Forum młodych chirurgów
Cardiac Surgery Training in Canada – Thoughts of a Resident

Cardiac surgery is changing, new catheter based technology, minimally invasive and robotic coronary artery bypass grafting (CABG) and mitral valve surgery, expanding surgical treatment of heart failure with mechanical support and stem cell transplantation and percutaneous aortic valve and mitral valve surgery are just some of the future endeavours in cardiac surgery. Training in cardiac surgery during these times is difficult. Trying to decide on the direction of one's training is not easy, gone are the times when an extra year in off-pump CABG was all that was needed to obtain a job in cardiac surgery. Not only are there a paucity of jobs these days but the amount of basic training and extra subspecialty training the current trainees have to do is enormous. With the cardiac surgery specialty changing so much residency training must change in parallel. It is with the following that I think cardiac surgery training in Canada is excellent. Years ago Canada began to train cardiac surgeons directly out of medical school, with two years of core general surgery training followed by focused training in cardiac surgery and its related subspecialties, like vascular surgery, thoracic surgery and pediatric cardiac surgery. This allowed the time for basic training to be completed in a shorter amount of time. It is with this in mind that many cardiac surgery programs in the USA are adopting a similar approach. This change was driven by the fact that it is not appropriate anymore to train cardio-vascular-thoracic surgeons. There is so much to learn that each division has branched out into its own entity. In my opinion the focused training in basic cardiac surgery and with it the earlier introduction of the trainees to the technical aspects of the specialty is the first strength of the cardiac surgery residency training in Canada. The next change I believe will be training in a division of cardiac sciences. This would be the close partnership between cardiac surgery and cardiology. Cardiac surgery training in Canada is already adopting this idea in the fact that in Canada cardiac surgery residents already perform 9 months of cardiology rotations, including, general cardiology, coronary care unit, electrophysiology, diagnostic interventional cardiology, interventional cardiology, echocardiography and heart failure rotations. This has grown in the last 3-4 years with the realization that bridging the gap between cardiologist and cardiac surgeons will only enhance both specialties. This is clearly illustrated by the new Mazankowski Heart Institute in Edmonton, Alberta, Canada in which cardiologist, cardiac surgeons and pediatric cardiac surgeons all work together in one state of the art institute. Working much closer together with our cardiology colleges is another strength of the cardiac surgery residency training in Canada. Finally, the six year training program in cardiac surgery designates one year for enrichment training. This year can be academic or clinical in nature and is solely in the hands of the trainee to set up. This year is outstanding in that it allows for academic work if in the future the trainee sees him/herself as being a clinical scientist or clinical work in a highly specialized subspecialty in cardiac surgery if in the future the trainee sees him/herself as a pure clinician. Further this year is completely sponsored by the trainee's home program taking away the hassle of trying to find money to complete such away rotations. As mentioned before it is not enough to perform basic cardiac surgery training, trainees these days must find something that will make them more marketable, this involves a clinical forte. This enrichment year can be used as precursor to obtaining basic catheter skills or introducing oneself to the art of robotic surgery in an away rotation. These rotations done at a more junior level (usually post graduate year – 4) don't allow the trainee to be considered to be specialized in such a field but allow the trainee to be introduced to the future of cardiac surgery with the plan of completing an official fellowship in such subspecialties in the future. I truly believe that the future of cardiac surgery is very bright and changes in the specialty and changes in the clinical training as mentioned above will allow trainees in cardiac surgery to be well prepared for what the future holds. I hope the changes that the Canadian cardiac surgery training program has introduced can be adapted to enhance the clinical and academic training of cardiac surgery in Poland, which I hope to be a part of in the very near future. The following are the Canadian cardiac surgery objectives in training and cardiac surgery specialty training requirements as published by the Royal College of Physicians and Surgeons of Canada (RCPSC). I'd like to sincerely thank the RCPSC for their permission to publish the two documents.