Thoracic surgery differs across the globe, but is one style of training superior to another? If it is the sheer amount of training, and time devoted to training in thoracic surgery, then by all accounts – Japan (with a twelve-year residency for potential thoracic surgeons*) is way out in front. Or, as Komatsu suggests, is it more cases in a shorter, more intensive training period?
Of course, part of the confusion regarding the training and practice of thoracic surgery is related to the nomenclature itself. As many of the surgeons I have interviewed have remarked or advocated – “Thoracic surgery, is in itself a complex surgical specialty required advanced skills and knowledge.” Few would dispute that. But then again, how would they define it?
In many countries, including my own, “thoracic surgery” may actually specify ‘cardiothoracic surgery’. In fact, cardiac surgeons in the USA (and several other countries) are not board certified in cardiac surgery – but within the broad umbrella of ‘thoracic surgery,’ and that’s where the confusion begins.
For dedicated thoracic surgeons (versus the more broad-based ‘cardiothoracic surgeons’) this is just a symptom of the problems within the specialty AND its training programs. As many of these surgeons have suggested, as general thoracic surgery has expanded and become more complex (with robotic, thoracoscopic and minimally invasive techniques being developed to treat more advanced diseased and conditions), a broad-based training program may no longer suffice. Indeed, with recent studies showing that over one-fifth of thoracic surgery residents in the USA being devoted to sole thoracic practice only, the time may have come for significant changes in our training programs. Gasparri, Tisol & Masroor (2012) recently published an article on the six-year integrated thoracic surgery program but these programs seek to integrate cardiothoracic training into what was previous the fifth year of general surgery (to shorten training by one year rather than to segregate cardiac and thoracic surgery into separate kingdoms.
In comparison to the United States – several countries offer specialty surgical training as thoracic surgery only. Conceptually, this makes more sense, as this training method may give better grounding than mixed programs. Unfortunately, there isn’t a lot of definitive data to suggest one method is superior to another.
However, in my humble opinion, as thoracic surgery continues to advance into more specialized and technically challenging procedures to treat a widening array of thoracic and mediastinal disease – thoracic surgery will require surgeons to devote themselves to continuing knowledge and skills acquisition to the exclusion of cardiac surgery. It’s already started, on some level – most of the great thoracic surgeons (and many of the surgeons profiled here) have elected to forgo cardiac surgery.
Komatsu T. (2011). Reflecting the thoracic fellowship in Canada as a Japanese thoracic surgeon: is there anything we should follow? Ann Thorac Cardiovasc Surg. 2011;17(4):327-331. (I must admit a partiality to Dr. Kotmatsu for his work on the role of nurse practitioners in thoracic surgery.)
Reddy VS, Calhoon JH (2010). Cardiothoracic surgical education: the ideal platform for tomorrow’s surgeon. Tex Heart Inst J. 2010;37(6):656-7.