Integrated cardiothoracic surgery: Navigating interviews and the match

Central MessageCritically reflecting on one's values and desires throughout surgical training will permit applicants to ask important questions of themselves programs when determining where they best fit.PerspectiveWe hope this Young Surgeon's Note can serve as a foundation for those applying integrated cardiothoracic surgery programs. We explore strategies maximize interview opportunities succeed in the match, while highlighting considerations apply how develop their rank list.See Commentaries pages 1896, 1897, 1898. Critically fit. list. See previously provided recommendations assist aspiring surgeons process developing competitive applications residency (IPs).1Smood B. Nguyen S.N. Kelly J.J. Han surgeon's note. Integrated successful application.J Thorac Cardiovasc Surg. December 10, 2019; ([Epub ahead print])Abstract Full Text PDF PubMed Scopus (10) Google Scholar individuals IPs order list (ROL). Several online resources exist interested IPs,2American Medical Association FREIDA fellowship database.https://www.ama-assn.org/life-career/search-freida-online-ama-residency-fellowship-databaseDate accessed: 30, 2019Google Scholar, 3Accreditation Council Graduate Education Program search.https://apps.acgme.org/ads/Public/Programs/SearchDate 4Thoracic Surgery Directors AssociationIntegrated thoracic programs.http://www.tsda.org/the-tsda/ct-residency-programs/integrated-residency-progamsDate including program websites, but these frequently lack additional information that may be pertinent applicants' decision making.5Miller V.M. Padilla L.A. Schuh A. Mauchley D. Cleveland Aburjania Z. et al.Evaluation websites.J Surg Res. 2020; 246: 200-206Abstract (12) Here we ability National Residency Matching Program, candidates determine ROL. These reflect our personal experiences recent application cycles incorporate solicited feedback from other resident physicians. Of course, no algorithm exists guarantee an applicant match with his or her first-choice program, readers certainly should not interpret suggestions modus operandi all who into IPs. Rather, peer guide surgeons, particularly have access mentors familiar IP process. Even outstanding face challenges matching given limited number positions unpredictability match.1Smood One survey found 60% received nearly pool, interviewed only 20 30.6Karim A.S. Meyerson S.L. The process: specialty.J 2017; 153: 1618-1620Abstract (2) In 2018, 170 (99 US medical graduates 71 international graduates) applied 36 positions. Programs average 114 out (67%) (69% 65% graduates).7Association American Colleges ERAS statistics preliminary data.https://www.aamc.org/data-reports/interactive-data/eras-statisticsDate total, 31 (86%) were filled by graduates, painting highly landscape even group filling majority positions.8National ProgramResults data 2018 main match.http://www.nrmp.org/wp-content/uploads/2018/04/Main-Match-Result-and-Data-2018.pdfDate Nevertheless, reassured still receive excellent become via general (GS) either 4 + 3 joint surgery/thoracic traditional fellowship.5Miller As such, dual both categorical GS is prudent strategy utilized more than 90% applicants.9Association cross specialty data.https://www.aamc.org/system/files/reports/1/residency-surgery.pdfDate Scholar,10Association Careers medicine: surgery–integrated.https://www.aamc.org/cim/specialty/exploreoptions/list/us/341828/thoracic_surgery-integrated.htmlDate Very few solely IPs, increasingly uncommon (only 1 6 2018).8National Although some successfully strongly discourage strategy. Developing unique difficult whose early commitments likely embody large portion accolades within applications. Some believe diminish chances programs.6Karim Scholar,11Meza J.M. Rectenwald J.E. Reddy R.M. bias against during interviews.Ann 2015; 99: 1206-1212Abstract (7) Certainly, relying too heavily merits convey single-track mindset directors, viewed neutral negative trait.11Meza However, need case. expressing interest done judiciously preparing 2 appropriately directed statements soliciting separate recommendation letters specialties. Demonstrating record commitment excellence academic surgery, regardless specialty, highlights acumen work ethic generally attractive There strong impetus high programs, GS, avoid risk at all. there point which becomes superfluous. For Board scores (≥239), benefit diminishes about applications.12Association Apply smart.https://students-residents.aamc.org/applying-residency/filteredresult/apply-smart-data-consider-when-applying-residency/Date Unfortunately, similar regarding diminishing returns available applicants. Most dual-program 30 non-IPs (ie, usually GS) addition (Figure 1).7Association combination reasonable sufficient, argue every because interviews always declined once offered. requires honest reflection competitiveness Highly comfortable fewer just less-competitive feel buffer applications.6Karim secure apply. been encouraging. Among applicants, ranking 11 programs.13National ProgramCharting outcomes match: allopathic seniors.https://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-Seniors.pdfDate are published caveats perspectives, suggest aim total. It attend 10 15 interviews,6Karim attending so many excessive significant invitations having higher proportion portends likelihood IP. Thus, although it broadly, realize sent, costs logistical associated interviewing. Moreover, underestimate demands repetitive interviews. Exhaustion reflected performance unintentionally perceived enthusiasm. To minimize fatigue, genuinely eagerly envision training. expect begin receiving offers October; however, delayed through November set take place January February. logistically able attend. Because dates overlap across institutions, one scheduling conflicts. This offer date, whereas others multiple first-come-first-served basis. Therefore, make effort respond soon possible reserve your desired date. Two tools helpful you First, Thoracic publishes previous year's (and instances, upcoming season).4Thoracic About one-third publish division websites.5Miller prudent, albeit time consuming, master calendar past future if listed) individual around same each season. With data, anticipate potential conflicts, days select offered program. A second tool useful creating e-mail address application-related correspondences. Many midst demanding visiting electives invitations. Providing trusted confidant account enable them scrubbed cases subinternships sent. Sharing aforementioned detailed prioritized help ensure pending left invited, single date expected schedule rotation, note traveling exceptionally busy early- mid-November January. recommend completing before focus Ideally, interviewing anxiety-provoking experience. Applicants pride chosen talented self-selecting pool Interviews culmination years hard opportunity lifetime demonstrate why would enjoy spending better part decade applicant. extent, what follows determination fit.14Woo Y.J. Baker C. Colson Y. Cooke D.T. Fann J. Goldstone Lessons learned: roundtable discussion succeeding practice.Semin 2018; 30: 293-303Abstract (3) intangible synergism acts facilitate collaboration among like-minded institutions residents, provides ideal environment education. also prepared talk anything detail, career path aspirations. reiterate, considering apply, think articulate looking attributes trainee thrive field, specifically, culture institution. remember gather much ultimately factor Each different varying degrees ROL, find perfect fit facets. Conversing current trainees integral vantage points understanding nuances curriculum Candid discussions education life outside hospital assess elements hold value system recall aspects months later finalize several heterogeneously valued (Table 1). discussed importance, weighted respect applicant's preferences.Table 1Considerations listVariable considerSupporting pointsVariety cardiac training-Equivalent dedicated rotations-Emphasized surgery-Ability elect surgery-Surgical exposure variety-Territory foregut operations (thoracic vs surgeons)-Minimally invasive/video-assisted open procedures-Robotic surgery-Transcatheter techniques-Subspecialty (congenital, transplantation, other)Operative experience: Volume autonomy-Total operative volume capacity perform cases-Complexity variety cases-Resident cover autonomy-Components performed levels-Difficulty meeting any graduation case requirements-Adherence 80-h week-Presence residents fellowsNonoperative duties: Clinic experience patient management-Clinic requirements-Role fielding consults preoperative evaluation-Postoperative management intensive care units wards-Advanced practice providers supporting staff-Non-operative responsibilities senior yearsTraining sites-Presence Veterans Administration hospital-Exposure community/private models-Number hospitals required cover-Distance between rotation sitesAcademic pursuits-Emphasis toward surgeon–scientists-Supportive careers private practice-Requirements inability research time-Flexibility allotment pursuits-Flexibility character pursuits (clinical fellowships, travel institutions)-Advanced offered-Funding research-Support presenting conferencesFellowships-Offer fellowships specific aspirations-Accessible field specialtyWork–life balance community-Geographic preferences-Outdoor activities-Housing prices-Job spouses-Local schools-Familial status colleagues-Sense community amongst residentsInstitutional culture-Frequency structure didactics-Formal mentorship-Resident-faculty dynamics-Culture operating room environment-Faculty fluidity Open table new tab remain open-minded aspirations must well rounded. consciously dedicate equivalent rotations entirety years. committed specializing might prefer broad initial areas, elected advance schedules proportionally surgery,15Tchantchaleishvili V. LaPar D.J. Stephens E.H. Berfield K.S. Odell D.D. DeNino W.F. Current residents: Residents survey.Ann 1040-1047Abstract (23) suitable evaluate procedures, prevalence thoracotomies, robotic and/or video-assisted thoracoscopic surgery. Determine whether institution, area often shared surgeons.14Woo respect, abdominal surgery.16Tchantchaleishvili Barrus Knight P.A. Jones C.E. Watson T.J. Hicks G.L. Six-year applicants: characteristics, expectations, concerns.J 2013; 146: 753-758Abstract (33) consider residency. Whereas necessarily provide adequate fulfilling requirements, concentrated emphasis surgery.14Woo Scholar,17Zhu A.B. Woo J.Y. residency: evolution.Semin 31: 345-349Abstract (16) subspecialization (eg, heart failure/mechanical circulatory support, aortic endovascular/transcatheter, congenital) identify field.17Zhu Graduating pursue after residency, direct transplant transcatheter accrued sufficient Determining meet such benchmarks consideration subspecialization. Ultimately, goals being sufficiently marketable upon interests change. considerable heterogeneity IPs.18Stephens Walters D.M. Eilers A.L. Tchantchaleisvili Gillaspie E.A. al.Variability curriculum.Ann 103: 1984-1991Abstract Evaluate based factors volume, cases, degree autonomy. Operative assessed speaking accumulate lion's share Simple metrics include per week, viewing residents' total logs graduation, difficulties requirements. introduce graduated over establishing introduced various components cannulation, harvesting internal artery, sewing distal anastomoses. evaluating autonomy, institution's educational culture, fellows side table. Keep mind assisting performing primary surgeon, levels complexity, uniquely lessons trainees.19Tolis G. Cardiac training: disincentivized necessity.Eur J Cardiothorac 55: 173-178Crossref (5) autonomy vary resident's technical level, attendings' willingness assist. patterns gleaned asking right questions. An ratio capacity. If far exceeds demand frequent coverage evenings, overnight, weekends. require in-house call, allow call home. procurements, optional. notion routinely surpassing 80-hour recognize uncommon,15Tchantchaleishvili protecting well-being, work-hour regulations. time, thus practical limitations feasibly participate, matter institution has. Also larger relieving coverage, reduce part. Furthermore, institutional day staff, units, availability limited. valuable understand evolving coming Recognize beyond contribute development surgeon. paramount facets considered, clinic requirements perioperative management. involved duties varies institutions,18Stephens interviews.5Miller On end spectrum, largely responsible decisions unit, floor, times week. essential clinical necessary managing patients nonoperative duties, years, interrupt spend room. At minimal monthly infrastructure moment-to-moment team intensivists advanced providers. When clinics function independently discipline ownership competent care. Understanding direction models light own preferred learning environments, balancing (VA) hospitals, resident-run services aspect presentation consults, indicated, operations, postoperatively. decision-making skills. VA tends lower centers, administrative comparatively diminished. hospitals. off-campus isolating training, needing transportation commuting sites burdensome. Conversely, private, community, vastly different, acuity, volume. Trainees versus practice. prioritize surgeon–scientists equally supportive required, optional, strictly forbidden crucial ROL.18Stephens ambitions, like participate earning time. know flexible decide want less expected. clinically focused (such critical care) inquire program's support endeavors case, funding independent grants. Similarly, leave national conferences. essential, subspecialized careers. aspirations, specialties interest, congenital, aortic, transplantation). foster relationships trainee's advocate behalf comes fellowships. well-being tremendous influence overall success. work–life taken perspective intense surrounding working. Geographic preferences reasons, nearby outdoor activities, social scene, housing prices, job spouses, local schools relevant. mix spouses children, attract family commitments. coworkers almost anyone else makes concerted cultivate distinct sense residents. camaraderie experienced brief insight anticipated. Realize communities personalities. Didactic conferences held week structured mentoring consist rare relatively informal mentorship. emphasized mentorship complement self-directed Dynamics faculty vary. clearly hierarchical, first-name basis surgeons. rooms extremely intense. Others calmer demeanor maintains urgency striving outcomes, harshly delivered encouragement. ascertain environment. revisiting look drawn permitted. inevitably interact admire interpersonal choose relationship, experience, expectation individual. Leadership changes fluid. inspired excited train Wherever matches, satisfied15Tchantchaleishvili appreciate peers, whom lives. helps qualities most train. More anything, efforts, discipline, finish independence