Surgical skills assessment during resident selection process: Survey of American cardiothoracic and Canadian cardiac surgery program directors.

Objective: Matching into cardiothoracic and cardiac surgery training programs is highly competitive. As surgical simulation becomes increasingly accessible, we present the various perspectives of program directors (PDs) on the potential assessment of surgical skills during the resident selection process. Methods: A 21-question survey was distributed to all 128 accredited American cardiothoracic (75 indirect-entry 5 + 2, 19 indirect-entry 4 + 3, and 34 direct-entry I-6 programs) and 12 Canadian direct-entry cardiac surgery residency programs. Questions were focused on respondent demographic characteristics, sentiments toward integration of surgical skills assessment in resident selection, and perceptions of residents' technical skills at different stages of training. A similar questionnaire was distributed to all 360 American and Canadian general surgery PDs given its foundation for indirect-entry cardiothoracic surgery fellowships. Data were analyzed descriptively and quantitatively. Results: Forty-nine American cardiothoracic (38%), 10 Canadian cardiac (83%), 50 American general (15%), and 10 Canadian general (59%) surgery PDs completed the survey. Cardiothoracic and cardiac surgery PDs were divided on whether surgical skill assessment should be part of the selection process (yes: 52.5%; n = 31). Although 35.6% (n = 21) believed residents were slightly underperforming at the start of training, 50.9% (n = 30) believed residents were slightly or significantly overperforming by the end. Similar patterns were seen among general surgery responses. Conclusions: Surgical skills assessment during the resident selection process is divisive among cardiothoracic and cardiac surgery PDs. Surgical skills remain largely untested before residency but are developed throughout training.