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The objective of this work was to delineate career progression and research productivity of women practicing cardiothoracic surgery in the academic setting.Cardiothoracic surgeons at the 79 accredited US cardiothoracic surgery training programs in 2020 were included in this cross-sectional analysis. Data regarding subspecialization, training, practice history, and publications were gathered from public sources including department websites, CTSNet, and Scopus.A total of 1065 surgeons (51.3% cardiac, 32.1% thoracic, 16.6% congenital) were identified. Women accounted for 10.6% (113) of the population (7.9% of cardiac, 15.5% of thoracic, 9.6% of congenital surgeons). The median number of cardiothoracic surgeons per institution was 12 (interquartile range [IQR], 10-17), with a median of 1 woman (IQR, 0-2). Fifteen of 79 programs (19%) had no women. Among women faculty 5.3% were clinical instructors, 51.3% were assistant professors, 23.0% were associate professors, 16.8% were full professors, and 3.5% had unspecified titles (vs 2.0%, 32.9%, 23.0%, 37.5%, and 4.6% among men, respectively; P.001). Women and men authored a comparable number of first-author (0.4 [IQR, 0.0-1.3] vs 0.5 [IQR, 0.0-1.1], P = .56) publications per year but fewer last-author (0.1 [IQR, 0.0-0.7] vs 0.4 [IQR, 0.0-1.3], P.0001) and total publications per year (2.7 [IQR, 1.0-6.2] vs 3.7 [IQR, 1.3-7.8], P = .05) than men. The H-index was lower for women than for men overall (8.0 [IQR, 3.0-15.0] vs 15.0 [IQR, 7.0-28.0], P.001) but was similar between men and women who had been practicing for 10 to 20 years.Gender disparities persist in academic cardiothoracic surgery. Efforts should be made to support women in achieving senior roles and academic productivity.

The National Institutes of Health (NIH) recently developed the relative citation ratio (RCR), calculated as article citations benchmarked to NIH-funded publications in the same field. Here, we characterized the scholarly impact of academic cardiothoracic (CT) surgeons and their research using the RCR.Using a database of 992 CT surgeons, we calculated the RCR for all articles published by each surgeon since 1980 using the NIH iCite database. All data were collected from publicly available online sources. Data are presented as median (interquartile range) or as odds ratios (ORs) for multivariable logistic regression analysis.Where RCR 1.00 indicates equal impact as an NIH-funded publication, the RCR among all 37,402 CT surgery articles was 0.84 (0.33-1.83) and the RCR among NIH-funded CT surgery articles was 1.07 (0.53-2.17). CT surgeons exhibited a career median RCR of 0.82 (0.54-1.13) and maximum RCR of 6.20 (3.04-13.57). Predictors of career median RCR1.00 included female gender (OR 2.23, P = 0.001), thoracic subspecialization (OR 2.50, P 0.001), full professor rank (OR 1.89, P = 0.001), and NIH funding (OR 1.75, P = 0.001). Predictors of career maximum RCR50th percentile among CT surgeons included male gender (OR 1.87, P = 0.030), thoracic subspecialization (OR 2.05, P 0.001), full professor rank (OR 4.89, P 0.001), NIH funding (OR 3.17, P 0.001), and career duration (OR 1.03, P = 0.002).We present the first assessment of the NIH-validated RCR for academic CT surgery. CT surgery research is highly impactful, although gender disparities persist with respect to the highest-impact research of our specialty.

OBJECTIVE Advanced clinical fellowship training has become a popular option for surgical trainees seeking to bolster their clinical training and expertise. However, the long-term academic impact of this additional training following a traditional thoracic surgery fellowship is unknown. This study aimed to delineate the impact of an advanced clinical fellowship on subsequent research productivity and advancement in academic career among general thoracic surgeons. METHODS Using an internally constructed database of active, academic general thoracic surgeons who are current faculty at accredited cardiothoracic surgery training programs within the United States, surgeons were dichotomized according to whether an advanced clinical fellowship was completed or not. Academic career metrics measured by research productivity, scholarly impact (H-index), funding by the National Institutes of Health, and academic rank were compared. RESULTS Among 285 general thoracic surgeons, 89 (31.2%) underwent an advanced fellowship, whereas 196 (68.8%) did not complete an advanced fellowship. The most commonly pursued advanced fellowship was minimally invasive thoracic surgery (32.0%). There were no differences between the two groups in terms of gender, international medical training, or postgraduate education. Those who completed an advanced clinical fellowship were less likely to have completed a dedicated research fellowship compared to those who had not completed any additional clinical training (58.4% vs. 74.0%, p = 0.0124). Surgeons completing an advanced clinical fellowship demonstrated similar cumulative first-author publications (p = 0.4572), last-author publications (p = 0.7855), H-index (p = 0.9651), National Institutes of Health funding (p = 0.7540), and years needed to advance to associate professor (p = 0.3410) or full rank professor (p = 0.1545) compared to surgeons who did not complete an advanced fellowship. These findings persisted in sub-analyses controlling for surgeons completing a dedicated research fellowship. CONCLUSIONS Academic general thoracic surgeons completing an advanced clinical fellowship demonstrate similar research output and ascend the academic ladder at a similar pace as those not pursuing additional training.

Surgeons are traditionally categorized as working either in academic or private/community practice, but some transition between the two environments. Here, we profile current academic cardiothoracic surgeons who began their attending careers in private or community practice. We hypothesized that research activity may distinguish cardiothoracic surgeons who started in non-academic versus academic practice.Publicly available data regarding professional history and research productivity were collected for 992 academic cardiothoracic surgeons on faculty at the 77 cardiothoracic surgery training programs in the United States in 2018. Data are presented as medians analyzed with the Mann-Whitney test or proportions analyzed with Fisher exact test or the χA total of 80 (8.1%) academic cardiothoracic surgery faculty started their careers in non-academic practice, and 912 (91.9%) started directly in academia. Those who started in non-academic practice spent a median 7.0 y in private/community practice and were more likely to be cardiac surgeons (68.8% vs 51.6%, P = .0132). They were equally likely to pursue a protected research fellowship (56.3% vs 57.0%, P = .9067) and publish research during training (92.5% vs 91.1%, P = .8374), but they published fewer total papers by the end of cardiothoracic surgery fellowship (3.0 vs 7.0, P = .0001) and fewer papers per year as an academic attending (0.8 vs 2.9, P.0001). Nevertheless, the majority of cardiothoracic surgery faculty who started in non-academic practice are currently active in research (68.8%), and 2 such surgeons received National Institutes of Health R01 funding.Transitioning from non-academic to academic practice is an uncommon but feasible pathway for interested cardiothoracic surgeons.

There is increasing concern regarding the attrition of surgeon-scientists in cardiothoracic (CT) surgery. However, the characteristics of CT surgeons who are actively leading basic science research (BSR) have not been examined. We hypothesized that early exposure to BSR during training and active grant funding are important factors that facilitate the pursuit of BSR among practicing CT surgeons.We created a database of 992 CT surgeons listed as faculty at accredited United States CT surgery teaching hospitals in 2018. Data regarding each surgeon's training/professional history, publication record, and National Institutes of Health funding were acquired from publicly available online sources. Surgeons who published at least one first- or last-author paper in 2017-2018 were considered to be active, lead researchers.Of the 992 CT surgeons, 73 (7.4%) were actively leading BSR, and 599 (60.4%) were actively leading only non-BSR. Only 2 women were actively leading BSR. Surgeons actively leading BSR were more likely to have earned a PhD degree (20.5% versus 9.7%, P = 0.0049), and more likely to have published a first-author BSR paper during training (76.7% versus 40.9%, P0.0001). Surgeons actively leading BSR were also more likely to have an active National Institutes of Health grant (34.2% versus 5.8%, P0.0001), especially an R01 grant (21.9% versus 2.5%, P0.0001).A small minority of CT surgeons at academic training hospitals are actively leading BSR. In order to facilitate the development of surgeon-scientists, additional support must be given to trainees and junior faculty, especially women, to enable early engagement in BSR.

BACKGROUND Early engagement in cardiothoracic (CT) surgery research may help attract trainees to academic CT surgery, but whether this early exposure boosts career-long academic achievement remains unknown. METHODS A database of all CT surgery faculty at accredited, academic CT surgery training programs in the United States during the year 2018 was established. Excluding international medical graduates, surgeons who started general surgery residency in the United States before 2004 and who published at least 1 manuscript before traditional CT fellowship training were included (n = 472). Each surgeon's educational background, work history, and research publications were recorded from publicly available online sources. RESULTS Before fellowship training, 370 surgeons (78.4%) coauthored a CT surgery manuscript, and 102 (21.6%) published only on subjects unrelated to CT surgery. Regardless of whether surgeons pursued dedicated research training or not, those who coauthored a CT surgery manuscript before fellowship training published more papers per year as an attending (P < .01), resulting in more total publications (P < .01) and a higher H-index (P < .01) over comparably long careers. Among CT surgeons who did not publish CT surgery research before fellowship training, those who coauthored a CT surgery manuscript during fellowship also exhibited enhanced future academic productivity. CONCLUSIONS Academic CT surgeons who published CT surgery research before fellowship training ultimately exhibited more prolific and impactful research profiles compared with those who published only on subjects unrelated to CT surgery during training. Efforts to increase early engagement in CT surgery research among trainees should be fully endorsed.

Background Women remain underrepresented in cardiothoracic surgery (CTS). In 2005, Women in Thoracic Surgery (WTS) began offering scholarships to promote engagement of women in CTS careers. This study explores the effect of WTS scholarships on CTS career milestones. Methods We assessed career development using the number of awardees matching into CTS residency/fellowship, American Board of Thoracic Surgery (ABTS) certification, and academic CTS appointment. Scholarship awardee data were obtained from our WTS database. Comparison data were gathered from the National Residency Match Program and ABTS. Details of the current roles of ABTS-certified women were determined from public resources. Qualitative results were gathered from post-scholarship surveys. Results A total of 106 WTS scholarships have been awarded to 38 medical students (36%), 41 general surgery residents (39%), and 27 CTS residents/fellows (25%). Among medical students, 26% of awardees entered integrated CTS residency (vs Conclusions Receipt of a WTS scholarship is associated with successful pursuit of CTS career milestones at significantly higher rates than contemporaries. These scholarships foster a supportive community for women trainees in CTS.

Background: The medial patellofemoral complex (MPFC) is a structure composed of the medial quadriceps tendon–femoral ligament (MQTFL) superiorly and the medial patellofemoral ligament (MPFL) inferiorly. The pediatric MPFL anatomy has been well described, but the precise anatomy of the MQTFL has only recently been described and studied in skeletally immature patients. Purpose: To describe the anatomic relationship between the MQTFL and its insertion on the quadriceps tendon and patella in pediatric specimens. Study Design: Descriptive laboratory study. Methods: A total of 22 pediatric cadaveric knee specimens were dissected to analyze attachment of the MQTFL to the quadriceps tendon and patella. Dissection was facilitated using lateral parapatellar arthrotomy followed by eversion of the extensor mechanism to evaluate MQTFL fibers from its undersurface. Results: The mean specimen age was 7.4 years. Specimens were divided based on age into a younger cohort (1-2 years), middle cohort (4-8 years), and older cohort (9-12 years). The quadriceps tendon attachment (QTA) of the MQTFL proximal to the patella extended a median of 5.0 mm in the younger cohort, 11.4 mm in the middle cohort, and 12.0 mm in the older cohort, with significant differences found between the younger and middle cohorts ( P < .047) and the younger and older cohorts ( P < .001). The QTA as a percentage of patellar articular height averaged 44.4% across all specimens. The vertical height of the patella measured a median of 14.0 mm, 22.3 mm, and 27.3 mm in the younger, middle, and older cohorts, respectively. Conclusion: This study expands on the recently described anatomy of the pediatric MPFC to quantify the anatomic relationship between the MQTFL attachment to the quadriceps tendon and patella in a more clinically relevant cohort of donor specimens. Clinical Relevance: As access to pediatric cadaveric tissue is extremely limited, a better understanding of MPFC and MQTFL anatomy will support surgeons in preoperative planning and intraoperative considerations for their approach to MQTFL and MPFL reconstruction. This may facilitate improved anatomic surgical stabilization of the patellofemoral joint in pediatric patients.

Gibraltar, the British territory located at the southernmost tip of the Iberian Peninsula, is one of those places which are frequently in the news, but which often confuse outsiders with their ‘more-than-meets-the-eye’ complexity. Is it a colony, or is it self-governing? What is its relationship with its much larger neighbour across the border? Is there a Gibraltarian way of thinking? In this interview the Gibraltarian writer and novelist M. G. Sanchez – who has spent the last twenty years expounding upon the contradictions and idiosyncrasies at the heart of modern-day Gibraltarian identity – discusses borders, Brexit, coloniality, hybridity, as well as his latest novel Gooseman and his 2018 travelogue Bombay Journal.

National Institutes of Health (NIH) funding has declined among cardiothoracic surgeons. R01 grants are a well-known mechanism to support high-impact research, and we sought to clarify the association between NIH funding and academic achievement. We hypothesized that cardiothoracic surgeons who acquired R01 funding exhibit greater research output and faster career advancement. All cardiothoracic surgeons (n = 992) working at accredited United States cardiothoracic surgery training hospitals in 2018 were included. Institutional webpages, Scopus, and Grantome were utilized to collect publicly-available data regarding each surgeon's training and career history, research publications, and NIH funding. Seventy-eight (7.9%) surgeons obtained R01 funding as a principal investigator while 914 (92.1%) did not. R01-funded surgeons started their attending careers earlier (1998 vs 2005, P0.0001) and were more likely to have pursued dedicated research training (P0.0001). R01-funded surgeons authored 5.3 publications/year before their first R01 grant, 9.3 during the grant period, and 8.6 after the grant expired, all of which were greater than the publication rate of non-R01-funded surgeons at comparable career timepoints (2.0-3.0 publications/year, P0.0001). Among time-matched surgeons who completed medical school in 1998 or earlier (n = 73 R01-funded vs n = 602 non-funded), R01-funded surgeons have published more total publications (178.0 vs 56.5 papers, P0.0001) and exhibit a greater H-index (41.0 vs 19.0, P0.0001). These R01-funded surgeons have also advanced to higher academic ranks (P0.0001) and are more likely to be chiefs of their departments or divisions (42.5% vs 25.7%, P = 0.0035). Cardiothoracic surgeons who obtain R01 funding exhibit greater research productivity and faster career advancement.

Background: The Micheli technique for anterior cruciate ligament (ACL) reconstruction (ACLR) has proven to be a reliable method with a minimal risk for growth disturbance among skeletally immature patients. Purposes: To evaluate the Micheli technique of iliotibial band (ITB) graft passage for ACLR using cadaveric knee models and to measure the distance between the surgical instrument tip and the neurovascular bundle in the posterior knee joint: specifically, the peroneal nerve, tibial nerve, and popliteal artery. Study Design: Descriptive laboratory study. Methods: Gross dissection was performed on 17 pediatric cadaveric knees (12 male and 5 female) aged between 4 and 12 years. To simulate ITB graft passage, we passed a curved-tip hemostat clamp through the posterior capsule, with the knee flexed from 90° to 100°. Next, clinical photographs were taken, and digital imaging software was used to measure the distance in centimeters from the clamp tip to each respective neurovascular structure. Results: The mean distances from the clamp tip to the tibial nerve, popliteal artery, and peroneal nerve were 0.875 cm (range, 0.468-1.737 cm), 0.968 cm (range, 0.312-1.819 cm), and 1.149 cm (range, 0.202-2.409 cm), respectively. Mean values were further calculated for age groups of ≤8, 9-10, and 11-12 years. The mean distance from the clamp tip to the peroneal nerve was 1.400 cm larger for 11- to 12-year-old specimens than for ≤8-year-old specimens (95% CI, 0.6-2.2 cm; P = .005). Conclusion: The neurovascular structures in the posterior knee were in close proximity to the path of graft passage, with distances Clinical Relevance: As the incidence of ACL tears is continuously increasing within the pediatric population, there are a larger number of ACLR procedures being performed. Although neurovascular injuries during ACLR are rare, this study clarifies the close proximity of neurovascular structures during ITB graft passage using the Micheli technique of ACLR.

A paucity of data exists on the treatment of pediatric lateral meniscus root tears (LMPRTs). This study aims to characterize the biomechanics of the lateral knee joint in pediatric cadavers following LMPRT and root repair. Our hypotheses were: (1) compared with the intact state, LMPRT would be associated with decreased contact area; (2) compared with the intact state, LMPRT would be associated with increased contact pressures; and (3) compared with LMPRT, root repair would restore contact area and pressures toward intact meniscus values.Eight cadaver knees (ages 8-12 years) underwent contact area and pressure testing of the lateral compartment. Tekscan pressure mapping sensors covering the tibial plateau were inserted underneath the lateral meniscus. Appropriate pressure load equivalents were applied by a robot at degrees of flexion: 0, 30, 60. Three meniscus conditions were tested: (1) intact, (2) complete root tear, and (3) repaired root tear. Root repairs were performed with transtibial pullout sutures. Statistical analysis was performed.Root tear significantly decreased mean contact area at 30° (Transosseous pullout repair is a clinically validated treatment for LMPRT. This study provides baseline biomechanics data of transtibial pullout repair of pediatric LMPRTs.

Background: Substantial research about the mechanical properties of adult knee ligaments exists, but comparatively little is known about the pediatric knee. Choosing a graft for ligament reconstruction in pediatric patients is limited by the lack of knowledge of the mechanical properties of those ligaments and potential graft options in the skeletally immature. Purpose: Describe the mechanical properties of the ACL, PCL, MCL, LCL, and iliotibial band (ITB) in pediatric patients. Methods: Skeletally immature fresh frozen whole knees from 18 human cadavers (mean specimen age = 10.4 years) were thawed and the ligaments grossly dissected with bone block attachments intact, and length, width, and thickness were measured. Specimens were tested as a single unit (for those containing multiple bundles) and hydrated throughout testing. Each specimen was secured in an MTS machine and underwent a tensile loading protocol to measure ultimate tensile strength, ultimate tensile strain, and linear modulus. Results: Under testing, the ACL exhibited ultimate tensile strength (8.7 +/- 4.1 MPa), ultimate tensile strain (54.4 +/- 20.8%), and linear modulus (31.0 +/- 22.8 MPa) that were similar to the PCL (9.8 +/- 6.6 MPa, 48.6 +/- 22.1%, and 47.9 +/- 53.5 MPa, respectively). The LCL ultimate tensile strength was 18.7 +/- 6.5 MPa, ultimate tensile strain was 57.2 +/- 22.2%, and linear modulus was 68.7 +/- 50.8 MPa, compared to the MCL (19.5 +/- 13.9 MPa, 38.9 +/- 15.7%, and 93.3 +/- 75.1 MPa, respectively). Finally, the ITB demonstrated an ultimate tensile strength of 11.8 +/- 4.4 MPa, ultimate tensile strain of 42.6 +/- 14.9%, and linear modulus of 55.5 +/- 27.7 MPa. Conclusion: The ITB demonstrated greater ultimate tensile strength and a higher linear modulus than the ACL and PCL, with a lower ultimate tensile strain. Conversely, the ITB demonstrated lower values for ultimate tensile strength and linear modulus than the LCL and MCL. The ITB may serve as a reasonable substitute for native ACL and PCL reconstruction due to similar ultimate tensile strengths. The ITB may be less well-suited to reconstruct the LCL and MCL due to more significant differences in ultimate tensile strength. [Table: see text][Figure: see text]

Background: The anatomy of the trochlea plays a significant role in patella stability. Surgical approaches to alter the anatomy of the trochlea and associated structures to influence patella tracking continue to evolve. Unlike the development of the pediatric hip joint which has been well studies for decades, the developmental anatomy of the trochlea and its relationship to patella stability remains poorly understood. An improved understanding of trochlear growth and development may alter both the timing and type of surgical procedures for patella stability. Purpose: The purpose of this study was to describe the developmental changes of the osseous and cartilage trochlear morphology in skeletally immature specimens. Methods: Fifty-five skeletally immature cadaveric knees between the ages of 2 months and 11 years were evaluated using 0.625mm computed tomography scans. In the axial plane, measurements included medial and lateral osseous condylar height, medial and lateral cartilaginous condylar height, osseous and cartilaginous sulcus angles, osseous and cartilaginous condylar height asymmetry, and trochlear depth. Results: Analysis of trochlear morphology using osseous and cartilaginous measurements of condylar height, condylar height asymmetry, and trochlear depth demonstrated an increase in the size of the medial and lateral trochlea as age increased. The osseous and cartilaginous sulcus angles decreased (became deeper) with age until around age 8 and then plateaued. This corresponded with an increase in trochlear depth that plateaued also around age 8. In contrast, medial and lateral condylar height continued to increase through age 11. Cartilaginous condylar asymmetry rose slightly with age with the lateral condyle consistently larger than the medial condyle. Osseous condylar asymmetry increased with age but flipped from a larger medial condyle to a larger lateral condyle around age 8. Conclusions: This cadaveric analysis demonstrated that there is an increase in the medial and lateral trochlear height as age increased by all measurements analyzed. These changes in height continue to be seen through age 11 suggesting a still developing trochlea past this age. By age 8, a plateau in sulcus angle and sulcus depth suggests more proportionate growth after this point. Access to pediatric cadaveric specimens is exceptionally rare. This study provides a unique evaluate of the developing trochlea in young children, especially those under age 7, who rarely receive advanced imaging. [Figure: see text][Figure: see text]

Background: For patients with significant growth remaining, the Micheli-Kocher (iliotibial band) ACL reconstruction technique has proven to be a reliable procedure with minimal risk for growth disturbance. Recent cadaveric studies have demonstrated that graft passage over the top of the femur may bring the graft and instrument close to the critical neurovascular structures. Purpose: The purpose of this study was to evaluate the over-the-top graft passage technique using pediatric cadaveric knees, and measure the distance between instruments and the peroneal nerve, tibial nerve, popliteal artery. Methods: Seventeen skeletally immature cadaveric knees between the ages of 4 and 12 years old were dissected and prepared for visualization of iliotibial band graft passage procedure. A curved hemostat clamp was used, creating a path through the posterior capsule. To avoid neurovascular injury, the tip of the instrument was kept close to the posterior and lateral cortex of the femur. Once the clamp was safely positioned in the posterior knee joint, photographs were taken. Digital imaging software was used to measure the distance in centimeters from clamp tip to peroneal nerve laterally, and the popliteal artery and tibial nerve medially for all specimens, FIGURE 1. Distances were averaged and stratified to assess differences in age, FIGURE 2. Results: The average distances from clamp to neurovascular bundle were 0.875cm (range: 0.468-1.737cm), 0.968cm (range: 0.312-1.819cm), and 1.149cm (range: 0.202-2.409cm) for tibial nerve, popliteal artery and peroneal nerve, respectfully. Means were further calculated for age groups ≤8, 9-10, and 11-12 years old. Conclusion: Iliotibial band graft ACL reconstruction is one of the best options in the skeletally immature, as it has the lowest risk of growth plate complications and growth arrest. The neurovascular structures are very close to the path for over-the-top graft clamp placement with distances

Introduction: There is growing concern regarding the attrition of surgeon-scientists in cardiothoracic (CT) surgery. The academic impact of conducting basic science research (BSR) during training, however, remains unknown. We hypothesized that CT surgeons who publish a first-author BSR paper during training exhibit enhanced future academic productivity. Methods: CT surgeons on faculty at accredited United States CT surgery training hospitals in 2018 who published a first-author BSR paper or a first-author clinical research (CR) paper during training were identified (n=762). To normalize for environmental differences in research exposure, we specifically studied the surgeons who pursued a research fellowship and who attended a top-50 NIH-funded institution at every stage of training (n=252). Data regarding each surgeon’s professional history and publication record were obtained from publicly-available online sources. Results: As shown in Table 1, surgeons who published a first-author paper in BSR during training and those who published a first-author paper only in CR share similar characteristics and have practiced as an attending surgeon for a similar duration (11.0 years each, p=0.486). However, surgeons who published a first-author BSR paper during training ultimately published more papers per year as an attending (4.3 vs 2.8, p=0.017), resulting in more total publications (73.5 vs 47.5, p=0.003) and a greater H-index (22.0 vs 18.0, p=0.004). The surgeons who published a first-author BSR paper during training were also more likely to have published a BSR paper in the past 2 years as an attending, both as a first or last author (12.0% vs 2.0%, p=0.004), or as a co-author (34.0% vs 15.7%, p=0.001). Conclusions: Academic CT surgeons who published a first-author BSR paper during training exhibit enhanced research productivity and scholarly impact. Funding and institutional support for aspiring CT surgeon-scientists may yield career-long academic benefits.

The foundation for a successful academic surgical career begins in medical school. We examined whether attending a top-ranked medical school is correlated with enhanced research productivity and faster career advancement among academic cardiothoracic (CT) surgeons.Research profiles and professional histories were obtained from publicly available sources for all CT surgery faculty at accredited US CT surgery teaching hospitals in 2018 (n = 992). We focused on surgeons who completed medical school in the United States during or after 1990, the first-year US NewsWorld Report released its annual medical school research rankings (n = 451). Subanalyses focused on surgeons who completed a research fellowship (n = 299) and those who did not (n = 152).A total of 124 surgeons (27.5%) attended a US NewsWorld Report top 10 medical school, whereas 327 (72.5%) did not. Surgeons who studied at a top 10 medical school published more articles per year as an attending surgeon (3.2 versus 1.9; P 0.0001), leading to more total publications (51.5 versus 27.0; P 0.0001) and a higher H-index (16.0 versus 11.0; P 0.0001) over a similar career duration (11.0 versus 10.0 y; P = 0.1294). These differences in career-long research productivity were statistically significant regardless of whether the surgeons completed a research fellowship or not. The surgeons in both groups, however, required a similar number of years to reach associate professor rank (P = 0.6993) and full professor rank (P = 0.7811) after starting their first attending job.Attending a top-ranked medical school is associated with enhanced future research productivity but not with faster career advancement in academic CT surgery.

Advanced clinical fellowships are important for training surgeons with a niche expertise. Whether this additional training impacts future academic achievement, however, remains unknown. Here, we investigated the impact of advanced fellowship training on research productivity and career advancement among active, academic cardiac surgeons. We hypothesized that advanced fellowships do not significantly boost future academic achievement.Using online sources (eg, department webpages, CTSNet, Scopus, Grantome), we studied adult cardiac surgeons who are current faculty at accredited United States cardiothoracic surgery training programs, and who have practiced only at United States academic centers since 1986 (n = 227). Publicly available data regarding career advancement, research productivity, and grant funding were collected. Data are expressed as counts or medians.In our study, 78 (34.4%) surgeons completed an advanced clinical fellowship, and 149 (65.6%) did not. Surgeons who pursued an advanced fellowship spent more time focused on surgical training (P.0001), and those who did not were more likely to have completed a dedicated research fellowship (P = .0482). Both groups exhibited similar cumulative total publications (P = .6862), H-index (P = .6232), frequency of National Institutes of Health grant funding (P = .8708), and time to achieve full professor rank (P = .7099). After stratification by current academic rank, or by whether surgeons pursued a dedicated research fellowship, completion of an advanced clinical fellowship was not associated with increased research productivity or accelerated career advancement.Academic adult cardiac surgeons who pursue advanced clinical fellowships exhibit similar research productivity and similar career advancement as those who do not pursue additional clinical training.

A first attending job often sets the tone for academic surgeons' future careers, and many graduating trainees are faced with the decision to begin their career at their training institution or another institution. We hypothesized that surgeons hired as first-time faculty at their cardiothoracic surgery fellowship institution exhibit greater research productivity and career advancement than those hired as first-time faculty at a different institution.Cardiothoracic surgeons who were listed as clinical faculty at all 77 accredited United States cardiothoracic surgery training programs in 2018 and who trained through the general surgery residency and cardiothoracic surgery fellowship pathway were included (n = 904). Surgeon-specific data regarding professional history, publications, and grant funding were obtained from publicly available sources.Of the 904 surgeons, 294 (32.5%) were hired as first-time faculty at their cardiothoracic surgery fellowship institution whereas 610 (67.5%) were hired at a different institution (start year 2005 vs 2006; P = .342). Both groups exhibited similar research productivity upon starting their first job (total papers: 7.0 vs 7.0, P = .591). Followed to the present, surgeons hired at their cardiothoracic surgery fellowship institution produced more total papers (64.5 vs 39.0, P.001) and exhibited a higher H-index (20.0 vs 14.0, P.001). Surgeons in both groups required a similar amount of time to achieve associate (P = .208) and full professor (P = .593) ranks.Surgeons hired as first-time faculty at their cardiothoracic surgery fellowship institution may experience benefits to research productivity but not career advancement. Trainees may find it advantageous to begin their careers in a familiar environment where they have already formed a robust specialty-specific network.

In recent years, there has been great interest in the looming shortage of general surgeons. The media has begun to take notice, and politicians are now being forced to answer difficult questions regarding access to emergent surgical care. There are a number of issues which have impacted upon the shortage: physician workforce shortages secondary to the population boom and the inadequate response of medical school enrollment; changes in the mentality of current medical graduates desiring a more "balanced lifestyle" and its impact on specialty selection; subspecialization; the malpractice crisis; and declining reimbursements for surgical procedures. This review examines these issues in depth and suggests several potential solutions to the problem, including the surgical hospitalist model; the integration of trauma with emergency surgery; and tort and legislative reform. Further discussion centers around the responsibilities of both the "system" and the individual general surgeon in dealing with this important crisis.

To determine the pregnancy rates of microtubal reanastomosis (MTR) and any associated clinical variables, to determine pregnancy rates and live birth rates of MTR as compared to in vitro fertilization (IVF) and to study the rates of ectopic pregnancy and spontaneous abortion (SAB) after MTR.Retrospective chart review.At our institution, the pregnancy rate in the first 12 months following MTR was 44.3%. The study also showed that 2 clinical variables of the MTR procedure that had higher pregnancy rates were when Hulka clips (Hulka-Clemens, Richard Wolf, Rosemont, Illinois) or Filshie clips (Coopersurgical, Lake Forest, California) were used as the mechanism of tubal occlusion and if bilateral MTR was performed instead of unilateral. There was not a significant difference in the pregnancy rates of MTR (44.3%) vs. IVF (38%). However, there was a statistically significant difference in the live birth rate of MTR (19%) vs. IVF (31%) (p=0.007). The rates of ectopic pregnancy and SAB after MTR were 10% and 15.7%, respectively.This study showed a significantly higher live birth rate when patients underwent IVF as compared to MTR in the first 12 months following an MTR procedure.