Ensuring Safe Skies: Navigating the Challenges of Cardiothoracic Surgery Training

Maria Comanici, Dr Maria Comanici is a Junior Clinical Fellow in Cardiothoracic Surgery at Harefield Hospital in London, UK. Her main interest lies in adult and congenital cardiac surgery, and she has made valuable contributions to the field through several peer-reviewed publications.

Cardiothoracic surgery training is a rigorous process with several challenges that can compromise the appropriate exposure of young surgeons to operative experience. Strategies such as simulation training, appropriate supervision and mentoring, effective communication and teamwork, patient selection, and competency-based training are essential to ensure safe and effective practice in cardiothoracic surgery. These strategies are vital to ensuring safe skies in the world of cardiothoracic surgery.


Cardiothoracic surgery is a challenging and complex field that requires a high level of skill and expertise. The training of cardiothoracic surgeons involves a combination of didactic and practical experience, with an emphasis on safety and minimizing risks to patients. This article aims to discuss the challenges of cardiothoracic surgery training and strategies to ensure safe practice.

Cardiothoracic surgery training is a rigorous process that involves several challenges. One significant challenge is the complexity of the procedures involved. Cardiothoracic procedures involve intricate anatomy, which requires a high level of understanding and expertise. The high risk associated with cardiothoracic procedures is another challenge. This risk is compounded by the fact that many patients undergoing cardiothoracic surgery have co-existing comorbidities, which can further complicate the procedure and increase the risk of adverse outcomes.

Another significant challenge in cardiothoracic surgery training is the steep learning curve. The training period is lengthy, and the learning curve is steep, making it difficult for trainees to achieve proficiency in a short period. In addition, trainees need to be able to adapt to new technologies and techniques, which can change rapidly.

To ensure safe practice in cardiothoracic surgery, several strategies can be implemented. One critical strategy is the use of simulation training. Simulation training allows trainees to gain practical experience in a safe and controlled environment, reducing the risk of complications and adverse outcomes. Simulation training has been found to be effective in improving trainee performance and reducing errors in cardiothoracic surgery training. It was explored by Feins et al. (2016) and it showed that the overall performance of cardiothoracic residents improved during simulation-based training [1].

Another strategy to ensure safe practice is appropriate supervision and mentoring. Mentorship has been found to be essential for improving safety and reducing the risk of adverse events. Odell et. al (2020) outline the most significant features and skills of both ideal mentors and mentees [2]. They concluded that a good mentor is genuine, accomplished, accessible, attentive, motivating, and accountable. These traits can be acquired with time, effort, experience and formal training. Excellent mentorship begins with the realization of the incredible privilege and impact that comes with shaping the future of an aspiring cardiothoracic surgeon. Trainees require appropriate supervision and guidance to ensure they are practicing safely and effectively. This supervision can take the form of direct supervision or indirect supervision, depending on the trainee's level of experience.

Effective communication and teamwork are also critical to ensure safe practice in cardiothoracic surgery. Communication breakdowns can lead to errors and adverse events. Communication and teamwork training programs have been found to be effective in improving safety in cardiothoracic surgery training.

Patient selection is another critical component of safe training in cardiothoracic surgery. It is imperative for trainees to gain experience performing procedures on patients who are appropriate candidates for the intended intervention. Knowing how to select patients who are appropriate for operative education and who can tolerate slightly longer operative times without any deleterious effects on myocardial protection and out comes is critical in delivering a safe training program. Comanici et al. (2022) assessed 474,160 operative outcomes and compared mortality and complication rates of patients operated on by fully trained surgeons and trainees [3]. They have demonstrated that even complex surgical procedures can be taught with careful patient selection under the guidance of experienced trainers.

Finally, competency-based training is an essential strategy to ensure safe practice in cardiothoracic surgery. Competency-based training programs allow trainees to demonstrate competence in specific skills and procedures before moving on to more complex procedures. This approach ensures that trainees have the necessary skills and knowledge to practice safely and effectively.

Ensuring safe practice in cardiothoracic surgery is a complex and challenging task. The challenges of cardiothoracic surgery training, including the complexity of procedures, the high risk associated with cardiothoracic procedures, and the steep learning curve, make it critical to implement strategies to ensure safe practice. Strategies such as simulation training, appropriate supervision and mentoring, effective communication and teamwork, and competency-based training can all contribute to safe practice in cardiothoracic surgery.

[1] Feins RH, Burkhart HM, Conte JV, Coore DN, Fann JI, Hicks GL Jr, Nesbitt JC, Ramphal PS, Schiro SE, Shen KR, Sridhar A, Stewart PW, Walker JD, Mokadam NA. Simulation-Based Training in Cardiac Surgery. Ann Thorac Surg. 2017 Jan;103(1):312-321. doi: 10.1016/j.athoracsur.2016.06.062. Epub 2016 Aug 25. PMID: 27570162.
[2] Odell DD, Edwards M, Fuller S, Loor G, Antonoff MB; Society of Thoracic Surgeons Workforce on Career Development. The Art and Science of Mentorship in Cardiothoracic Surgery: A Systematic Review of the Literature. Ann Thorac Surg. 2022 Apr;113(4):1093-1100. doi: 10.1016/j.athoracsur.2020.06.051. Epub 2020 Aug 26. PMID: 32857995.
[3] Comanici M, Salmasi Y, Schulte KL, Raja S, Attia R. Are there differences in cardiothoracic surgery performed by trainees vs fully trained surgeons? J Card Surg. In-press. doi:10.1111/jocs.16925

Maria Comanici

Cardiothoracic Surgery Department, Harefield Hospital

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