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Ann Thorac Surg 1998;65:13-16
© 1998 The Society of Thoracic Surgeons
Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
Dr Baumgartner, The Johns Hopkins Hospital, 600 N Wolfe St, Blalock 618, Baltimore, MD 21287.
Presented at the Forty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Naples, FL, Nov 6–8, 1997.
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 than 90% of the respondents agreed that having "experienced, involved faculty serving as mentors’ enhanced the development of mature clinical judgement" [5]. Although there were several important recommendations and proposals that were developed at the Joint Conference, the development of a thoracic surgical curriculum was reemphasized [6]. The goal and objective of every thoracic surgery residency program is to produce an individual who " ... has a sound knowledge of thoracic disease, and possesses appropriate operative skills. The residency curriculum should emphasize social consciousness, sound ethics, a commitment to continuing self-education and adaptability" [6].
In 1994, Drs Robert Salley and Stan Nolan, under the direction of the Thoracic Surgery Directors Association (TSDA), spearheaded the development of a comprehensive curriculum for thoracic surgery education. They enlisted the help of several thoracic surgeons in the development of an outline that specifically incorporates information basic to all aspects of thoracic surgery. In the past year, the TSDA has created a committee entitled "Curriculum Implementation Task Force" to explore the newer technological communication developments for the establishment of content for the curriculum. This committee received further endorsement and support as part of an action plan proposed at the Thoracic Surgery Directors Association retreat, which was held in Chicago in 1996 [7]. Several aspects of surgical education were discussed at this retreat. Various action plans were developed to carry out the strategic directions of the TSDA. In addition to providing content to the core curriculum using a variety of newer informational technology tools, the meeting addressed a prerequisite curriculum in detail.
Internet technology has set the stage for this revolution in thoracic surgical education. The development of a cardiothoracic surgery Web site on the Internet (www.ctsnet.org) provides an excellent vehicle for information dissemenation and education for all organizations involved in thoracic surgery (Fig 1). This will become a particularly important conduit for surgery resident education. With each of these organizations having its independent domain on CTSNet, there can be an organized and consistent approach to the publishing of content.
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The current emphasis in our specialty of thoracic surgery has been appropriately placed on thoracic surgical education. In addition to the time-proven mentor approach to training that is exemplified in several programs throughout the country, the newer informational and technological advances will provide our future residents with the knowledge base necessary for their successful practice. Considerable effort has already been expended in the outline development of the comprehensive thoracic surgical curriculum. The challenge to all of us is to prepare the appropriate content for that curriculum in an expeditious manner.
Acknowledgments
I acknowledge the help and expertise of Dr John R. Doty, Dr John R. Liddicoat, Dr Peter S. Greene, Dr Jorge D. Salazar, and Mr Monish Bhatia.
References
This article has been cited by other articles:
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  J. P. Gold, W. B. Begg, D. A. Fullerton, D. J. Mathisen, M. B. Orringer, and E. D. Verrier Evaluation of Web-Based Learning Tools: Lessons Learned from the Thoracic Surgery Directors Association Curriculum Project Three-Year Experience Ann. Thorac. Surg., September 1, 2005; 80(3): 802 - 810. [Abstract] [Full Text] [PDF]
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J. P. Gold, E. A. Verrier, G. N. Olinger, and M. B. Orringer Development of a CD-ROM internet hybrid: a new thoracic surgery curriculum Ann. Thorac. Surg., November 1, 2002; 74(5): 1741 - 1746. [Full Text] [PDF]
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 W. A. Baumgartner and R. S. Stuart Building a clinical program in a single institution J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): S12 - 16. [Abstract] [Full Text] [PDF]
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W. A. Baumgartner Reassessing our core values Ann. Thorac. Surg., February 1, 2000; 69(2): 321 - 325. [Full Text] [PDF]
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F. A. Crawford Jr Thoracic surgery education Ann. Thorac. Surg., February 1, 2000; 69(2): 330 - 333. [Full Text] [PDF]
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