Insights from Year 1 of Cardiothoracic Surgery Residency: A US Perspective

The transition from medical school to the first postgraduate training year (ie, internship/Foundation Year 1) remains one of the most challenging periods in an aspiring cardiothoracic surgeon’s career.1,2 Despite increasing exposure through assistantships, shadowing, subinternships, and recruitment initiatives, nothing truly prepares you for the moment the clinical system depends on your decisions.3 Prior studies have reported attrition rates approaching 20% in general surgery training programs, with nearly half of these departures occurring within the first postgraduate year.4 Similarly, integrated cardiothoracic surgery programs have been shown to have an annual attrition rate of up to 3.2%.5 Accordingly, ensuring adequate preparation and support during this transition is of utmost importance. In this article, we present key insights drawn from the perspectives of surgical residents in the United States. Efficiency and organization define successful residents. Unlike medical school, where you follow 1 or 2 patients, surgical residents may pre-round on 10-30 complex patients before morning ward rounds. Arrive early—especially on new services—and develop a consistent, reproducible approach to reviewing patient records that minimizes clicks within the electronic-health-record. At a minimum, take note of postoperative day, vitals, fluid balance, blood results, imaging, nutrition status, medications, and antithrombotic therapy (Table 1). Efficiency is not about speed, but intention, as your goal is always to identify and synthesize key information for your team. Even though final decisions are made by senior team members, a key aspect of internship is learning how to develop and articulate proposed management plans. Residents should therefore ask themselves 2 questions daily: