...Integrated programs will adequately train candidates that are good protoplasm/ work ethic to begin with- a good resident will succeed no matter what type of program they complete. However, there exists a substantial amount of residents who will only succeed in the "right" environment, and its this category that I think will fail miserably in an integrated program...
I was speaking to some residents & fellows recently and we were asking them just this question. Five years of GSurge is a long time with enumerable experiences that lend themselves to weeding out those that may not be suited for advanced fellowships. In recent years, numerous programs have had difficulty matching. I think I read something in which some attendings actually cited a "decrease in quality" of applicants as part of the problem. I don't know how one can improve the quality of applicants in a pool that has no residency or training experience....
...Its hard enough to get some staff to train an R-7 to do a mitral valve, how do you think they would feel training someone at the R3/4 level?...
They were talking about this too. CT surgery training programs depend heavily on the "crutch" provided by some foundation in general surgery. The residents were telling me numerous CT residencies traditionally have limited actual hands-on and can have a dramatically greater amount of "observation". From the talk, it seems like CT attendings are less then great teachers even with a student fully trained in GSurgery. An integrated program would require the attendings to take a greater direct role in both "real teaching" and also the foundation teaching. I suspect most "full professors" in CTSurg have not had to actually do that.
...staff who is dedicated to the integrated model and willing to spend the extra time necessary to develop residents with less experience than the traditional model.
Yep, that is what it sounds like talking to residents and recent grads. The staff can not be too busy. They will have to roll their sleeves up and become the primary teachers. I think any marginal 2 or 3 year program can not be expected to have the ability to run a six year integrated program. I think I googled it somewhere, the ABTS board pass rate has been the lowest ever in recent years. I heard upwards of 30% fail rate!!! As it stands, that means most of that 30% represents 2-3 year programs under the direct leadership of the current CT attendings.
I really havent heard of any current (traditonal) thoracic residents who havent taken the gen surg boards. ...personally I may not recertify in 10 years...
I actually have heard of that. I spoke with some fellows that actually failed. They said it was expensive, not required, and preparation deterred from their focus on their CT training and ABTS board preparation. They also site numerous attendings allowing their own ABS cert to lapse.
I just don't think CTVS... lend themselves to abbreviated programs well. ...At the end of the day, the infrastructure to allow an integrated model for CTVS just doesn't exist ...
If even half of what the residents/fellows have told me is true, I have to agree. It sounds like at the core is a lack of senior attending capacity for this large challenge. Again, maybe just exageration, but the residents & fellows constantly talk about excessive observation accompanied with the "go home and read (i.e. teach yourself)" ..."old school" approach. If the senior faculty and those newly arrived have been raised on that mentality and structure, I think IMHO it will be hard for them to successfully implement this new pathway.
We are not just talking about a new 80 hour work week obligation.... anyone remember that? Numerous attendings, especially the subspecialty fellowships/residencies constantly talked about an inability to train a resident under those restrictions. Well, that was with 5 years of general surgery. Looking up some of these integrated programs, they may be talking 9 months of GSurg, with some trauma, cardiology, EP, IR..... all under 80/wk. This is an enormous undertaking. If you consider that numerous attendings did not take the time to consider creative and modern ways to improve education with the work hours restriction, I doubt they can become creative with this dramatic change.
Having said all that, I believe in theory it is possible. There needs to be clear efficiency of teaching. The integrated programs are likely to be watched more closely and hopefully the marginal/weak non-teaching old-school attending staff will step up or step-out.
