Preparing for transition from medical school to intern year of integrated cardiothoracic surgical residency

Abstract

Central MessageEight residents who recently finished their internship at their respective I-6 programs identified core areas of challenges related to transitioning from medical school to I-6 residency.PerspectiveTransitioning to an I-6 residency after medical school entails a unique set of challenges for aspiring CT surgeons that differ from other residency paths and are only just now being identified. I-6 programs demand an accelerated convergence of surgical skills and knowledgebase in general, vascular, cardiac and thoracic surgery, as well as interventional cardiology, heart failure, and cardiac imaging.See Commentary on page XXX. Eight residents who recently finished their internship at their respective I-6 programs identified core areas of challenges related to transitioning from medical school to I-6 residency. Transitioning to an I-6 residency after medical school entails a unique set of challenges for aspiring CT surgeons that differ from other residency paths and are only just now being identified. I-6 programs demand an accelerated convergence of surgical skills and knowledgebase in general, vascular, cardiac and thoracic surgery, as well as interventional cardiology, heart failure, and cardiac imaging. See Commentary on page XXX. In medicine, we constantly undergo transitions. As providers, we must grow into new roles and responsibilities at various stages of our careers, learning to both navigate associated challenges while continuing the journey of lifelong learning (Figure 1). Of all transitions, the progression from being a medical student to resident is one of the most stark and formative leaps in our careers. Significant efforts have been allocated in academia to better understand this process and to provide beneficial resources and advice. Although traditional cardiothoracic (CT) surgical training has required general surgical qualification followed by subsequent 2- or 3-year CT fellowship training, integrated 6-year (I-6) programs have emerged as a popular alternative in the past decade because they provide earlier and more direct exposure to the field right after graduating from medical school. In 2021, there were 121 applicants competing for 46 available positions in the United States, and this growth trajectory is expected to continue. Transitioning to an I-6 residency after medical school entails a unique set of challenges for aspiring CT surgeons. In part, I-6 programs demand an accelerated convergence of surgical skills and knowledge base in general, vascular, cardiac, and thoracic surgery, as well as interventional cardiology, heart failure, and cardiac imaging. In a similar vein, some of the more traditional challenges associated with starting residency, such as learning to navigate a new system, including team dynamics, hospital workflow, and work–life balance, are complicated by the fact that I-6 residents rotate through multiple departments as off-service trainees. Because there is currently a paucity of literature on how to succeed during this transition, here we present a list of important considerations and advice for applicants. In conjunction with the Thoracic Surgery Residents Association (Figure 2), a committee of 8 residents who recently finished their internship at their respective I-6 programs were organized on a voluntary basis by senior trainees from both I-6 and traditional pathways, as well as an attending surgeon. Core areas of challenges related to transitioning from medical school to I-6 residency were identified. Traditionally, the intern is the workhorse of the team, often the first to know about changes in patients’ clinical status and to see and triage patients in the emergency department. The intern is a care coordinator, advocate, documenter, teacher of medical students, and (lest we forget) a surgeon in training. Transitioning to residency entails successfully adopting this multitude of roles. An intern must quickly grow proficient in navigating a new hospital system in ad