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Background Workforce estimates suggest 11% of general surgery residents are considering careers in cardiothoracic (CT) surgery. In an effort to identify areas for programmatic improvement, we examined trends in thoracic surgery residents' perspectives on training and employment. Methods Results from the 2010 Thoracic Surgery Residents Association workforce survey were analyzed. The survey was administered to all trainees in North America during the annual in-service exam. Longitudinal trends from 2006 to 2010 are reported. Results Of 299 respondents, 76% (228 of 299) were US citizens. The most common determinants in choosing CT surgery were types of cases (123 of 299, 41%) and mentorship (95 of 299, 32%). Sixty-five percent (193 of 299) would recommend CT surgery to potential trainees. While 81% (242 of 299) felt they would be adequately trained in their program, 39% (118 of 299) planned additional fellowship training. Only 23% (70 of 299) felt the 80-hour work week had a positive impact on training. Of residents seeking jobs, 68% (62 of 92) received 2 or more job interviews and 70% (69 of 99) more than 1 job offer. Seventeen percent (16 of 92) had no offers. While 45% (51 of 114) reported still searching for employment, 20% (23 of 114) had accepted private practice positions, 25% (29 of 114) academic positions, and 6% (7 of 114) fellowship positions. Education-related debt was greater than $100,000 in 46% (140 of 299) and greater than $200,000 in 17% (52 of 299). From 2007 to 2010, CT residents reporting debt greater than $200,000 rose from 8% to 17%. Accepted fellowship training positions dropped to 6% in 2010 compared with 13% and 15% in 2008 and 2009, respectively. Conclusions Diminished CT job opportunities remain a concern. There are concerning trends in debt accrual and perceptions of work-hour restrictions on quality of training. These data justify further investigation into areas of improvement in CT training.

A retrospective study was performed to evaluate the association between arterial invasion and survival in patients with stage I non-small cell lung cancer.One hundred patients were identified who had undergone complete anatomic resection as definitive treatment for stage I non-small cell lung cancer. The tumors were reviewed for the presence or absence of arterial invasion. Five-year survival data were obtained for all patients.The 100 patients had an overall 5-year survival of 61%. There were 64 stage IA patients with a 62% 5-year survival and 36 stage IB patients with a 58% 5-year survival. The 39 patients identified with arterial invasion had a 38% 5-year survival compared with a 73% 5-year survival in the 61 patients without arterial invasion (p0.001), with an unadjusted hazard ratio of 3.5 (p0.001). Multivariate analysis by stage IA versus IB and by size greater or less than 2 cm demonstrated hazard ratios of 3.5 and 4.0, respectively (p0.001). This difference was independent of demographic characteristics, tumor type, or grade. Subgroup analysis revealed a hazard ratio of 5.8 in patients with stage IA non-small cell lung cancer (p0.001) and 19.8 in patients with tumorsor = 2 cm (p = 0.006).Arterial invasion is present in a substantial percentage of patients with stage I non-small cell lung cancer and is adversely associated with survival.

Workforce estimates suggest 11% of general surgery residents are considering careers in cardiothoracic (CT) surgery. In an effort to identify areas for programmatic improvement, we examined trends in thoracic surgery residents' perspectives on training and employment.Results from the 2010 Thoracic Surgery Residents Association workforce survey were analyzed. The survey was administered to all trainees in North America during the annual in-service exam. Longitudinal trends from 2006 to 2010 are reported.Of 299 respondents, 76% (228 of 299) were US citizens. The most common determinants in choosing CT surgery were types of cases (123 of 299, 41%) and mentorship (95 of 299, 32%). Sixty-five percent (193 of 299) would recommend CT surgery to potential trainees. While 81% (242 of 299) felt they would be adequately trained in their program, 39% (118 of 299) planned additional fellowship training. Only 23% (70 of 299) felt the 80-hour work week had a positive impact on training. Of residents seeking jobs, 68% (62 of 92) received 2 or more job interviews and 70% (69 of 99) more than 1 job offer. Seventeen percent (16 of 92) had no offers. While 45% (51 of 114) reported still searching for employment, 20% (23 of 114) had accepted private practice positions, 25% (29 of 114) academic positions, and 6% (7 of 114) fellowship positions. Education-related debt was greater than $100,000 in 46% (140 of 299) and greater than $200,000 in 17% (52 of 299). From 2007 to 2010, CT residents reporting debt greater than $200,000 rose from 8% to 17%. Accepted fellowship training positions dropped to 6% in 2010 compared with 13% and 15% in 2008 and 2009, respectively.Diminished CT job opportunities remain a concern. There are concerning trends in debt accrual and perceptions of work-hour restrictions on quality of training. These data justify further investigation into areas of improvement in CT training.