior faculty is the imperative to pass the American Board of Thoracic Surgery (ABTS) Board certification exam.4American Board of Thoracic SurgeryInitial training and certification.https://www.abts.org/ABTS/CertificationWebPages/Initial_Certification_Page.aspxDate accessed: June 15, 2022Google Scholar Even if you choose a specialty-specific track within residency/fellowship, the relevant topics for cardiothoracic surgery encompass thoracic surgery, adult cardiac surgery, critical care, and congenital cardiac surgery. Yearly, about 15% to 20% will fail. In the midst of starting at a new institution, it can be difficult to prioritize study time. Also, surgical Board certification exams are in 2 parts: written and oral. This process extends the examination process over an entire year, at minimum, usually starting at the beginning of your faculty position. Also, mock oral exam preparation necessitates at least 2 people to practice—an examiner and an examinee. Literally, effective exam preparation cannot be completed by 1 individual. Thus, the strategy for preparing for this exam requires intentional studying—at least in pairs—with faculty members who are knowledgeable in these subspecialties. In addition to studying, an extension of professional productivity that younger surgeons struggle with early on is maintaining consistent time to write. Professional writing is a broad term and includes manuscripts, essays, project proposals, and letters of recommendation, to name a few examples. This time also includes preparation around writing, including reading relevant articles, outlining, or reworking drafts with collaborator comments.5Silvia P. How to Write a Lot: A Practical Guide to Productive Academic Writing.2nd ed. American Psychology Association, 2019Crossref Google Scholar Another example of meaningful work outside of an individual's current institution is finishing projects from training that are in the final stages. One can imagine that the greater the distance from the institution where the project was started (both time and space), the more difficult it is to complete, regardless of how much time has been invested. Once at a new institution, what is the ability of a cardiothoracic surgeon to continue productive work outside of the operating room, such as publishing and research? In 2018, a database of more than 900 cardiothoracic surgeons in US academic teaching hospitals was created to track authorship publication history and National Institutes of Health grant funding. Wang and colleagues6Wang H. Bajaj S.S. Krishnan A. Heiler J.C. Williams K.M. Pickering J.M. et al.Characterization of cardiothoracic surgeons actively leading basic science research.J Surg Res. 2021; 268: 371-380Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar found that only 7% (n = 73) were actively leading basic science research and only 60% (n = 599) were actively leading nonbasic science research. In subgroup analysis, the proportion of women leading basic science research was much lower (n = 2). Proportionally, surgeons were designated as 47.6% (n = 320) cardiac, 35.4% (n = 238) thoracic, and 17.1% (n = 115) congenital. It is notable that research involvement was similarly distributed across cardiac (42.5% vs 48.2%), thoracic (39.7% vs 34.7%), and congenital (17.8% vs 17.0%) specialties when analyzing by basic and nonbasic science research categories, respectively.6Wang H. Bajaj S.S. Krishnan A. Heiler J.C. Williams K.M. Pickering J.M. et al.Characterization of cardiothoracic surgeons actively leading basic science research.J Surg Res. 2021; 268: 371-380Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar The uniform division of research type suggests that the specific category of research—nonbasic science versus basic science—is not a determining factor when comparing pursuit of research across different cardiothoracic subspecialties. Some of the challenges to pursuing research include needing to obtain funding, staff, and statistical support. As a junior faculty member, finding, applying, and wisely managing these resources is not guaranteed with intentional, consistent effort. With limited time outside of operating rooms, it may be tempting to balance the desire to collaborate on projects with inexperienced, but enthusiastic, research participants; that is, medical students or residents/fellows. The potential conflicts are competing goals of pursuing high-quality, established projects; obtaining support for your own independent work; and/or sharing your research knowledge with less-experienced others. Strategizing and choosing collaborators may be difficult with differing experience levels and existing hierarchies. Self-advocacy is a necessary skill. Do not hesitate to ask for what you need early on or ask for assistance from those with skills to help you. The inevitable maze that is any new health system requires timely, flexible navigation and calibration to orient any faculty surgeon. Besides becoming functional in the operating room, other career development areas outside of clinical practice can also be challenging environments to become quickly self-sufficient. Befriending other junior cardiothoracic faculty members with similar training backgrounds can provide increased accountability in writing and studying with formation of dedicated groups. Exposure to research resources, prioritizing personal well-being, and finding mentorship are all examples of how an effective peer surgery support group can lead efforts toward achieving individual career goals while facing similar obstacles (Figure 1). For some board-eligible cardiothoracic program graduates, when it comes time to actually sit for the ABTS examination, it has already been years beyond when we were actively on clinical rotations in that particular subspecialty. Frequently, the most challenging topics to study for are those remote from what we are doing in our day-to-day surgical practice. By becoming study partners with faculty members in a different subspecialty, you can exchange clinical expertise. A list of study resources on various subspecialties shows the difference in study approach depending on topic focus (Table 1). For oral exams, plan on scheduling practice sessions focused on the subspecialty that is beyond your daily clinical practice. Being connected to someone simultaneously studying for the same exam provides an added level of accountability and motivation. For anyone who is faced with retaking the exam, peer support from cardiothoracic faculty in different subspecialties who have taken the Boards can be an effective way to master unfamiliar topics.Table 1Resources for cardiothoracic surgery (CTS) Board examination preparation by subspecialty topic∗Textbooks, study guides, and miscellaneous materials resources: 1. Kaiser LR, Kron IL, and Spray TL. Mastery of Cardiothoracic Surgery. 3rd ed. Lippincott Williams & Wilkins; 2014. 2. Ardehali A and Chen JM. Khonsari's Cardiac Surgery Safeguards and Pitfalls in Operative Technique. Wolters Kluwer Health; 2017. 3. Yuh DD, Vricella LA, Yang SC, and Doty JR. Johns Hopkins Textbook of Cardiothoracic Surgery. 2nd ed. McGraw Hill Medical; 2014. 4. Selke F, Del Nido PJ, Swanson SJ. Sabiston & Spencer Surgery of the Chest. 8th ed. Elsevier; 2016. 5. Cohn L. Cardiac Surgery in the Adult. 4th ed. McGraw Hill; 2018. 6. TSRA Resources for Residents: https://www.tsranet.org/resources/tsra-resources-for-residents/. 7. Cantu E, Turek JW. Case-based Review of Cardiothoracic Surgery. 2013. Cases structured for oral exam review with scenarios/questions on the left and answers on the right. https://www.amazon.com/Case-Based-Review-Cardiothoracic-Surgery-Edward/dp/0615535348. 8. Chikwe J, Cooke D, and Weiss A. Cardiothoracic Surgery Handbook. Oxford University Press; 2006. 9. SESATS. http://www.sesats.org/. 10. JTCVS Operative Techniques in Thoracic and Cardiovascular Surgery articles. https://www.optechtcs.com. 11. Osler Review Course. https://www.osler.org/product-category/specialties/thoracic-surgery/. 12. Doty Intermountain Review of Cardiovascular & Thoracic Surgery. https://intermountain.cloud-cme.com/course/courseoverview?P=5&EID=14145.All CTS topicsCongenitalThoracicCardiacTextbooks•Mastery of CTS1 (w)•Khonsari's Cardiac Surgery Pitfalls2 (w/o)•Johns Hopkins Textbook of CTS3 (w)•Sabiston's Surgery of the Chest4 (w)•Khonsari's Cardiac Surgery Pitfalls2 (w/o)•Cardiac Surgery in the Adult, Cohn Textbook5•Johns Hopkins Textbook of CTS3 (w)Study guides•TSRA Clinical Scenarios6 (w/o)•TSRA Operative Dictations6 (o)•Case-Based Review of CTS7 (o)•CTS Handbook8Miscellaneous•SESATS QBank9•JTCVS Op-Tech articles10•Osler Review Course11 (o)•Intermountain (Doty) Review Course12 (w)w, Written; o, oral; TSRA, Thoracic Surgery Residents Association; SESATS, Self-Education Self Assessment in Thoracic Surgery; JTCVS, Journal of Thoracic and Cardiovascular Surgery.∗ Textbooks, study guides, and miscellaneous materials resources: 1. Kaiser LR, Kron IL, and Spray TL. Mastery of Cardiothoracic Surgery. 3rd ed. Lippincott Williams & Wilkins; 2014. 2. Ardehali A and Chen JM. Khonsari's Cardiac Surgery Safeguards and Pitfalls in Operative Technique. Wolters Kluwer Health; 2017. 3. Yuh DD, Vricella LA, Yang SC, and Doty JR. Johns Hopkins Textbook of Cardiothoracic Surgery. 2nd ed. McGraw Hill Medical; 2014. 4. Selke F, Del Nido PJ, Swanson SJ. Sabiston & Spencer Surgery of the Chest. 8th ed. Elsevier; 2016. 5. Cohn L. Cardiac Surgery in the Adult. 4th ed. McGraw Hill; 2018. 6. TSRA Resources for Residents: https://www.tsranet.org/resources/tsra-resources-for-residents/. 7. Cantu E, Turek JW. Case-based Review of Cardiothoracic Surgery. 2013. Cases structured for oral exam review with scenarios/questions on the left and answers on the right. https://www.amazon.com/Case-Based-Review-Cardiothoracic-Surgery-Edward/dp/0615535348. 8. Chikwe J, Cooke D, and Weiss A. Cardiothoracic Surgery Handbook. Oxford University Press; 2006. 9. SESATS. http://www.sesats.org/. 10. JTCVS Operative Techniques in Thoracic and Cardiovascular Surgery articles. https://www.optechtcs.com. 11. Osler Review Course. https://www.osler.org/product-category/specialties/thoracic-surgery/. 12. Doty Intermountain Review of Cardiovascular & Thoracic Surgery. https://intermountain.cloud-cme.com/course/courseoverview?P=5&EID=14145. Open table in a new tab w, Written; o, oral; TSRA, Thoracic Surgery Residents Association; SESATS, Self-Education Self Assessment in Thoracic Surgery; JTCVS, Journal of Thoracic and Cardiovascular Surgery. In addition to keeping each other accountable for studying, writing accountability is another practical way junior surgical faculty can support each other. There are several strategies to become a more effective and productive writer. One of these strategies, suggested by Silva,5Silvia P. How to Write a Lot: A Practical Guide to Productive Academic Writing.2nd ed. American Psychology Association, 2019Crossref Google Scholar is to create an accountability group. There are several types of accountability groups: reviewing each individual's written works, setting time to write individually but at a prearranged time, and meeting regularly to update each other on progress in writing goals. The beauty of this type of format is it can be virtual. Junior cardiothoracic faculty members should be motivated to continue their productivity; a writing accountability group can allow all members of this peer group to benefit simply from each individual's presence and consistent participation. Creating accountability a peer group can also be to research. There are several obstacles to starting a research project for faculty members. Some challenges are unique to the institution and can include or for an institutional review Junior faculty members can each other by sharing resource or a faculty member for In addition to a to pursuing research is of funding. provides research time, is critical to the development of academic some for basic science research involvement include having a publishing a publication during or an National Institutes of Health Wang and colleagues6Wang H. Bajaj S.S. Krishnan A. Heiler J.C. Williams K.M. Pickering J.M. et al.Characterization of cardiothoracic surgeons actively leading basic science research.J Surg Res. 2021; 268: 371-380Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar that to the development of support be to junior faculty junior cardiothoracic faculty members can help each other by sharing resources to obtain research navigate and obtain statistical support. cardiothoracic surgery subspecialties have similar challenges to research as and sharing opportunities across all can improve the for identifying or fostering H. Bajaj S.S. Krishnan A. Heiler J.C. Williams K.M. Pickering J.M. et al.Characterization of cardiothoracic surgeons actively leading basic science research.J Surg Res. 2021; 268: 371-380Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Early in obtaining research resources will cardiothoracic surgeons to in research There is that this career is the of support each individual has may be M. 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A list of members with subspecialty, practice current and career establishing these This list the of career within cardiothoracic surgery. of how to this type of a connection with faculty members who have left your institution you can ask about or faculty members who are already the or faculty members in that with your career a new as a cardiothoracic surgeon can be from past of the for cardiothoracic surgeons of career and J.J. J.J. A. M. C. from the past and of cardiothoracic surgery Thorac Cardiovasc Surg. 2020; Full Text Full Text PDF PubMed Scopus Google Scholar these beyond a individual and require in a community of cardiothoracic surgeons building connection and networks can be mutually by identifying common challenges and productive to goals. for career can be by sharing resources, and An peer group when starting a career include other junior faculty members in different surgical subspecialties. these are a career support peers, surgeons, and to navigate early career collective