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Training the novice to become cardiac surgeon: does the “early learning curve” training compromise surgical outcomes?

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Abstract

Objective

It is unclear whether novice trainees can be taught safely to perform adult cardiac surgery without any impact on early or late outcomes.

Methods

All patients (n = 1305) data were obtained from an externally validated, mandatory institutional database (2003–2010). ‘Novice’ is defined as a trainee who required substantial assistance or supervision to perform part or whole of the specified procedure (Intercollegiate Surgical Curriculum Programme UK, Competency Level ≤2). Outcome measures were in-hospital mortality, composite score of in-hospital mortality-morbidities, mid-term survival and revascularisation rate after CABG. Follow-up up to 7 years (median 3.2 years) was determined.

Results

Some 39 % (n = 510) of the cases involved novice (28 %-part, 11 %-whole procedure), 12 % (n = 157) competent trainees and 49 % (n = 638) consultant. Median EuroSCORE was higher in consultant group (p < 0.001). Without risk adjustment, composite outcome score and mid-term mortality were higher in consultant group (p = 0.03). With adjustment using EuroSCORE and propensity scores, EuroSCORE was significantly predictive of in-hospital mortality [odd ratio (OR) 1.38, 95 %CI 1.20–1.57, p < 0.001], composite outcome (OR 1.26, 95 %CI 1.15–1.37, p < 0.001) and mid-term mortality (HR 1.24, 95 %CI 1.18–1.31, p < 0.001) but not the operator categories. Further analysis of subcohort undergoing first-time, isolated CABG (n = 1070) showed that EuroSCORE remained predictive of adjusted in-hospital mortality (OR 1.39, 95 %CI 1.13–1.71, p = 0.002), composite outcome (OR 1.33, 95 %CI 1.19–1.49, p < 0.001) and mid-term mortality (HR 1.22, 95 %CI 1.10–1.35, p < 0.001). The operator categories were not associated with adjusted outcome measures including revascularisation rate after CABG.

Conclusion

Supervised training in adult cardiac surgery can be achieved safely at the early learning curve phase without compromising both early and mid-term clinical outcomes.

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References

  1. Kron IL. Surgical mentorship. J Thorac Cardiovasc Surg. 2011;142(3):489–92.

    Article  PubMed  Google Scholar 

  2. Alexiou C, Doukas G, Oc M, Oc B, Hadjinikolaou L, Spyt TJ. Effect of training in mitral valve repair surgery on the early and late outcome. Ann Thorac Surg. 2005;80(1):183–8.

    Article  PubMed  Google Scholar 

  3. Asimakopoulos G, Karagounis AP, Valencia O, Rose D, Niranjan G, Chandrasekaran V. How safe is it to train residents to perform off-pump coronary artery bypass surgery? Ann Thorac Surg. 2006;81(2):568–72.

    Article  PubMed  Google Scholar 

  4. Caputo M, Chamberlain MH, Ozalp F, Underwood MJ, Ciulli F, Angelini GD. Off-pump coronary operations can be safely taught to cardiothoracic trainees. Ann Thorac Surg. 2001;71(4):1215–9.

    Article  CAS  PubMed  Google Scholar 

  5. Haan CK, Milford-Beland S, O’Brien S, Mark D, Dullum M, Ferguson TB, et al. Impact of residency status on perfusion times and outcomes for coronary artery bypass graft surgery. Ann Thorac Surg. 2007;83(6):2103–10.

    Article  PubMed  Google Scholar 

  6. Jenkins DP, Valencia O, Smith EE. Risk stratification for training in cardiac surgery. Thorac Cardiovasc Surg. 2001;49(2):75–7.

    Article  CAS  PubMed  Google Scholar 

  7. Oo AY, Grayson AD, Rashid A. Effect of training on outcomes following coronary artery bypass graft surgery. Eur J Cardiothorac Surg. 2004;25(4):591–6.

    Article  PubMed  Google Scholar 

  8. Goodwin AT, Birdi I, Ramesh TP, Taylor GJ, Nashef SA, Dunning JJ, et al. Effect of surgical training on outcome and hospital costs in coronary surgery. Heart. 2001;85(4):454–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Yap CH, Andrianopoulos N, Dinh TD, Billah B, Rosalion A, Smith JA, et al. Short- and midterm outcomes of coronary artery bypass surgery performed by surgeons in training. J Thorac Cardiovasc Surg. 2009;137(5):1088–92.

    Article  PubMed  Google Scholar 

  10. Stoica SC, Kalavrouziotis D, Martin BJ, Buth KJ, Hirsch GM, Sullivan JA, et al. Long-term results of heart operations performed by surgeons-in-training. Circulation. 2008;118(14 Suppl):S1–6.

    Article  PubMed  Google Scholar 

  11. Cohen MS, Jacobs JP, Quintessenza JA, Chai PJ, Lindberg HL, Dickey J, et al. Mentorship, learning curves, and balance. Cardiol Young. 2007;17(Suppl 2):164–74.

    PubMed  Google Scholar 

  12. Hasan A, Pozzi M, Hamilton JR. New surgical procedures: can we minimise the learning curve? BMJ. 2000;320(7228):171–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Shuhaiber JH, Goldsmith K, Nashef SA. Impact of cardiothoracic resident turnover on mortality after cardiac surgery: a dynamic human factor. Ann Thorac Surg. 2008;86(1):123–30.

    Article  PubMed  Google Scholar 

  14. D’Agostino RB Jr. Propensity scores in cardiovascular research. Circulation. 2007;115(17):2340–3.

    Article  PubMed  Google Scholar 

  15. Wu AH, Aaronson KD, Bolling SF, Pagani FD, Welch K, Koelling TM. Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. J Am Coll Cardiol. 2005;45(3):381–7.

    PubMed  Google Scholar 

  16. Wright T. Factors affecting the cost of airplanes. J Aeronaut Sci. 1936;3(4):122–8.

    Article  Google Scholar 

  17. Beard J, Rowley D, Bussey M, Pitts D. Workplace-based assessment: assessing technical skill throughout the continuum of surgical training. ANZ J Surg. 2009;79(3):148–53.

    Article  PubMed  Google Scholar 

  18. Beard JD. Assessment of surgical skills of trainees in the UK. Ann R Coll Surg Engl. 2008;90(4):282–5.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Marriott J, Purdie H, Crossley J, Beard JD. Evaluation of procedure-based assessment for assessing trainees’ skills in the operating theatre. Br J Surg. 2011;98(3):450–7.

    Article  CAS  PubMed  Google Scholar 

  20. Khan OA, Iyengar S, Pontefract DE, Rogers V, Ohri SK, Livesey SA. Impact of surgeon-specific data reporting on surgical training. Ann R Coll Surg Engl. 2007;89(8):796–8.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Maddaus MA. Would I do it again? Evolution to a new training paradigm. J Thorac Cardiovasc Surg. 2010;140(1):8–9.

    Article  PubMed  Google Scholar 

  22. de Leval MR, Carthey J, Wright DJ, Farewell VT, Reason JT. Human factors and cardiac surgery: a multicenter study. J Thorac Cardiovasc Surg. 2000;119(4 Pt 1):661–72.

    Article  PubMed  Google Scholar 

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Acknowledgments

Dr David Young Ph.D. from Department of Statistics and Modelling Science, University of Strathclyde, Glasgow reviewed the statistical method and results in this study. Richard Gadd, Amir Tahvili and Louisa Yates provided assistance in retrieving data.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK

    Ed Peng

  2. Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK

    Pradip K. Sarkar

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  1. Ed Peng
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  2. Pradip K. Sarkar
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Correspondence to Pradip K. Sarkar.

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Peng, E., Sarkar, P.K. Training the novice to become cardiac surgeon: does the “early learning curve” training compromise surgical outcomes?. Gen Thorac Cardiovasc Surg 62, 149–156 (2014). https://doi.org/10.1007/s11748-013-0321-6

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  • DOI: https://doi.org/10.1007/s11748-013-0321-6

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