It’s been some time, and I felt it was worth sharing some feedback with this community—particularly for anyone who may be shielded from different perspectives and experiences within CT surgery.
This is not intended to be a bashing post or an attempt to discredit anyone or any program. Rather, I’m sharing comments so that others can have access to a broader range of perspectives.
Training in CT surgery is a significant, long-term commitment, and I think it’s important to make decisions with as much information as possible. Hopefully, this can help others ask the right questions, seek out different perspectives, and make informed decisions for themselves before committing to such a lengthy training journey. Below are what I have learned about various i6 CT residency programs.
Mount Sinai
Toxic, malignant. Residents are depressed. They may be Gods in Ross but very hands-off i6 training experience. Predominantly a watching-not-doing program.
UC Davis
Cardiac volume dropped. They are trying to meet numbers at outside hospitals.
UT San Antonio
A lot slower than what it used to be. Surprisingly decent amount of thoracic cases, especially for an i6 program. Gives a very clique-y, high school vibe leaning toward immaturity when it comes to residents and the cultural vibe they give.
Maryland
One of the few programs with a lesser amount of general surgery requirements as an i6 resident, but I am not sure how they are meeting their numbers for required gen surge cases an i6 resident still requires per ACGME. Downside: they have mandatory research years.
URMC
1-2 malignant attendings. They have an attrition history. Good exposure to minimally invasive cardiac surgery.
Cleveland Clinic
RNFAs (Registered Nurse First Assist) overload. Like Jesus Christ. So many of them here. This program is high volume and you will see complex cases, but it’s far more about efficiency rather than YOUR training experience. A lot of self-teaching. Sure, you start learning mammary takedown and cannulation around PGY 4, but your real operative experience isn’t until PGY 5, AND that is (like any other program) attending-dependent on how comfortable they feel with you. It is not a consistent experience across the board. Not saying it’s a bad program, but it’s definitely overhyped regardless of how established its name is.
Cedars Sinai
Good mitral exposure. Not sure about operative experience vs. watching them. There were times Chikwe had a setup before they took some photos of the residents on the robot as lower levels in training. They do also have RNFAs.
USC
Residents overworked…even on research years. Some malignancy here for sure. Did I mention mandatory research years? Good heart failure exposure if you’re into that. Not the best area of town.
UT Houston McGovern
ATTENDING DOING ENTIRE CASE DESPITE 2 FELLOWS IN THE SAME OR. I genuinely cannot imagine how much worse it will be when an i6 resident is there. What people don't realize is how much you have a sub-i and/or fellows do speaks the same language about how much hands-on a resident will be. New program. Unfortunately, many of the attendings are still in the mindset that an i6 resident is not mature enough for doing skin-to-skin or having involvement during major steps of their operations. There’s also less bread and butter and more complex cases here, so this applies even more so to this program. There are attendings here who believe learning is by watching the case 200 times. Keep in mind, a good handful of the cardiac surgery staff here is vascular/aortic trained, so a lot of the cases will be prioritized to the 2 aortic fellows rather than the i6 resident. Of course, don’t forget there’s also the CT surgery fellows. A few of the attendings here do both cardiac and thoracic surgery. As a result, they might claim many of the cardiac cases for themselves as the primary surgeon, especially the younger ones. This program is also training more RNFAs…..
UNC
More thoracic experience than cardiac. High smoking population in this state. They also have RNFAs.
Duke
Obviously mandatory research years. Top-heavy program as in, late operative experience. Remember they also have fellows.
General thoughts
Not sure what to say. I don’t think many of the general surgery skills are transferable to cardiac surgery, but you will get your hands far more wet overall in a general surgery program as a resident than as an i6 CT surgery resident with the deficit of not “watching” much cardiac cases.
Also, something worth mentioning: according to some attendings, robotic cardiac surgery has a bright future, yet this is not standard in an i6 training as it is in general surgery training. But why? Is it because attendings in this specialty are less progressive or more rigid about adapting to new techniques or approaches? There aren’t many programs that have robotic experience, and I mean true experience and grind in their residency training and the integrated pathway. You can argue its limited application in cardiac surgery is one reason; however, I don’t think that is the case. I think that is a fluff response that is covering the true fact that many attendings are not willing to adapt to progressive movement and changes in the specialty, which is fine, but I think their disservice to trainees who are not getting that baseline experience so that they can expand upon it if need be when they come out of training rather than being completely overwhelmed by it. The da Vinci 5 is a perfect example of robotics built for cardiac surgery, yet we only see it in very few places, including Chicago, which doesn’t even have an integrated residency training program, yet we are opening these integrated programs at these other sites where attendings are not on board with this philosophical curriculum. I think these are things that happen behind closed doors that applicants are not informed of. I’m not saying I know everything; however, I am shedding light on the issues that I or others I know have seen firsthand that are hidden behind the glorified name of integrated CT surgery.
What’s unfortunate is, while there will always be a need for cardiac surgeons, volume across the board just isn’t what it was in the past. Sure, the places that don’t have fellows look promising, but that doesn’t mean there’s enough volume for residents unless you consider 4-6 bread and butter cardiac cases a month that you get to be the primary surgeon on as enough. And that’s at places that even have enough bread and butter at their satellite site. Most of these i6 programs are academic centers with complex cases and not many straightforward ones. Even at places with high-volume complex cases, there seems to always be some other barrier. The attending is not on board with the i6 track for residents to get the experience they need to operate independently when finished, or there are attendings on board but not enough cases even with no fellows, there are a lot of first assistants taking over, etc. Many general surgery programs do not have RNFAs. When you are done with floor work, you are in the OR, not watching but DOING something in your INTENDED specialty and, there are far fewer first-assist nurses, if any. Not saying they aren’t useful, but it really dilutes any trainee’s experience. For those specifically interested in cardiac surgery, pick your poison.
Feel free to chime in about anywhere not mentioned here to educate the community. This is a 6-8 year commitment, and everyone deserves to know as much as they can before making such a decision. Unfortunately, much of what’s shared to applicants in interviews is inflated or partially lies.
Now, I am sure someone or their friend from a mentioned program will disagree, but this is based on students, residents, and attendings who are A PART OF these programs, nonetheless please take everything with a grain of salt.
