Cardiothoracic Surgery Fellowship-- is research needed?

[MD927]

Hello, I am a general surgery resident. I wasn't sure what specialty I wanted to pursue when I graduated medical school and entered residency but now am considering a CT fellowship. My general surgery residency program has the option to do two years of research or go straight through and finish in five. I am not 100% sure want to do research but I would like to be competitive for a future fellowship/ leaning towards a CT fellowship. Seeking advice: do you need to do research to get into a good fellowship program (specifically CT) or can you go straight through (with a respectable medical school/ residency program background) and still get a good match? Thank you in advance!

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[filter07]

Hello, I am a general surgery resident. I wasn't sure what specialty I wanted to pursue when I graduated medical school and entered residency but now am considering a CT fellowship. My general surgery residency program has the option to do two years of research or go straight through and finish in five. I am not 100% sure want to do research but I would like to be competitive for a future fellowship/ leaning towards a CT fellowship. Seeking advice: do you need to do research to get into a good fellowship program (specifically CT) or can you go straight through (with a respectable medical school/ residency program background) and still get a good match? Thank you in advance!

Only do research if you want to do research. Doing research to match is really not worth it in my opinion. CT is not hard to match into.

 

[Winged Scapula]

Only a few fellowships essentially require research; I would not include CTS in that group.

 

[jc7721]

If you want to get into the top programs: such as (but not limited to, and of course different for thoracic and cardiac) Virginia, Duke, WashU, Stanford, and the list goes on and on, then you will be up against applicants who have mostly done research. This is a small group of applicants with the research background of course, since CT is still not that competitive (like onc, plastics, peds), but that small group of researchy residents basically fills all the top programs. Been there. Can't avoid the reality that the programs that people put on a pedestal (whether deserved or not) attract the best (and sometimes most narcissistic) applicants that did the research thing. Faculty definitely factor research in at these programs. Sometimes these applicants go on to be researchers, and sometimes research was just a 2 year hiatus to pad the resume. If you choose not to do research, you can still be competitive for these programs if you publish. If you don't do any research, with no publications, no lab time, and expect to get into a top program on your LOR and residency pedigree, my guess is it won't work. But do you really need to go to those programs. No.

 

[dienekes88]

If you want to get into the top programs: such as (but not limited to, and of course different for thoracic and cardiac) Virginia, Duke, WashU, Stanford, and the list goes on and on, then you will be up against applicants who have mostly done research. This is a small group of applicants with the research background of course, since CT is still not that competitive (like onc, plastics, peds), but that small group of researchy residents basically fills all the top programs. Been there. Can't avoid the reality that the programs that people put on a pedestal (whether deserved or not) attract the best (and sometimes most narcissistic) applicants that did the research thing. Faculty definitely factor research in at these programs. Sometimes these applicants go on to be researchers, and sometimes research was just a 2 year hiatus to pad the resume. If you choose not to do research, you can still be competitive for these programs if you publish. If you don't do any research, with no publications, no lab time, and expect to get into a top program on your LOR and residency pedigree, my guess is it won't work.

Agree: there's always competition at the top.

But do you really need to go to those programs. No.

Probably depends on overall goals.

Most - if not all - programs out there should be able to produce a safe surgeon who is able to do an AVR or CABG with the usual 3. Even with the fellowship contraction in the face of the I6 programs, I think there are still a lot of fellowship programs and only about 20 integrated programs.

On the other hand, if the OP wants to do some of the more complex operations, to which the residents likely will have more exposure at one of these large high volume referral centers that you have referenced, then going to one of these programs - and thus doing research - could be of benefit.

 

[el_pistolero]

Most - if not all - programs out there should be able to produce a safe surgeon who is able to do an AVR or CABG with the usual 3. Even with the fellowship contraction in the face of the I6 programs, I think there are still a lot of fellowship programs and only about 20 integrated programs.

On the other hand, if the OP wants to do some of the more complex operations, to which the residents likely will have more exposure at one of these large high volume referral centers that you have referenced, then going to one of these programs - and thus doing research - could be of benefit.

Besides CABG and open AVR, what additional skill-sets are required by a CT surgeon in order to make him/herself more "marketable" in the future? PCI? TEVAR? LVAD? Adult ECMO?

 

[ThoracicGuy]

Besides CABG and open AVR, what additional skill-sets are required by a CT surgeon in order to make him/herself more "marketable" in the future? PCI? TEVAR? LVAD? Adult ECMO?

If you are interested, there are fellowships after your CT training that can add to your marketability:

Congenital
Heart failure/transplant
Minimally invasive thoracic
Minimally invasive cardiac

 

[dienekes88]

Besides CABG and open AVR, what additional skill-sets are required by a CT surgeon in order to make him/herself more "marketable" in the future? PCI? TEVAR? LVAD? Adult ECMO?

A lot of thing can be covered in a variety of super fellowships (as below), with the exception that it is quite unusual for a cardiac surgeon to be doing PCI. I honestly only know of one. The super specialized stuff is a definite selling point for your practice and marketability for jobs.

TEVAR is not technically complicated like EVAR unless you venture into zone zero deployment or using branched devices in zone 2 deployment. So this should probably be covered in a cardiac fellowship and definitely in an I6.

I wish I had an answer for you for what the cardiothoracic surgeon of tomorrow needs to know to be successful and marketable. I also ask around and try to figure out for myself! I imagine that the academic cardiothoracic surgeon of tomorrow is going to be super specialized, but the community cardiac surgeon is also going to need a few tricks up his/her sleeve like port access mitral, MIDCAB, or mini-AVR. The utility of adult ECMO and LVAD in the community is going to be largely limited by your support structure, the size of your ICU, experience of your intensivists, cardiology buy-in, quality of your ward team, etc.

If you are interested, there are fellowships after your CT training that can add to your marketability:

Congenital
Heart failure/transplant
Minimally invasive thoracic
Minimally invasive cardiac

Agree.

There are also fellowships in aortic surgery and TAVR.

Some places have high enough volume that you won't need an extra fellowship to do some of the minimally invasive stuff, aortic, and even actually LVAD and transplant.

 

[deleted50541]

Only do research if you want to do research. Doing research to match is really not worth it in my opinion. CT is not hard to match into.

That may have been true in the past, but this year's CT match was especially competitive. Every program matched, leaving a fair number of folks without a spot.

I took a year off to do research and it was highlighted at every interview I went to. I wasn't shooting for a top program, but did match at one of my top choices.

That said, I agree that doing research just to pad your CV isn't worth it, especially if not much comes of it, e.g. presentations, publications.

 

[SLUser11]

That may have been true in the past, but this year's CT match was especially competitive. Every program matched, leaving a fair number of folks without a spot.

I took a year off to do research and it was highlighted at every interview I went to. I wasn't shooting for a top program, but did match at one of my top choices.

That said, I agree that doing research just to pad your CV isn't worth it, especially if not much comes of it, e.g. presentations, publications.

http://www.nrmp.org/wp-content/uploads/2015/02/Results-and-Data-SMS-2015.pdf

Some stats on the fellowship match. To me, one of the most reliable determinants of competitiveness is % matched by US allopathic grads. Thoracic surgery definitely had a competitive year. It's probably best to trend this over a couple years before insisting that the sky is falling, but certainly this is concerning for current residents interested in CTS.

In my opinion, a resident should do research if he/she specifically has a desire to do research. However, it is not mandatory to match into the majority of surgical fellowships, therefore he/she shouldn't feel obligated to take time for research just to improve match statistics. Traditionally, pediatric surgery and surgical oncology were the two fellowships that required research. However, it will be looked upon fondly by ALL fellowships, so it will be a feather in your cap even if you apply to transplant, or some other non-competitive specialty.

Anecdotally, I have a friend who recently finished up at Wash U CTS coming from a community program without any research. I also have 2 recent resident graduates who matched into Surg Onc without dedicated research years during residency. I am not pointing this out to discourage research...instead, I simply want residents to choose research for the right reasons.

 

[addy]

I also have 2 recent resident graduates who matched into Surg Onc without dedicated research years during residency. I am not pointing this out to discourage research...instead, I simply want residents to choose research for the right reasons.

Were these guys really involved with research throughout residency? Past PhD's?

 

[CTFellowMD]

http://www.nrmp.org/wp-content/uploads/2015/02/Results-and-Data-SMS-2015.pdf

Some stats on the fellowship match. To me, one of the most reliable determinants of competitiveness is % matched by US allopathic grads. Thoracic surgery definitely had a competitive year. It's probably best to trend this over a couple years before insisting that the sky is falling, but certainly this is concerning for current residents interested in CTS.

I agree with a lot of what is being said, especially this. CT is no longer an easy match -- it has become extremely competitive. The last two cycles have had an approx 70% match rate (vs 95%+ over the last 10 years).

I posted the stats from 2015 in a previous thread:
In 2011 there were 99 applicants for 113 spots. // Last year, 114 applicants for 87 spots.
Last year they listed 4 unfilled spots (in reality, only 2 - Kansas and Nebraska), and 31 unmatched applicants (overall 73% match rate)
If you look at only US grads, there were 87 applicants, 65 who matched (75% match rate)

For 2016 appointment year there were no unfilled spots.

If you don't want to do research, don't take dedicated time off for it. Training is long enough as it is. However, you should do some sort of scholarly activity during you residency to make yourself stand out -- case reports/series, videos, posters. This stuff is easy to get do and get accepted. Get a few lines on your CV and that should be enough with some strong letters and decent absite scores to get into an average/above average CT fellowship. If you want one of the historical powerhouses -- michigan, Wash U, Duke, etc, then Yes, you will likely need dedicated lab time.

 

[ThoracicGuy]

I agree with a lot of what is being said, especially this. CT is no longer an easy match -- it has become extremely competitive. The last two cycles have had an approx 70% match rate (vs 95%+ over the last 10 years).

I posted the stats from 2015 in a previous thread:
In 2011 there were 99 applicants for 113 spots. // Last year, 114 applicants for 87 spots.
Last year they listed 4 unfilled spots (in reality, only 2 - Kansas and Nebraska), and 31 unmatched applicants (overall 73% match rate)
If you look at only US grads, there were 87 applicants, 65 who matched (75% match rate)

For 2016 appointment year there were no unfilled spots.

If you don't want to do research, don't take dedicated time off for it. Training is long enough as it is. However, you should do some sort of scholarly activity during you residency to make yourself stand out -- case reports/series, videos, posters. This stuff is easy to get do and get accepted. Get a few lines on your CV and that should be enough with some strong letters and decent absite scores to get into an average/above average CT fellowship. If you want one of the historical powerhouses -- michigan, Wash U, Duke, etc, then Yes, you will likely need dedicated lab time.

Wow, things sure have changed quickly. I suppose that's what happens when you have so many I6 programs going and less traditional pathway programs.

 

[deleted123544]

Hey everyone, Happy Holidays! I am currently a 3 yr and I have grown an interest for the 4+3 program. Do you guys have any recommendations in applying to these? I also have to turn in my 4th yr schedule soon and I don't know what to do in regards to away rotations. Any advice on that as well? I don't know if it is better to apply to general surgery aways in 4+3 programs or to do CT surgery aways. As it is traditional, Ill be looking to apply to I6 and to general surgery but I am kind of loss and at my school the advise isn't the greatest. Any suggestions anyone can swing my way would be awesome! Thank you all and Merry Christmas.