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Residency in Cardiothoracic and Vascular Surgery: My viewpoint
I have recently completed my cardiothoracic and vascular surgery (CTVS) residency. It not only taught me the techniques and art of surgery but also enriched me spiritually. There are many things which I think can make our training programmes highly successful and beneficial. We as residents should learn to take maximum benefit from our residency, as this prepares the foundation on which our future will be built. The details of an ideal resident training programme will always be debated, and it’s not always possible to achieve the ideal. Residents will continue to expect many things from their course of instruction, and the demands of residency training will continue to create obstacles. What are the ways by which residents can increase the productivity of their residency, and how should we conduct ourselves during this period? Though I have a limited experience in this field still my heart and mind couldn’t stop me from sharing my ideas on these issues. I hope that, by working together, we can make the training of cardiothoracic and vascular surgeons of the future a highly fruitful and pleasurable experience so that the very best of Humane CTV Surgeons are produced and more and more bright young minds are attracted to this wonderful specialty
What constitutes an ideal CTVS residency programme? What are the expectations of a CTVS resident from his/her training programme? What should be the conduct of a CTVS resident during his/her training period? What are the obstacles that a resident faces during his/her training period and how should one overcome them?
These questions have been debated, and will continue to be debated, by many great minds all over the world, resulting in the formulation of many well defined guidelines. I am a very young mind in this exciting, stimulating, challenging, rewarding and glamorous field, and I have seen very little of the practical aspects of it. Yet I would like to share my thoughts and insights on these issues.
Expectations of the Resident
When most of us join our residency programmes we have already undergone years of hard work, lots of studies and sacrifices in our personal and family life. Those who come to do a residency in cardiothoracic surgery are those who love it by their heart and mind, because survival in this line is impossible without passion for it.
Naturally the expectations are also high. Residents expect academics of highest quality with the best and latest of clinical and operative experience ranging from cardiac to thoracic and vascular work as well as thoracic trauma. A disciplined, cordial, friendly and honest working environment makes the whole team happy and refreshing and is welcomed by all. Adequate time off to devote to one’s family and recreation is also needed and expected.
It’s true that one cannot have everything of one’s choice at every place, yet we all need to strive for providing a training programme of the above type. It will not only attract more and more medical graduates towards this wonderful specialty but also help to get the best out of those who join it, and it will produce not only technically and clinically superior surgeons but also more humane beings, the so-called Humane Surgeons.
Conduct of the CTVS Resident
If you expect the best, then you are also expected to give your best. This holds true for residency training also. Residents who have qualities such as competence, persistence and motivation to work long hours and to go through a tough training schedule, psychological strength to overcome stressful situations, a humane attitude and ability to work as a team member are better able to do justice to their training opportunities. Most of these qualities are also required during our General Surgery Residency, and we learn the first lessons of them there. However, the necessity of these qualities becomes more apparent during the CTVS residency. Therefore, we need to develop these qualities as our basic habits. One of the most important lessons a resident should learn is his/her respectful behavior for all the members of the unit and the realization that all the members are equally important in the smooth functioning and thus success of the unit. No one’s contribution is lesser or greater. The ability to work as a team member should be learned, those who learn it will be successful team leaders in the future, a role which we all have to perform at some stage of our professional lives.
The prime aim of the Resident should be his/her studies and duties. Knowledge should be welcomed from all the sources; it may come from a nurse, a technician, a clerk or often a patient. One’s mind should be receptive and thoughtful. A regular and productive academic programme helps in this regard. A wonderful source of information in the present era is the internet. The latest information and journals are just a mouse click away. Residents should become expert in internet-browsing and net-based literature search. The sources of information on the net are frequently audio-visual as well, which increases their usefulness. To utilize this information in the best possible way, we should have our own computers. The internet is also a wonderful means of being in touch with our colleagues and teachers and is a good platform for sharing our ideas and opinions with almost anyone around the globe. In a nutshell facility with using the internet is a must for productive residency training.
Another very important aspect of learning is the art of writing and producing some publications. Maintaining a Log-Book with honest documentation of our clinical failures and successes helps us to improve our work and our results. We need to know our limitations, and we should develop the habit of seeking help to improve outcomes for the good of the patient. Absolute integrity and honesty should become our habit. Residents should take part in teaching Medical and Nursing students. This not only inspires us to read but also to develop teaching expertise, which is an asset for the future. In my opinion rotations in Cardiology Department, Catheterization Lab and Echo Room should be part of the training programme.
Residents should also take some time to visit the Anatomy Department and if possible attend lectures on thoracic anatomy and participate in thoracic dissections. We should make ourselves well versed with cardiorespiratory physiology and cardiovascular radiology. Thorough knowledge of the latest technologies such as robotics, lasers, immunology, molecular biology, bioengineering, xenotransplantation, gene therapy, stem cell therapy and nanotechnology is also desirable. Fellowship or exchange programmes should be developed and utilized for learning those things which are not part of the routine at the resident’s own institute. Mentorship is also important to career development. As a surgeon we should develop the quality of self confidence, but humility should always be around the corner to prevent arrogance. Lastly, we should remember that humor is an important part of residency and life in general and anger is a self- defeating emotion.
Obstacles Faced by the Resident
Various hurdles and obstacles may arise in our lives; these may hinder our path of training. Most of them are either in the form of health and family related issues or at times various aspects of the hard and rigorous training which test the resident’s psychological strength. From time to time residents may develop negative thoughts about the decision to become a Cardiothoracic Surgeon. We should learn to minimize the loss and distraction that these situations inflict on our learning and career. There are many ways of doing so. Exercise is one of the best ways to shed one’s worries and increase physical and psychological strength. ‘Yoga’ is a great help in this regard. Yoga in Sanskrit Language means union. It teaches our body and mind to work in synchrony, thereby increasing our concentration power also. Yoga, in my opinion, should be part of our training schedule. Yogic exercises designed for back pain are especially useful for people in this profession. We should dedicate at least half an hour of each day to our own health regardless of how busy is the schedule. Exercise is all about habit; once it becomes a habit we will not feel burdened finding time for it. It rejuvenates us, it entertains us.
Another commonly neglected thing in our life style is the diet. We all know what wonders a good and healthy diet taken at the proper time can do to our productivity. In spite of preaching the value of a good diet to others we ourselves never practice it. Our work pressure and uncertain working hours force us to unhealthy dietary habits. Lots of fruits and water and less junk-food, hot and alcoholic beverages will make us more active and productive. The meals should be taken in a relaxed atmosphere whenever possible, not just to push in something for the sake of filling our stomach. If we can be careful about the protection of our patients’ myocardium, why cannot we practice protection of our own stomach and myocardium?
Nothing is more relaxing than a good sound sleep. Deprivation of sleep is a big enemy for all residents, but it is the call of the duty that keeps us awake for long hours. Resting areas in the hospital should be comfortable and peaceful, so that even a short nap is refreshing. Residents should try to have a good sound sleep the night before their call day.
Almost all of us have one or another hobby, but most of us are not able to pursue it. Some time should be set aside in our busy routine for hobbies. They have a very good relaxing and refreshing effect.
Another way of relieving stress is socializing together, going out for a dinner or picnic. Departments should have their own protocol for such get-togethers at least once a month. Apart from cementing the unity between team members, these occasions also let everyone know each other in a relaxed atmosphere. Such get-togethers don’t lead to loss of working hours; rather they increase the productivity of the team members. Music at the working place has been proven to improve the atmosphere. Lots of musical compositions which suit such places are available and should be played.
Reading popular books on topics like How to Win Friends and Influence People, How to Stop Worrying and many others written on related issues have a very positive impact on our thinking and behavior.
Last but not least a supportive family is of great assistance in helping us to become a Cardiothoracic surgeon. Their contribution is no less than anyone else is because they sacrifice a lot to enable us to remain busy during our training and throughout our career. During residency which is difficult, demanding and exhausting, when the hours are long and days unpredictable, many times a negative thought comes into our mind. One might question why I chose this endeavor. But then thinking about the challenges, excitement, and rewards that lie ahead will help remind you that the choice was correct. Rewards are immeasurable after the hard work of residency. The future is full of opportunities in our specialty, we have to recognize and seize them. Many life saving opportunities that this profession provides are very gratifying. Cardiothoracic surgeons are frequently given special respect. They are almost uniformly considered leaders among the surgical specialties. Heading a team of skilled healthcare providers of many types is satisfying and stimulating. We should be proud that we will be trusted and called upon to treat some of the sickest patients with the most complex problems in the hospital. We will be dealing with the most vibrant and dynamic organ, i.e., the heart. It will be our privilege to touch and mend the heart, to work inside its chambers and restore the health of a gravely ill patient. It is an honor which few people ever get to experience. The joys of being a Cardiothoracic and Vascular Surgeon will certainly greatly outweigh the frustrations and irritations that lie in the path of becoming one.
Ideas about an ideal CTVS residency programme will remain different and will continue to be debated at various levels. Nevertheless, training residents with the best and latest knowledge in an environment which is cordial, friendly, disciplined and honest, is essential. We as residents should try to make our learning as productive as possible. Frustrations should not be allowed to creep in. The whole idea of residency training should be not only to produce the best of surgeons but also the best of ‘humane’ surgeons. Let us all work together to accomplish this goal.
I will always be extremely grateful and thankful to Professors T.K. Lahiri, J.L.Sahni and Vinay Krishna, Dr. Ajai Kaul,Dr. R. K. Deewan, Dr. Sushmit and all my teachers who have always taught me the art and science of this specialty and encouraged me to realize my dreams. Many thanks to my great parents, sweet and caring wife, wonderful friends and colleagues, family members and all the staff of the hospital who supported and loved me all throughout my CTVS residency.
We are extremely pleased to post the article “Residency in Cardiothoracic and Vascular Surgery; My viewpoint” by Dr. Lakhotia. New Horizons continues to search for and welcome different points of view, especially those of younger surgeons. Dr. Lakhotia has recently completed his training in cardiothoracic surgery, and this posting is the first of what is hoped will be many more contributions from international authors. He offers many insightful comments concerning residency training and the hopeful expectation that it can be improved for current and future residents. He suggests that "we can make the training of cardiothoracic and vascular surgeons of the future a highly fruitful and pleasurable experience so that the very best of Humane CTV Surgeons are produced and more and more bright young minds are attracted to this wonderful specialty." Let us all hope that he is correct. Surely there are readers who will wish to offer additional insights concerning resident training or other important topics related to cardiothoracic surgery. Your input is welcome.
Walter H. Merrill, MD
Division of Cardiothoracic Surgery
University of Cincinnati
Cincinnati, OH USA