Training cardiothoracic surgeons of the future: The UK experience Louise Kenny, MBBS, MRCS, MED, a Karen Booth, MBBS, FRCS (C-Th), MED, a Kathrin Freystaetter, MD, a Greta Wood, MRes, b Gary Reynolds, MBBS, MRCP, PhD, b Sridhar Rathinam, MBBS, FRCS (C-Th), c and Narain Moorjani, MB ChB, MD, FRCS (C-Th) d ABSTRACT Objective: The study aimed to assess targeted simulation courses, including live animal operating, as complementary training tools with regard to 2 key surgical skills in early cardiothoracic surgeon training. Methods: Twenty UK surgical trainees (equivalent to cardiothoracic surgery resi- dent physicians in the United States) in their first year of residency training were evaluated. Assessment of skills in pulmonary wedge resection and cardiopulmo- nary bypass were undertaken before and after 2 boot camp-style courses, including live animal operating (boot camp 1 and boot camp 2). Resident perfor- mance was evaluated by surgical trainers using objective structured assessment of technical skills matrices. Trainers completed a survey on skill development and trainer confidence in the trainee precourse and postcourse. Results: Trainee assessment scores pre- and postcourses were analyzed using a 2- tailed Wilcoxon signed-rank test demonstrating a significant improvement in trainee performance in boot camp 1 in performing cardiopulmonary bypass (me- dian score, 21 precourse and 28 postcourse; P ¼ .001) and pulmonary wedge resection (median score, 25 precourse and 32 postcourse; P ¼ .012), and in boot camp 2, in performing cardiopulmonary bypass (median score, 28 precourse and 30.5 postcourse; P ¼ .018) and pulmonary wedge resection (median score, 31.5 precourse and 37 postcourse; P ¼ .018). Trainers reported increased confi- dence and decision-making competency of residents and increased confidence of trainers to allow more participation in management. It was found that 83.3% of trainers would support trainee attendance in subsequent years. Conclusions: Live animal operating as a component of targeted cardiothoracic surgery skill training courses significantly improves technical skills, builds confi- dence of surgical trainers in resident physicians’ practice, and should be supported by the surgery community. (J Thorac Cardiovasc Surg 2018;155:2526-38) Louise Kenny, MBBS, MRCS, MED, with boot camp participants. Central Message Targeted skill training utilizing live animal operating as part of boot camp-style courses is an effective tool that improves technical per- formance in future cardiothoracic surgeons. Perspective This study explores the utility and influence of structured curriculum-targeted surgical courses in light of current training challenges. Live an- imal operating safely facilitates training of the current generation of trainees in a controlled environment with positive implications for pa- tient care in the operating room. See Editorial Commentary page 2539. Cardiothoracic surgeon training is facing multifactorial challenges and establishing safe and effective training pathways is paramount. In the United Kingdom, particular challenges have arisen due to reduced exposure of residents to operating rooms as a consequence of the European Work- ing Time Directive alongside publication of surgeon- specific mortality data. UK residents in their first year of training are greatly var- ied in experience in the specialty, meaning they possess From the a Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom; b Faculty of Medical Sciences, Newcastle University, New- castle Upon Tyne, United Kingdom; c Department of Thoracic Surgery, Glenfield Hospital, Leicester, United Kingdom; and d Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom. Read at the 97th Annual Meeting of The American Association for Thoracic Sur- gery, Boston, Massachusetts, April 29-May 3, 2017. Received for publication April 7, 2017; revisions received Jan 15, 2018; accepted for publication Jan 26, 2018; available ahead of print April 13, 2018. Address for reprints: Louise Kenny, MBBS, MRCS, MED, Department of Cardiotho- racic Surgery, Freeman Hospital, Freeman Rd, Newcastle Upon Tyne NE7 7DN, United Kingdom (E-mail: Lkenny@doctors.net.uk). 0022-5223/$36.00 Copyright Ó 2018 by The American Association for Thoracic Surgery https://doi.org/10.1016/j.jtcvs.2018.01.088 Scanning this QR code will take you to a supplemental video and appendix. To view the AATS Annual Meeting Webcast, see the URL next to the webcast thumbnail. 2526 The Journal of Thoracic and Cardiovascular Surgery c June 2018 ADULT: EDUCATION: INTERNATIONALTRAINING PERSPECTIVE ADULT