(CCSP035) CARDIAC SURGERY TRAINING IN CANADA: PERCEPTIONS AND BARRIERS

Background: Current surgical residents are sub optimally prepared for autonomous, independent practice. This may be related to discrepancies between how surgeons and trainees perceive training. Although the Royal College of Physicians and Surgeons of Canada (RCPSC) have mandated a set of competencies that every graduated trainee must possess, evidence suggests that these competencies are not being adequately met. This qualitative study aimed to clarify perceptions of competency, autonomy, and surgical training goals, including barriers by Canadian cardiac surgery programs and trainees.

METHODS AND RESULTS: Semi-structured interviews were conducted with program directors and trainees from Canadian cardiac surgery programs. Interviews were audio recorded and transcribed verbatim. Thematic and content analysis were used to deductively analyze interview transcripts. From this, major themes were identified describing competency, autonomy, goals of surgical training and barriers to training. A total of 16 individuals (seven trainees and nine program directors) from ten training programs were interviewed. Both trainees and staff agreed that the goal of surgical residency is to produce competent, not autonomous, surgeons. When defining competency, both faculty and trainees identified the importance of technical skills and nontechnical skills, such as surgical decision making. Both groups believed autonomy and competency to be different, wherein autonomy assumes competency and is distinguished by the ability to make decisions independently. Importantly, 81% (n=13) believed that nontechnical skills were more important for independent practice than technical skills. Only 57% (n=4) of trainees and 33% (n=3) of staff surgeons felt that the current RCPSC competencies were reasonable to achieve during residency training. Major themes describing barriers encountered during training included factors pertaining to patients (safety, medicolegal liability), trainees (pace of learning), surgeons (comfort with procedure, years in practice, formal background in education) as well as time constraints and program setup.

Conclusion: There are important discrepancies in the perceptions of competency, autonomy, and surgical training goals between training programs and trainees. The RCPSC’s stated goal of producing trainees ready for independent practice is discordant with those of Canadian cardiac surgery programs. Many staff and trainees do not feel that the currently espoused competencies are feasible to achieve by graduation. Understanding of the multiple identified barriers during training may allow for solutions that address these differences.