AATS: Boston, Massachusetts, 1998
I. Introduction - Michael S. Mulligan, M.D., University of Michigan
To date, no organization exists that specifically represents thoracic surgery residents. There is spotty feedback to attendings and chairmen and many suppositions are made about resident interests and perspectives. However, too often there seems to be two very different dialogues occurring, one among the residents and one about the residents. Recent developments have created a sense of urgency in organizing communications between attendings and residents. Specifically there is a movement at the federal level to reduce reimbursement to thoracic surgeons by as much as 40% across the board. Thoracic surgery has organized a lobbying effort and has some inroads into forestalling that. There has also been a suggestion that federal salaries that support the residents may be significantly reduced or eliminated beyond the first year of general surgery board eligibility. Thirdly, an over supply of supply of thoracic surgeons by the year 2007 has been predicated by the Pew Commission Report and others. A suggestion has been made to eliminate the American Board of Surgery certification requirements and ideas have been put forward to shorten the general surgery training requirement and institute a prerequisite curriculum for thoracic surgery training. This might be accompanied by additional time spent in thoracic surgery residency, or at the very least at thoracic surgery GMEB overhauled to become more efficient (use new technologies, teaching modalities, and laboratory experience).
At present, thoracic surgery residents are represented by two delegates to the organization of resident representatives of the American Association of Medical Colleges appointed by the TSDA. For four years, Dr. David Jones of the University of North Carolina at Chapel Hill, was one of our representatives and participated on the ORR administrative board. The past year, Scott Arnold from the University of Virginia, has also served and I am now entering my fourth year of services you represented to the ORR. In addition, I have served on a task force known as the Group on Resident Affairs. This group was charged with delivering a set guidelines that would be instructive for those interested in reducing the size, or reconfiguring the composition of the resident work force on the national level. Last year the ORR delegates from thoracic surgery were invited to the TSDA meeting in Chicago and participated in discussions about American Board of Surgery certification requirements, CORE curriculum, prerequisite curriculum, utilization of CD rom's, WWW sites, other educational materials, and changing the possible duration of general surgery prerequisite training and thoracic surgery residency. While this representation is good, it is not sufficient. At the organization of resident representatives we attempt to represent you without direct communication. That organization is excellent, but it is for residents in general and the thoracic surgery voice is very small compared to so many of our vocal colleagues in Pediatrics, Internal Medicine, and Primary Care. It is imperative that we organize and take advantage of the TSDA's desire to support us and to hear what we have to say.
Today I would like us to discuss two things: 1. establishing a potential structure for the TSRA, 2. to come up with a proposed functions for the TSRA and concerns we would like addressed for services provided by the TSDA.
First, let's consider a potential structure for the TSRA. Enthusiasm is great but is difficult to sustain unless there are individuals assigned to present ideas and questions for the residents at large, organize future meetings and summarize our opinions and desires and communicate them effectively to the TSDA leadership. I would like to propose a structure and get your feedback so we can shape it into a general consensus. It is my hope that we can then build on the momentum generated here today in order to foster a strong and meaningful presence for the TSRA. I would suggest that membership in the TSRA be available to all thoracic surgery residents and fellows in ASGME training programs. All general surgery residents accepted into such programs would also be automatically included in its membership. Residents and fellows in international or non-recognized programs would also be eligible for membership upon receipt of a letter of interest to the TSRA. Membership would exist for the duration of fellowship and should continue for one year post fellowship. It is my hope that we would therefore be able to take advantage of input from individuals experiencing the difficult transition to staff from residency and the challenges inherit in that fate. Application to the TSRA is automatic upon acceptance into an ASGME approved fellowship. I would hope that all incoming residents would receive a directory and questionnaire in order to facilitate communication from the time of acceptance. Members would be encouraged to communicate at the state regional levels, but formal organization would be at the national level. I propose a structure similar to the other resident organizations with a successful track records such as the ORR, and the American Association of General Surgery residents. The structure should exist as follows: a chairman or president and chairman elect would share a primary organizational responsibilities; in addition, a five to seven member executive board would serve as regional contact people for the purposes of funneling information, facilitation communication, and sharing the responsibilities inherit in administrating such an organization. The chairman should serve as the TSRA representing to the TSDA and the administrative board or executive board should have the authority to manage the business of the TSRA and represent the interest of its members to the TSDA and other similar organizations. Annual meetings of AATS and STS supplemental work meeting could be organized. All members of the executive board should plan on attending both meetings and it is my hope that concurrent business meetings could be arranged biannually. All meetings of the membership at large would be open. Jennifer Ritmare of the TSDA office, would serve as our administrative assistant until we get off the ground and will be available at (703) 820-7400. At the conclusion of our discussion today I would hope that we would be able to elect a president/president elect and executive board so that this structure could be in place for the STS meeting in the fall.
The second main topic of discussion today will be to determine what functions the TSRA should serve and what our expectations should be from the TSDA. I would suggest the TSRA would serve as an excellent conduit for the dissemination of educational materials and reviews. On line textbooks could perhaps be circulated through the CTS net and the TSDA web site. Electronically, communication would also facilitate feedback about the resident experience with the curriculum designed by the TSDA for immediate refinement so that all residents could experience a maximal benefit. I would hope that the TSRA could help provide sponsorship for professional developments wherein residents could attend additional workshops involving such topics as grant writing, practice management, and balancing service and research responsibilities. All too often these areas are neglected and resident education might be better addressed in a protected retreat type forms. Course offerings could be announced on STC net and might be enhanced with sponsorship from Medtronics, St. Jude, and other corporate sponsors. I hope we can agree to a structure similar to the one that I've outlined and can come up with a list of goals and expectations for the TSRA at the conclusion of this meeting.
Thank you. I would now like to open the floor for discussion.
II. Presentation - Dr. Mark Orringer, President of TSDA
At this point, Dr. Orringer entered the room at the conclusion of Dr. Mulligan's remarks and echoed his sentiments about the need to have the TSRA take hold. He agreed that establishing a structure would be important in order to sustain a momentum and underscored the enthusiasm of the TSDA for support the development of a resident organization.
II. Open Session
Areas of interest and concern identified by the membership at large included:
- The TSRA should serve as a feedback mechanism regarding the effectiveness of the TSDA curriculum from the resident perspective.
- The TSRA membership extension to include the first year after thoracic residency would allow for and excellent means of identifying issues in the difficult transition for resident to staff. Wide support was gained for extending membership.
- The CTS net would serve as the basic form for communication for the TSRA.
- John Doty or Jorge Salazar and John Liddicoat at Johns Hopkins University would look into additional corporate sponsorship for the TSRA. It was hoped that additional moneys procured from a variety of sources would help sponsor a professional development meetings as outlined above.
- The TSRA should not serve as a grievance committee, but rather should be a mechanism aimed at improving thoracic residency education and not as a form for canvassing resident complaints.
- The TSRA would also supply a feedback mechanism for the experience of the match by residents entering the program and may provide a different perspective on that gain from TSDA circulated questionnaires.
- The CTS might also publish a listing of the corporate educational opportunities (laboratories, symposia available around the country and dates).
- List of professional development conferences and opportunities to be made available to the residents at the AATS and STS meetings would include seminars in contract negotiations, grant writing, CV and interview skills "getting a job".
IV. Elections
The results of elections for chairman/chairman elect and administrative board are as follows:
Chairman - Michael S. Mulligan, M.D. University of Michigan
Chairman elect - Scott Arnold, M.D. University of Virginia
Executive Committee Members -
John Liddicoat, M.D. Johns Hopkins University
Jorge Salazar, M.D. Johns Hopkins University
John Doty, M.D. Johns Hopkins University
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Thank you.
Respectfully submitted,
Michael S. Mulligan, M.D.
Lecturer
Section of Thoracic Surgery
University of Michigan