# An Analysis of Trainees’ Operative Experiences Over the Past 16 Years Based on the Requirements of the New 2021 Cardiothoracic Surgery Curriculum in the United Kingdom and Ireland

## TL;DR

This study evaluates how cardiothoracic surgery trainees in the UK and Ireland met the new 2021 curriculum requirements over the past 16 years, including the impact of the pandemic.

## Contribution

The study provides the first analysis of trainees' operative experiences against the new 2021 curriculum requirements.

## Key findings

- Trainees logged a median of 378 major cases, exceeding the new curriculum's 250-case requirement.
- The median time to reach 250 cases was 6.25 years for cardiac and 5.25 years for thoracic trainees.
- The pandemic increased the time needed to complete training by a median of one year.

## Abstract

Before introducing the new 7-year curriculum in 2021, cardiothoracic surgery trainees were required to complete a 2-year basic surgical training programme followed by 6 years of higher speciality training. The new curriculum eliminates the need for basic surgical training. It is outcome-based, requiring a minimum of 250 major cases performed as the first operator. We assess trainees’ operative experiences over the past 16 years based on the requirements of the new curriculum. The impact of the COVID-19 pandemic on training was also investigated.

All trainees who commenced higher cardiothoracic surgical training from 2007 and graduated were included. Operative volumes were categorised into 13 major procedures (6 cardiac and 7 thoracic). The total number of major cases logged and the time required to achieve 250 cases were evaluated.

A total of 290 trainees were included, of whom 145 (50%) had completed training with validated eLogbooks. The median number of cases logged was 378 (interquartile range [IQR]: 309, 474) for all trainees across their training period. Cardiac-themed trainees logged 378 (IQR: 312.5, 474.5) cases, of which 202 (IQR: 166.5, 257.0) were coronary artery bypass grafting, followed by aortic valve surgery (n = 39, 14%, IQR: 15, 54.5). Thoracic-themed trainees logged 383.5 (IQR: 304.5, 469.75) cases, of which 345 (IQR: 270.25, 457.75) were anatomical lung resections followed by surgery for secondary pneumothorax (n = 124, 35%, IQR: 100.25, 165.0). The median time required to achieve 250 cases was 6.25 and 5.25 years for cardiac and thoracic trainees, respectively. There was an increase in time for trainees to complete higher surgical training before and during/after the COVID-19 pandemic (median 6 [IQR: 5, 8] vs 7 [IQR: 6, 10] years, P = 0.01).

The new 2021 curriculum’s target of 250 major cases appears feasible. However, post-COVID-19 reductions in surgical volume and the removal of basic surgical training require integration and reform to ensure trainees can complete the programme in the 7-year timeframe.

The United Kingdom and Ireland cardiothoracic surgery (CTS) curriculum underwent a significant reform in August 2021, following approval by the General Medical Council (GMC) and the Medical Council of Ireland (MCI).