Connection through cardiothoracic surgery subspecialty collaboration: Strategies for Early Faculty Peer Network Development

An enormous task that all newly graduated trainees in cardiothoracic residency and fellowship have in their first few years as junior faculty is the imperative to pass the American Board of Thoracic Surgery (ABTS) Board certification exam. Even if you choose a specialty-specific track within residency/fellowship, the relevant topics for cardiothoracic surgery encompass thoracic surgery, adult cardiac surgery, critical care, and congenital cardiac surgery. Yearly, about 15% to 20% will fail. In the midst of starting at a new institution, it can be difficult to prioritize study time. Also, surgical Board certification exams are in 2 parts: written and oral. This process extends the examination process over an entire year, at minimum, usually starting at the beginning of your faculty position. Also, mock oral exam preparation necessitates at least 2 people to practice—an examiner and an examinee. Literally, effective exam preparation cannot be completed by 1 individual. Thus, the strategy for preparing for this exam requires intentional studying—at least in pairs—with faculty members who are knowledgeable in these subspecialties.

In addition to studying, an extension of professional productivity that younger surgeons struggle with early on is maintaining consistent time to write. Professional writing is a broad term and includes manuscripts, essays, project proposals, and letters of recommendation, to name a few examples. This time also includes preparation around writing, including reading relevant articles, outlining, or reworking drafts with collaborator comments. Another example of meaningful work outside of an individual's current institution is finishing projects from training that are in the final stages. One can imagine that the greater the distance from the institution where the project was started (both time and space), the more difficult it is to complete, regardless of how much time has been invested.

Once at a new institution, what is the ability of a cardiothoracic surgeon to continue productive work outside of the operating room, such as publishing and research? In 2018, a database of more than 900 cardiothoracic surgeons in US academic teaching hospitals was created to track authorship publication history and National Institutes of Health grant funding. Wang and colleagues found that only 7% (n = 73) were actively leading basic science research and only 60% (n = 599) were actively leading nonbasic science research. In subgroup analysis, the proportion of women leading basic science research was much lower (n = 2). Proportionally, surgeons were designated as 47.6% (n = 320) cardiac, 35.4% (n = 238) thoracic, and 17.1% (n = 115) congenital. It is notable that research involvement was similarly distributed across cardiac (42.5% vs 48.2%), thoracic (39.7% vs 34.7%), and congenital (17.8% vs 17.0%) specialties when analyzing by basic and nonbasic science research categories, respectively. The uniform division of research type suggests that the specific category of research—nonbasic science versus basic science—is not a determining factor when comparing pursuit of research across different cardiothoracic subspecialties.

Some of the challenges to pursuing research include needing to obtain funding, staff, and statistical support. As a junior faculty member, finding, applying, and wisely managing these resources is not guaranteed with intentional, consistent effort. With limited time outside of operating rooms, it may be tempting to balance the desire to collaborate on projects with inexperienced, but enthusiastic, research participants; that is, medical students or residents/fellows. The potential conflicts are competing goals of pursuing high-quality, established projects; obtaining support for your own independent work; and/or sharing your research knowledge with less-experienced others. Strategizing and choosing collaborators may be difficult with differing experience levels and existing hierarchies. Self-advocacy is a necessary skill. Do not hesitate to ask for what you need early on or ask for assistance from those with skills to help you.

For some board-eligible cardiothoracic program graduates, when it comes time to actually sit for the ABTS examination, it has already been years beyond when we were actively on clinical rotations in that particular subspecialty. Frequently, the most challenging topics to study for are those remote from what we are doing in our day-to-day surgical practice. By becoming study partners with faculty members in a different subspecialty, you can exchange clinical expertise. A list of study resources on various subspecialties shows the difference in study approach depending on topic focus (Table 1). For oral exams, plan on scheduling practice sessions focused on the subspecialty that is beyond your daily clinical practice. Being connected to someone simultaneously studying for the same exam provides an added level of accountability and motivation. For anyone who is faced with retaking the exam, peer support from cardiothoracic faculty in different subspecialties who have taken the Boards can be an effective way to master unfamiliar topics.

In addition to keeping each other accountable for studying, writing accountability is another practical way junior surgical faculty can support each other. There are several strategies to become a more effective and productive writer. One of these strategies, suggested by Silva, is to create an accountability group. There are several types of accountability groups: reviewing each individual's written works, setting time to write individually but at a prearranged time, and meeting regularly to update each other on progress in writing goals. The beauty of this type of format is it can be virtual. Junior cardiothoracic faculty members should be motivated to continue their productivity; a writing accountability group can allow all members of this peer group to benefit simply from each individual's presence and consistent participation.

Creating accountability through a peer group can also be applied to research. There are several obstacles to starting a research project for early-career faculty members. Some challenges are unique to the institution and can include completing online training, accessing databases, or applying for an institutional review board approval. Junior faculty members can assist each other by sharing resource templates or jointly asking a senior faculty member for guidance. In addition to institution-specific challenges, a universal challenge to pursuing research is lack of available funding. Research funding provides protected research time, which is critical to the development of early-career academic surgeons. Predictably, some factors for basic science research involvement include having a PhD degree, publishing a first-author publication during training, or possessing an active National Institutes of Health grant. Wang and colleagues concluded that to facilitate the development of surgeon–scientists, additional funding support must be granted to junior faculty members, especially women. Peer junior cardiothoracic faculty members can help each other by sharing resources to obtain research mentorship, navigate intense grant-writing processes, and obtain statistical support. Many cardiothoracic surgery subspecialties have similar challenges to performing research as surgeon–scientists, so discovering and sharing opportunities across all domains can improve the chances for funding opportunities, identifying sustainable projects, or fostering multidisciplinary collaboration. Early success in obtaining valuable research resources will encourage cardiothoracic surgeons to engage in substantive research endeavors.

There is no doubt that this career path is stressful. And, the amount of social support each individual has may be limited. Compounding these factors are the stresses of continuing to move and start over at each level of training. Oftentimes, to combat the isolation, it becomes necessary to connect with people outside your direct chain of command. During training, your closest friends could be co-residents or co-fellows because you shared similar experiences. Trustworthy, kind, and supportive colleagues can help you survive during the early stages of transition by offering emotional support and collegiality. Befriending junior faculty members outside your specific department may facilitate the coping process. Another idea is to find someone who is more advanced in his or her career to gain some valuable wisdom and perspective. Discover who else may share your struggles and start to come up with creative solutions through connectivity. Ideas for spending time to decompress outside of work include getting coffee, taking a walk, or telling a joke. Even talking about nonwork-related topics can be cathartic. Most importantly, you should find faculty who can celebrate your successes with you. We all need these joyful moments to remind us that we are human, especially in a career field that can be dehumanizing.

Although not without flaws, using social media as a method for finding and connecting like-minded peers professionally may be necessary if you have limited access to other junior faculty members at your local institution. Luc and colleagues have published several studies showing the importance of social media participation in increasing networking and mentorship among smaller groups, specifically for women interested in cardiothoracic surgery. As a real-world example of effectively utilizing social media to find underrepresented mentors within cardiothoracic surgery at different institutions, accessing cardiothoracic surgery peers and senior mentors could be enhanced by visibility through social media. This virtual network can grow through virtual communication and digital connections via already established thoracic surgery social media communities.

For any junior faculty, networking is a key strategy for establishing a regional, national, and international community in the exciting field of cardiothoracic surgery. By interfacing with faculty across cardiothoracic subspecialties, the potential pool of peer surgeons multiplies immediately. The Society of Thoracic Surgeons (STS), Women in Thoracic Surgery (WTS), and the American Association of Thoracic Surgeons (AATS) are some examples of global networks that include all cardiothoracic subspecialties.

Recently, other organizations such as the Thoracic Surgery Resident Association have been instrumental at providing quality educational study materials for trainees. These comprehensively cover all cardiothoracic surgical subspecialty topics in each resource (Table 1). However, there is a lack of these types of resources crafted by and targeted toward junior faculty members, at a deeper level of clinical practice and understanding. For instance, imagine a manual authored by junior faculty members focusing on common challenges and solutions to early career development unique to cardiothoracic surgery (eg, scarcity of cases early on, limited experience in surgical fellowship, knowing when and how to ask for assistance, learning to work with different surgical staff, getting familiar with new instruments, and completing documentation and billing). A companion piece with senior cardiothoracic surgery authors with advice and experience for each topic could also be created. The biggest challenge would be to create collaboration across all subspecialties as faculty instead of trainees.

The amount of scholarship and award opportunities through the various cardiothoracic surgery societies continues to grow for trainees as well. Or, specific subgroups within the specialty, such as WTS, offer targeted mentoring opportunities for individual trainees. Examples of career development opportunities for early career faculty do exist. Yet, these efforts are broadly provided at annual meeting 1-day sessions for individuals and 1-on-1 mentoring opportunities. In a recent systematic review of mentorship, published by Odell and colleagues as part of The STS Workforce on Career Development, there is undeniable value to these professional relationships in fostering career success. However, a construct of mentorship diversity and peer support becomes especially necessary when early-career surgeons need a variety of advice, support, and skills imminently. One example of how accessible an already-established professional community can make this wisdom is the STS Career Blog with practical, timely advice for all early career cardiothoracic faculty members. Furthermore, in-person relationship building could be an integral part that junior faculty members are missing. Group-based activities can be another strategy, similar to Thoracic Surgery Directors Association Bootcamp (now managed by STS) for cardiothoracic surgical residents/fellows at the beginning of their training. Envisioning a cardiothoracic surgery junior faculty career development bootcamp for the first few years of practice that fosters peer relationships and practical advice for overcoming the obstacles of early career surgeons is something that the societies or ABTS should provide. Why do the structured, collaborative resources for learning, training, and preparation have to stop when training has officially completed? Investment by societies in junior faculty members will be paramount to growing the next generation of well-developed cardiothoracic surgeons, regardless of institution affiliation.

Besides creating educational resources, the advantage of surgical societies is in their community spanning across different institutions worldwide. To harness the power of this diverse mentorship and sage advice, there should be a directory accessible for graduating trainees during their job search and junior faculty members designed to facilitate contact of specific peers/mentors with a focus on early career development. A list of interested society members with subspecialty, practice type, previous job locations/rank, current position, and career focus, would make establishing these connections easier. This list would reflect the diversity of career paths within cardiothoracic surgery. Examples of how to use this type of directory would be: making a connection with faculty members who have left your institution so you can ask about his or her experiences, midcareer faculty members who are already going through the promotion process, or senior faculty members in leadership positions that align with your career aspirations.