Mara Antonoff, MD

The 2014 Residents’ Symposium at the STS 50th Annual Meeting in Orlando was heavily attended and greatly appreciated by current thoracic surgical trainees.

This outstanding forum boasted several experienced and informative speakers, with the overall goals of helping residents to find the right job and transition to practice.

Moderated by Dr. Sidhu Gangadharan, Dr. Sandra Starnes, and Dr. Ara A. Vaporciyan, this session addressed several key foci, specifically aiming to help residents plan a successful job search, negotiate important elements of a contract, plan for ways to bring new technologies into a practice, recognize the legal issues of billing and coding, and identify the important aspects of early career development. This phenomenal collection of talks featured a number of key speakers, who provided tips and recommendations received with great interest by the resident participants.

The symposium was kicked off by Dr. Danny Chu of the University of Pittsburgh Medical Center, who spoke on how to find a job position. He shared his personal experiences and gave attendees an overview of the actual job-search process. He provided several tips for finding the best job. He stated that since, "good positions are almost never advertised until they are filled, it helps to have a big network." He explained that, "in such a small community, there are literally 3 degrees of separation, and everyone knows everyone. In addition to being a good surgeon, being a nice and affable person will get you a good position." His top tips for finding a job are to "Work hard, be nice, and be social." Dr. Chu concluded his presentation by explaining that there’s no magic formula for finding a job, but that it’s very much like dating. He warns that money is not everything, details are all negotiable, and one should be cautious in trusting others. In the end, he believes that "nice guys will win," and tells the group despite much anxiety, it will work out in the end.

This was followed by a talk from Dr. Christine Lau of the University of Virginia, Charlottesville, on interviewing and self-marketing. Dr. Lau provided her insights on how to best represent yourself in the interview process, with a number of great points about putting your best foot forward. She emphasized the importance of being prepared, and she strongly advised that, prior to going on an interview, you do your homework. "Know what the position entails," explained Dr. Lau, "and have a well-thought-out plan regarding what you uniquely bring to it."

She advised speaking to a number of people in advance in order to elucidate the specific needs of the group. And, while Dr. Lau encourages you to have a clear explanation as to how you might meet the expectations of the job, she offered a reminder of the importance of being honest. "Yes, you want to explain how you fit into the spot; however, if it’s not a good fit, don’t try to be something that you’re not. You won’t be happy in the long run, and neither will they." Dr. Lau also offered some advice regarding the concept of specialization.

"Everybody wants to have a niche. But you don’t need to force yourself to differentiate early on." She continued, "If your interests and skills are broad at this point, that’s not a bad thing. You can always morph later."

Dr. Faiz Bhora of Columbia University, N.Y., wrapped up the first session with a discussion of contract negotiations – helping attendees prioritize what’s worth fighting for, how to fight for it, and how to avoid going so far as to negotiate oneself out of a job.

After the opportunity to partake in both small and large group sessions and a short break, the symposium resumed, with the second half focusing on the transition from trainee to attending surgeon.

Dr. Edward Chen of Emory University in Atlanta provided suggestions for adding new technologies to one’s practice and the effective team interactions required to do so. He listed several key strategies that he feels are critical to a successful transition. Communication, communication, and communication were at the top of his list. He advised that it’s a two-way street and that ample meetings may be necessary regarding one’s needs and expectations. He warned not to make any assumptions and to be flexible about adapting to the system that is in place. He also stressed the importance of a willingness to educate the staff about specific technology – in the ICU, in the OR, and on the ward. Dr. Chen also spoke about professional behavior and team building once one is out in the real world.

His advice to trainees entering practice entails the following three recommendations: "1) Make patient care your absolute top priority. 2) Treat everyone around you with utmost respect and dignity. Care about and find value in all team members, even those who are not the strongest members. Always have your team member’s back and never openly criticize anyone. And 3) embrace your new institution and new team members." These suggestions are useful for trainees entering their first job; however, they are also incredibly practical advice for anybody working on a medical team, regardless of the environment or their role on the team.

Dr. Francis C. Nichols, from the Mayo Clinic, in Rochester, Minn., gave a great update on the new ICD-10, explaining key differences between previous coding systems and the new one.

He provided attendees with a helpful understanding of the importance of appropriate coding and billing strategies, and offered tips for accurately optimizing one’s ability to bill for provided services.

Finally, this wonderful series of brief lectures was finished off with a top-notch presentation from Dr. Elizabeth A. David of the University of California, Davis, who spoke about the various means of developing your career in the early years. She provided insight and details about developing reasonable, achievable 5- and 10-year plans; finding mentors (both within and outside of one’s institution); and how not to fail as a junior attending. The most important thing that you should do as a junior attending, according to Dr. David, is to make sure that your patients do well. She recommends, "Check everything, be vigilant, make sure your outcomes are yours, and be available to your patients and your referring physicians."

When asked what she wishes she’d known before venturing into practice, Dr. David states, "I wish I had known how hard I was going to work as a junior faculty member. People had told me that the first year would be a hard year, but it never really sunk in until I was experiencing it." She continues, "my first year was definitely a challenging year, but like all things you work hard for – it was very rewarding!"

Likewise, the symposium was incredibly rewarding. States Dr. Michelle Ellis, a finishing fellow at the University of Michigan, Ann Arbor, "I enjoyed the symposium very much. It was timely and relevant. I would definitely recommend it to other residents and fellows. I especially liked the break-out sessions which allowed for detailed discussion."

Dr. Antonoff is a second-year, thoracic-track trainee at Washington University in St Louis.

The 2014 Residents’ Symposium at the STS 50th Annual Meeting in Orlando was heavily attended and greatly appreciated by current thoracic surgical trainees.

This outstanding forum boasted several experienced and informative speakers, with the overall goals of helping residents to find the right job and transition to practice.

Moderated by Dr. Sidhu Gangadharan, Dr. Sandra Starnes, and Dr. Ara A. Vaporciyan, this session addressed several key foci, specifically aiming to help residents plan a successful job search, negotiate important elements of a contract, plan for ways to bring new technologies into a practice, recognize the legal issues of billing and coding, and identify the important aspects of early career development. This phenomenal collection of talks featured a number of key speakers, who provided tips and recommendations received with great interest by the resident participants.

The symposium was kicked off by Dr. Danny Chu of the University of Pittsburgh Medical Center, who spoke on how to find a job position. He shared his personal experiences and gave attendees an overview of the actual job-search process. He provided several tips for finding the best job. He stated that since, "good positions are almost never advertised until they are filled, it helps to have a big network." He explained that, "in such a small community, there are literally 3 degrees of separation, and everyone knows everyone. In addition to being a good surgeon, being a nice and affable person will get you a good position." His top tips for finding a job are to "Work hard, be nice, and be social." Dr. Chu concluded his presentation by explaining that there’s no magic formula for finding a job, but that it’s very much like dating. He warns that money is not everything, details are all negotiable, and one should be cautious in trusting others. In the end, he believes that "nice guys will win," and tells the group despite much anxiety, it will work out in the end.

This was followed by a talk from Dr. Christine Lau of the University of Virginia, Charlottesville, on interviewing and self-marketing. Dr. Lau provided her insights on how to best represent yourself in the interview process, with a number of great points about putting your best foot forward. She emphasized the importance of being prepared, and she strongly advised that, prior to going on an interview, you do your homework. "Know what the position entails," explained Dr. Lau, "and have a well-thought-out plan regarding what you uniquely bring to it."

She advised speaking to a number of people in advance in order to elucidate the specific needs of the group. And, while Dr. Lau encourages you to have a clear explanation as to how you might meet the expectations of the job, she offered a reminder of the importance of being honest. "Yes, you want to explain how you fit into the spot; however, if it’s not a good fit, don’t try to be something that you’re not. You won’t be happy in the long run, and neither will they." Dr. Lau also offered some advice regarding the concept of specialization.

"Everybody wants to have a niche. But you don’t need to force yourself to differentiate early on." She continued, "If your interests and skills are broad at this point, that’s not a bad thing. You can always morph later."

Dr. Faiz Bhora of Columbia University, N.Y., wrapped up the first session with a discussion of contract negotiations – helping attendees prioritize what’s worth fighting for, how to fight for it, and how to avoid going so far as to negotiate oneself out of a job.

After the opportunity to partake in both small and large group sessions and a short break, the symposium resumed, with the second half focusing on the transition from trainee to attending surgeon.

Dr. Edward Chen of Emory University in Atlanta provided suggestions for adding new technologies to one’s practice and the effective team interactions required to do so. He listed several key strategies that he feels are critical to a successful transition. Communication, communication, and communication were at the top of his list. He advised that it’s a two-way street and that ample meetings may be necessary regarding one’s needs and expectations. He warned not to make any assumptions and to be flexible about adapting to the system that is in place. He also stressed the importance of a willingness to educate the staff about specific technology – in the ICU, in the OR, and on the ward. Dr. Chen also spoke about professional behavior and team building once one is out in the real world.

His advice to trainees entering practice entails the following three recommendations: "1) Make patient care your absolute top priority. 2) Treat everyone around you with utmost respect and dignity. Care about and find value in all team members, even those who are not the strongest members. Always have your team member’s back and never openly criticize anyone. And 3) embrace your new institution and new team members." These suggestions are useful for trainees entering their first job; however, they are also incredibly practical advice for anybody working on a medical team, regardless of the environment or their role on the team.

Dr. Francis C. Nichols, from the Mayo Clinic, in Rochester, Minn., gave a great update on the new ICD-10, explaining key differences between previous coding systems and the new one.

He provided attendees with a helpful understanding of the importance of appropriate coding and billing strategies, and offered tips for accurately optimizing one’s ability to bill for provided services.

Finally, this wonderful series of brief lectures was finished off with a top-notch presentation from Dr. Elizabeth A. David of the University of California, Davis, who spoke about the various means of developing your career in the early years. She provided insight and details about developing reasonable, achievable 5- and 10-year plans; finding mentors (both within and outside of one’s institution); and how not to fail as a junior attending. The most important thing that you should do as a junior attending, according to Dr. David, is to make sure that your patients do well. She recommends, "Check everything, be vigilant, make sure your outcomes are yours, and be available to your patients and your referring physicians."

When asked what she wishes she’d known before venturing into practice, Dr. David states, "I wish I had known how hard I was going to work as a junior faculty member. People had told me that the first year would be a hard year, but it never really sunk in until I was experiencing it." She continues, "my first year was definitely a challenging year, but like all things you work hard for – it was very rewarding!"

Likewise, the symposium was incredibly rewarding. States Dr. Michelle Ellis, a finishing fellow at the University of Michigan, Ann Arbor, "I enjoyed the symposium very much. It was timely and relevant. I would definitely recommend it to other residents and fellows. I especially liked the break-out sessions which allowed for detailed discussion."

Dr. Antonoff is a second-year, thoracic-track trainee at Washington University in St Louis.

The 2014 Residents’ Symposium at the STS 50th Annual Meeting in Orlando was heavily attended and greatly appreciated by current thoracic surgical trainees.

This outstanding forum boasted several experienced and informative speakers, with the overall goals of helping residents to find the right job and transition to practice.

Moderated by Dr. Sidhu Gangadharan, Dr. Sandra Starnes, and Dr. Ara A. Vaporciyan, this session addressed several key foci, specifically aiming to help residents plan a successful job search, negotiate important elements of a contract, plan for ways to bring new technologies into a practice, recognize the legal issues of billing and coding, and identify the important aspects of early career development. This phenomenal collection of talks featured a number of key speakers, who provided tips and recommendations received with great interest by the resident participants.

The symposium was kicked off by Dr. Danny Chu of the University of Pittsburgh Medical Center, who spoke on how to find a job position. He shared his personal experiences and gave attendees an overview of the actual job-search process. He provided several tips for finding the best job. He stated that since, "good positions are almost never advertised until they are filled, it helps to have a big network." He explained that, "in such a small community, there are literally 3 degrees of separation, and everyone knows everyone. In addition to being a good surgeon, being a nice and affable person will get you a good position." His top tips for finding a job are to "Work hard, be nice, and be social." Dr. Chu concluded his presentation by explaining that there’s no magic formula for finding a job, but that it’s very much like dating. He warns that money is not everything, details are all negotiable, and one should be cautious in trusting others. In the end, he believes that "nice guys will win," and tells the group despite much anxiety, it will work out in the end.

This was followed by a talk from Dr. Christine Lau of the University of Virginia, Charlottesville, on interviewing and self-marketing. Dr. Lau provided her insights on how to best represent yourself in the interview process, with a number of great points about putting your best foot forward. She emphasized the importance of being prepared, and she strongly advised that, prior to going on an interview, you do your homework. "Know what the position entails," explained Dr. Lau, "and have a well-thought-out plan regarding what you uniquely bring to it."

She advised speaking to a number of people in advance in order to elucidate the specific needs of the group. And, while Dr. Lau encourages you to have a clear explanation as to how you might meet the expectations of the job, she offered a reminder of the importance of being honest. "Yes, you want to explain how you fit into the spot; however, if it’s not a good fit, don’t try to be something that you’re not. You won’t be happy in the long run, and neither will they." Dr. Lau also offered some advice regarding the concept of specialization.

"Everybody wants to have a niche. But you don’t need to force yourself to differentiate early on." She continued, "If your interests and skills are broad at this point, that’s not a bad thing. You can always morph later."

Dr. Faiz Bhora of Columbia University, N.Y., wrapped up the first session with a discussion of contract negotiations – helping attendees prioritize what’s worth fighting for, how to fight for it, and how to avoid going so far as to negotiate oneself out of a job.

After the opportunity to partake in both small and large group sessions and a short break, the symposium resumed, with the second half focusing on the transition from trainee to attending surgeon.

Dr. Edward Chen of Emory University in Atlanta provided suggestions for adding new technologies to one’s practice and the effective team interactions required to do so. He listed several key strategies that he feels are critical to a successful transition. Communication, communication, and communication were at the top of his list. He advised that it’s a two-way street and that ample meetings may be necessary regarding one’s needs and expectations. He warned not to make any assumptions and to be flexible about adapting to the system that is in place. He also stressed the importance of a willingness to educate the staff about specific technology – in the ICU, in the OR, and on the ward. Dr. Chen also spoke about professional behavior and team building once one is out in the real world.

His advice to trainees entering practice entails the following three recommendations: "1) Make patient care your absolute top priority. 2) Treat everyone around you with utmost respect and dignity. Care about and find value in all team members, even those who are not the strongest members. Always have your team member’s back and never openly criticize anyone. And 3) embrace your new institution and new team members." These suggestions are useful for trainees entering their first job; however, they are also incredibly practical advice for anybody working on a medical team, regardless of the environment or their role on the team.

Dr. Francis C. Nichols, from the Mayo Clinic, in Rochester, Minn., gave a great update on the new ICD-10, explaining key differences between previous coding systems and the new one.

He provided attendees with a helpful understanding of the importance of appropriate coding and billing strategies, and offered tips for accurately optimizing one’s ability to bill for provided services.

Finally, this wonderful series of brief lectures was finished off with a top-notch presentation from Dr. Elizabeth A. David of the University of California, Davis, who spoke about the various means of developing your career in the early years. She provided insight and details about developing reasonable, achievable 5- and 10-year plans; finding mentors (both within and outside of one’s institution); and how not to fail as a junior attending. The most important thing that you should do as a junior attending, according to Dr. David, is to make sure that your patients do well. She recommends, "Check everything, be vigilant, make sure your outcomes are yours, and be available to your patients and your referring physicians."

When asked what she wishes she’d known before venturing into practice, Dr. David states, "I wish I had known how hard I was going to work as a junior faculty member. People had told me that the first year would be a hard year, but it never really sunk in until I was experiencing it." She continues, "my first year was definitely a challenging year, but like all things you work hard for – it was very rewarding!"

Likewise, the symposium was incredibly rewarding. States Dr. Michelle Ellis, a finishing fellow at the University of Michigan, Ann Arbor, "I enjoyed the symposium very much. It was timely and relevant. I would definitely recommend it to other residents and fellows. I especially liked the break-out sessions which allowed for detailed discussion."

Dr. Antonoff is a second-year, thoracic-track trainee at Washington University in St Louis.

In nearly every facet of our lives, our mobile devices have taken over. Managing our calendars, organizing our contacts, and planning our driving directions -- our devices have become invaluable and ubiquitously present. While the ease of use of smartphones and tablets puts the power of portable computing in the hands of everyone, mobile software seems to be particularly appreciated by young professionals, who seek the convenience of on-the-go functionality and feel comfortable with computing in the palms of their hands. Throughout the world of education and a breadth of academic fields, advanced software programs have gained momentum, recognized for their ability to provide up-to-date, on-the-ground information.

In recent years, there has been an explosion of new software programs applicable to the field of cardiothoracic surgery, and these applications have been well received by modern trainees.

"Mobile apps are incredibly convenient because they provide a means of accessing information while on the go," states Jonathan Spicer, a thoracic trainee at M.D. Anderson Cancer Center in Houston.

He continues, "Having the capacity to look up helpful information from my phone while in the operating room, on the ward, or in transit is particularly helpful."

In this article, we aim to highlight some of the more exciting and innovative mobile software programs available today for those interested in expanding their knowledge in cardiothoracic surgery or looking for an easy-to-access resource.

iBronch (Edward Bender), $0.99: iBronch is one of the many outstanding thoracic surgical apps developed by Ed Bender. This program aims to guide learners through the basic anatomy of the trachea and bronchial tree, with correlation of simultaneous images from a fiberoptic bronchoscope and along an anatomic airway diagram. Branches of the pulmonary tree are labeled on the schematic and the bronchoscopy images. This app is particularly useful for those trainees gaining comfort with bronchoscopic procedures; however, its utility may be less significant for more advanced learners. Regardless, this is a great program, quite helpful for the intended audience.

Thoracic Lymph Node Map (RADIOLOGiQ, LLC), Free: This app provides a color-coded lymph node map, associated with computed tomography images and adapted from the International Association for the Study of Lung Cancer (IASLC) lung cancer project. This program provides excellent illustrations of the anatomic definitions for each of the intrathoracic lymph node stations. This is helpful both in examining imaging studies of actual patients and in the operating room.

CT Journals (Edward Bender), Free: This software program serves as a scholarly journal aggregator for the field of cardiothoracic surgery. The app displays feeds for journals of interest, with inclusion of those relevant periodicals with the most readership and highest impact factors. Not only can one access the articles while online, abstracts can be saved for future use offline. This is a great resource, but users should be aware that access to the full articles is available only for those who have active accounts providing them access to the specific journals.

CTSNetWiki (Edward Bender), Free: Cardiothoracic Surgery Notes is an online review developed and maintained by residents in thoracic surgical training. This resource is a tremendous repository of information, compiling graphics, text, and other multimedia content on a breadth of topics. This app allows general review of a wide variety of cardiothoracic surgical problems and is appropriate for both the novice learner and as a review for those who are further along in their training.

SESATS IX (Edward Bender), Free: Perhaps the most valuable mobile software application out there, the Self Education Self Assessment in Thoracic Surgery (SESATS) IX application contains actual questions from previous versions of the SESATS. The mobile app even includes the associated images, videos, and CT scans that correspond with the questions. Although the program does not contain the latest version of SESATS, the utility of this app cannot be overestimated. This program is enormously helpful for self-testing, on-the-go topic-specific learning, and exam preparation. This is a real gem of a find, and it comes with a strong recommendation to all trainees for its download and use.

TSRA Primer of Cardiothoracic Surgery (Thoracic Surgery Residents' Association), $4.99: Produced by CT residents for CT residents, this is probably the most useful resource for the intern, junior resident, or new fellow who needs to brush up on the basics before rounds, in between consults, and before assisting in the OR. It's not comprehensive, but it is full of clinical pearls covering all the major divisions of cardiothoracic surgery. Many cardiac residents, especially younger integrated residents, have been waiting for a straightforward, practical tutorial like this for years. Beautiful and often interactive illustrations and videos really make this iBook memorable.

NCCN Guidelines (TIP Medical Communications), Free: Available for Android and iOS, this compendium of NCCN guidelines for 56 cancers and cancer-related topics is indispensible for trainees. The utility of having up-to-date, in-depth guidelines for diagnosis and staging of all commonly encountered malignancies cannot be overstated. Additional topics ranging from management of cancer-related emesis to lung cancer screening guidelines polish it off. A must have for anyone who treats cancer, not just thoracic surgeons.

CathSource (ECGSource, LLC), $3.99: Available for Android and iOS, CathSource is a mobile app that aims to teach cardiovascular medicine fellows about coronary anatomy, angiogram projections, and catheter-based hemodynamic measurements. Luckily, CT trainees stand to benefit from the app as well. It seems to be most helpful for learning coronary anatomy on the different projections, but it also has exhaustive hemodynamic formulae and tracings for more detailed review. The app has over 30 videos of normal and abnormal findings.

EchoSource (ECGSource, LLC), $4.99:It's the same idea as above, but -- you guessed it -- for echocardiography. Both are good tools, especially for residents who teach. Both apps take simple, conceptual drawings to start and expand them with real imaging. Residents who have spent a good deal of time in learning cath and echo may find these apps less useful.

Pocket Heart (PocketAnatomy), $9.99: This is an interactive, 3D heart model with a fairly detailed presentation of cardiac anatomy and added features such as pinning quizzes and case studies. While cardiothoracic residents ought to have the anatomy down, the app can be used to teach patients and families about various anatomical aspects of cardiac disease. The graphics leave a little to be desired, but anyone who teaches medical students or patients frequently will enjoy having this easy-to-understand tool handy.

This list of cardiothoracic-specific mobile applications is by no means exhaustive. Each physician's needs will be different, and the options are countless. Countless risk calculators, mnemonic databases, formula compendiums, and pharmacologic formularies clutter the app store. Note-taking suites such as OneNote and Evernote (personal favorite of both of the authors) can help turn the most hare-brained resident into a paragon of organizational excellence. Journal citation managers such as EndNote, Dropbox, Mendeley, and Yep can help organize and manage that virtual pile of unread but probably important journal articles that keeps building up in your inbox. Even the humble iBooks app can be used to read and mark up pdf files on the fly, all while syncing with your library on your home computer. Many hospital EMRs have mobile platforms with various levels of functionality for tablets and smartphones.

What is obvious is that mobile computing technology is rapidly changing medicine and surgery in many ways. Although each one of us strives to be a complete physician, utterly self-reliant and assured of one's clinical knowledge, we all must learn the basics first. Whether at the bus stop, in a resident lounge, or in the operating room, these mobile technologies help us to learn more efficiently while on the go.

If there are any gems we have forgotten to highlight, please send an e-mail to Thoracic Surgery News and we will try to present them in the future. We hope that the residents reading this column can find a new app they didn't know they needed, one that will energize them and push their learning to a new height. Just don't forget to look up once in a while.

Dr. Antonoff is a 2nd-year, Thoracic-track trainee at Washington University in St Louis. Dr. Zeigler is a 3rd-year, integrated Cardiothoracic Surgery trainee at Stanford (Calif.) University. They reported no relevant financial conflicts.

In nearly every facet of our lives, our mobile devices have taken over. Managing our calendars, organizing our contacts, and planning our driving directions -- our devices have become invaluable and ubiquitously present. While the ease of use of smartphones and tablets puts the power of portable computing in the hands of everyone, mobile software seems to be particularly appreciated by young professionals, who seek the convenience of on-the-go functionality and feel comfortable with computing in the palms of their hands. Throughout the world of education and a breadth of academic fields, advanced software programs have gained momentum, recognized for their ability to provide up-to-date, on-the-ground information.

In recent years, there has been an explosion of new software programs applicable to the field of cardiothoracic surgery, and these applications have been well received by modern trainees.

"Mobile apps are incredibly convenient because they provide a means of accessing information while on the go," states Jonathan Spicer, a thoracic trainee at M.D. Anderson Cancer Center in Houston.

He continues, "Having the capacity to look up helpful information from my phone while in the operating room, on the ward, or in transit is particularly helpful."

In this article, we aim to highlight some of the more exciting and innovative mobile software programs available today for those interested in expanding their knowledge in cardiothoracic surgery or looking for an easy-to-access resource.

iBronch (Edward Bender), $0.99: iBronch is one of the many outstanding thoracic surgical apps developed by Ed Bender. This program aims to guide learners through the basic anatomy of the trachea and bronchial tree, with correlation of simultaneous images from a fiberoptic bronchoscope and along an anatomic airway diagram. Branches of the pulmonary tree are labeled on the schematic and the bronchoscopy images. This app is particularly useful for those trainees gaining comfort with bronchoscopic procedures; however, its utility may be less significant for more advanced learners. Regardless, this is a great program, quite helpful for the intended audience.

Thoracic Lymph Node Map (RADIOLOGiQ, LLC), Free: This app provides a color-coded lymph node map, associated with computed tomography images and adapted from the International Association for the Study of Lung Cancer (IASLC) lung cancer project. This program provides excellent illustrations of the anatomic definitions for each of the intrathoracic lymph node stations. This is helpful both in examining imaging studies of actual patients and in the operating room.

CT Journals (Edward Bender), Free: This software program serves as a scholarly journal aggregator for the field of cardiothoracic surgery. The app displays feeds for journals of interest, with inclusion of those relevant periodicals with the most readership and highest impact factors. Not only can one access the articles while online, abstracts can be saved for future use offline. This is a great resource, but users should be aware that access to the full articles is available only for those who have active accounts providing them access to the specific journals.

CTSNetWiki (Edward Bender), Free: Cardiothoracic Surgery Notes is an online review developed and maintained by residents in thoracic surgical training. This resource is a tremendous repository of information, compiling graphics, text, and other multimedia content on a breadth of topics. This app allows general review of a wide variety of cardiothoracic surgical problems and is appropriate for both the novice learner and as a review for those who are further along in their training.

SESATS IX (Edward Bender), Free: Perhaps the most valuable mobile software application out there, the Self Education Self Assessment in Thoracic Surgery (SESATS) IX application contains actual questions from previous versions of the SESATS. The mobile app even includes the associated images, videos, and CT scans that correspond with the questions. Although the program does not contain the latest version of SESATS, the utility of this app cannot be overestimated. This program is enormously helpful for self-testing, on-the-go topic-specific learning, and exam preparation. This is a real gem of a find, and it comes with a strong recommendation to all trainees for its download and use.

TSRA Primer of Cardiothoracic Surgery (Thoracic Surgery Residents' Association), $4.99: Produced by CT residents for CT residents, this is probably the most useful resource for the intern, junior resident, or new fellow who needs to brush up on the basics before rounds, in between consults, and before assisting in the OR. It's not comprehensive, but it is full of clinical pearls covering all the major divisions of cardiothoracic surgery. Many cardiac residents, especially younger integrated residents, have been waiting for a straightforward, practical tutorial like this for years. Beautiful and often interactive illustrations and videos really make this iBook memorable.

NCCN Guidelines (TIP Medical Communications), Free: Available for Android and iOS, this compendium of NCCN guidelines for 56 cancers and cancer-related topics is indispensible for trainees. The utility of having up-to-date, in-depth guidelines for diagnosis and staging of all commonly encountered malignancies cannot be overstated. Additional topics ranging from management of cancer-related emesis to lung cancer screening guidelines polish it off. A must have for anyone who treats cancer, not just thoracic surgeons.

CathSource (ECGSource, LLC), $3.99: Available for Android and iOS, CathSource is a mobile app that aims to teach cardiovascular medicine fellows about coronary anatomy, angiogram projections, and catheter-based hemodynamic measurements. Luckily, CT trainees stand to benefit from the app as well. It seems to be most helpful for learning coronary anatomy on the different projections, but it also has exhaustive hemodynamic formulae and tracings for more detailed review. The app has over 30 videos of normal and abnormal findings.

EchoSource (ECGSource, LLC), $4.99:It's the same idea as above, but -- you guessed it -- for echocardiography. Both are good tools, especially for residents who teach. Both apps take simple, conceptual drawings to start and expand them with real imaging. Residents who have spent a good deal of time in learning cath and echo may find these apps less useful.

Pocket Heart (PocketAnatomy), $9.99: This is an interactive, 3D heart model with a fairly detailed presentation of cardiac anatomy and added features such as pinning quizzes and case studies. While cardiothoracic residents ought to have the anatomy down, the app can be used to teach patients and families about various anatomical aspects of cardiac disease. The graphics leave a little to be desired, but anyone who teaches medical students or patients frequently will enjoy having this easy-to-understand tool handy.

This list of cardiothoracic-specific mobile applications is by no means exhaustive. Each physician's needs will be different, and the options are countless. Countless risk calculators, mnemonic databases, formula compendiums, and pharmacologic formularies clutter the app store. Note-taking suites such as OneNote and Evernote (personal favorite of both of the authors) can help turn the most hare-brained resident into a paragon of organizational excellence. Journal citation managers such as EndNote, Dropbox, Mendeley, and Yep can help organize and manage that virtual pile of unread but probably important journal articles that keeps building up in your inbox. Even the humble iBooks app can be used to read and mark up pdf files on the fly, all while syncing with your library on your home computer. Many hospital EMRs have mobile platforms with various levels of functionality for tablets and smartphones.

What is obvious is that mobile computing technology is rapidly changing medicine and surgery in many ways. Although each one of us strives to be a complete physician, utterly self-reliant and assured of one's clinical knowledge, we all must learn the basics first. Whether at the bus stop, in a resident lounge, or in the operating room, these mobile technologies help us to learn more efficiently while on the go.

If there are any gems we have forgotten to highlight, please send an e-mail to Thoracic Surgery News and we will try to present them in the future. We hope that the residents reading this column can find a new app they didn't know they needed, one that will energize them and push their learning to a new height. Just don't forget to look up once in a while.

Dr. Antonoff is a 2nd-year, Thoracic-track trainee at Washington University in St Louis. Dr. Zeigler is a 3rd-year, integrated Cardiothoracic Surgery trainee at Stanford (Calif.) University. They reported no relevant financial conflicts.

In nearly every facet of our lives, our mobile devices have taken over. Managing our calendars, organizing our contacts, and planning our driving directions -- our devices have become invaluable and ubiquitously present. While the ease of use of smartphones and tablets puts the power of portable computing in the hands of everyone, mobile software seems to be particularly appreciated by young professionals, who seek the convenience of on-the-go functionality and feel comfortable with computing in the palms of their hands. Throughout the world of education and a breadth of academic fields, advanced software programs have gained momentum, recognized for their ability to provide up-to-date, on-the-ground information.

In recent years, there has been an explosion of new software programs applicable to the field of cardiothoracic surgery, and these applications have been well received by modern trainees.

"Mobile apps are incredibly convenient because they provide a means of accessing information while on the go," states Jonathan Spicer, a thoracic trainee at M.D. Anderson Cancer Center in Houston.

He continues, "Having the capacity to look up helpful information from my phone while in the operating room, on the ward, or in transit is particularly helpful."

In this article, we aim to highlight some of the more exciting and innovative mobile software programs available today for those interested in expanding their knowledge in cardiothoracic surgery or looking for an easy-to-access resource.

iBronch (Edward Bender), $0.99: iBronch is one of the many outstanding thoracic surgical apps developed by Ed Bender. This program aims to guide learners through the basic anatomy of the trachea and bronchial tree, with correlation of simultaneous images from a fiberoptic bronchoscope and along an anatomic airway diagram. Branches of the pulmonary tree are labeled on the schematic and the bronchoscopy images. This app is particularly useful for those trainees gaining comfort with bronchoscopic procedures; however, its utility may be less significant for more advanced learners. Regardless, this is a great program, quite helpful for the intended audience.

Thoracic Lymph Node Map (RADIOLOGiQ, LLC), Free: This app provides a color-coded lymph node map, associated with computed tomography images and adapted from the International Association for the Study of Lung Cancer (IASLC) lung cancer project. This program provides excellent illustrations of the anatomic definitions for each of the intrathoracic lymph node stations. This is helpful both in examining imaging studies of actual patients and in the operating room.

CT Journals (Edward Bender), Free: This software program serves as a scholarly journal aggregator for the field of cardiothoracic surgery. The app displays feeds for journals of interest, with inclusion of those relevant periodicals with the most readership and highest impact factors. Not only can one access the articles while online, abstracts can be saved for future use offline. This is a great resource, but users should be aware that access to the full articles is available only for those who have active accounts providing them access to the specific journals.

CTSNetWiki (Edward Bender), Free: Cardiothoracic Surgery Notes is an online review developed and maintained by residents in thoracic surgical training. This resource is a tremendous repository of information, compiling graphics, text, and other multimedia content on a breadth of topics. This app allows general review of a wide variety of cardiothoracic surgical problems and is appropriate for both the novice learner and as a review for those who are further along in their training.

SESATS IX (Edward Bender), Free: Perhaps the most valuable mobile software application out there, the Self Education Self Assessment in Thoracic Surgery (SESATS) IX application contains actual questions from previous versions of the SESATS. The mobile app even includes the associated images, videos, and CT scans that correspond with the questions. Although the program does not contain the latest version of SESATS, the utility of this app cannot be overestimated. This program is enormously helpful for self-testing, on-the-go topic-specific learning, and exam preparation. This is a real gem of a find, and it comes with a strong recommendation to all trainees for its download and use.

TSRA Primer of Cardiothoracic Surgery (Thoracic Surgery Residents' Association), $4.99: Produced by CT residents for CT residents, this is probably the most useful resource for the intern, junior resident, or new fellow who needs to brush up on the basics before rounds, in between consults, and before assisting in the OR. It's not comprehensive, but it is full of clinical pearls covering all the major divisions of cardiothoracic surgery. Many cardiac residents, especially younger integrated residents, have been waiting for a straightforward, practical tutorial like this for years. Beautiful and often interactive illustrations and videos really make this iBook memorable.

NCCN Guidelines (TIP Medical Communications), Free: Available for Android and iOS, this compendium of NCCN guidelines for 56 cancers and cancer-related topics is indispensible for trainees. The utility of having up-to-date, in-depth guidelines for diagnosis and staging of all commonly encountered malignancies cannot be overstated. Additional topics ranging from management of cancer-related emesis to lung cancer screening guidelines polish it off. A must have for anyone who treats cancer, not just thoracic surgeons.

CathSource (ECGSource, LLC), $3.99: Available for Android and iOS, CathSource is a mobile app that aims to teach cardiovascular medicine fellows about coronary anatomy, angiogram projections, and catheter-based hemodynamic measurements. Luckily, CT trainees stand to benefit from the app as well. It seems to be most helpful for learning coronary anatomy on the different projections, but it also has exhaustive hemodynamic formulae and tracings for more detailed review. The app has over 30 videos of normal and abnormal findings.

EchoSource (ECGSource, LLC), $4.99:It's the same idea as above, but -- you guessed it -- for echocardiography. Both are good tools, especially for residents who teach. Both apps take simple, conceptual drawings to start and expand them with real imaging. Residents who have spent a good deal of time in learning cath and echo may find these apps less useful.

Pocket Heart (PocketAnatomy), $9.99: This is an interactive, 3D heart model with a fairly detailed presentation of cardiac anatomy and added features such as pinning quizzes and case studies. While cardiothoracic residents ought to have the anatomy down, the app can be used to teach patients and families about various anatomical aspects of cardiac disease. The graphics leave a little to be desired, but anyone who teaches medical students or patients frequently will enjoy having this easy-to-understand tool handy.

This list of cardiothoracic-specific mobile applications is by no means exhaustive. Each physician's needs will be different, and the options are countless. Countless risk calculators, mnemonic databases, formula compendiums, and pharmacologic formularies clutter the app store. Note-taking suites such as OneNote and Evernote (personal favorite of both of the authors) can help turn the most hare-brained resident into a paragon of organizational excellence. Journal citation managers such as EndNote, Dropbox, Mendeley, and Yep can help organize and manage that virtual pile of unread but probably important journal articles that keeps building up in your inbox. Even the humble iBooks app can be used to read and mark up pdf files on the fly, all while syncing with your library on your home computer. Many hospital EMRs have mobile platforms with various levels of functionality for tablets and smartphones.

What is obvious is that mobile computing technology is rapidly changing medicine and surgery in many ways. Although each one of us strives to be a complete physician, utterly self-reliant and assured of one's clinical knowledge, we all must learn the basics first. Whether at the bus stop, in a resident lounge, or in the operating room, these mobile technologies help us to learn more efficiently while on the go.

If there are any gems we have forgotten to highlight, please send an e-mail to Thoracic Surgery News and we will try to present them in the future. We hope that the residents reading this column can find a new app they didn't know they needed, one that will energize them and push their learning to a new height. Just don't forget to look up once in a while.

Dr. Antonoff is a 2nd-year, Thoracic-track trainee at Washington University in St Louis. Dr. Zeigler is a 3rd-year, integrated Cardiothoracic Surgery trainee at Stanford (Calif.) University. They reported no relevant financial conflicts.

Much anticipated by many, exciting to the tech-savvy among us, and unbeknownst to others, yet equally relevant to all: The new curriculum is here. Whether you are a trainee, an educator, or a thoracic surgeon interested in the future of our specialty, the unveiling of the new curriculum is of key significance.

In 1992, at the Joint Conference on Graduate Education in Thoracic Surgery, significant emphasis was placed upon curricular change for thoracic surgical education. In response, the Thoracic Surgery Directors Association (TSDA) initiated the comprehensive thoracic surgery curriculum project in order to develop a consensus as to the content that ought to be learned during thoracic surgical training. Published in 1994, and available online, the TSDA Curriculum was intended to serve as a study guide to individual trainees and a useful resource for Program Directors. While of enormous utility over the last 2 decades, the curriculum is getting a makeover.

Being released this July is a brand-new curriculum, with updated topics and an excitingly novel platform, as a collaborative project from several organizations committed to thoracic surgical education. The Joint Council on Thoracic Surgery Education (JCTSE) has been working closely with the TSDA, with significant input from the American Board of Thoracic Surgery (ABTS), the Society of Thoracic Surgeons (STS), and the Residency Review Committee (RRC) for Thoracic Surgery. Dr. Ara Vaporciyan, Program Director at the University of Texas MD Anderson Cancer Center and 2013 Secretary/Treasurer of the TSDA, has been a key player in the development of the new curriculum.

When asked about the impetus for developing a new curriculum, Dr. Vaporciyan acknowledges that the old curriculum was an enormous advantage when first introduced, but that, now, it is somewhat outdated, and, further, new technology allows us to deliver the content better and more efficiently. Further, Dr. Vaporciyan highlights the valuable aspect of the new curriculum that links its content to expectations of the ABTS for board certification and the requirements of the Accreditation Council for Graduate Medical Education (ACGME) Milestones project.

Similar to the old curriculum, the basic architecture of the new curriculum contains 88-90 separate topics. However, within the new curriculum, the topics have been selected to cover each element of the published learning objectives provided by the ABTS.

Specific topics were identified by appointed section editors (Cardiac: Drs. James Fann and Craig Baker, Thoracic: DRs. Stephen Yang and Ara Vaporciyan, Congenital: Drs. Ram Subramanyan and Winfield Wells). Approximately 20 topic editors from all over the country have helped populate the new curriculum with content, and have additionally provided some input toward the division of topics.

For many, the most exciting feature of the new curriculum relates to the way that the educational materials will be delivered. Using WebBrain software (TheBrain, Los Angeles) for content management, all topics are organized like a mind map. For example, on the main tree, one can click on Thoracic Surgery, then neoplasm of the lung, which then explodes into three related topics: medical knowledge, patient care, and technical skills, which each branch out further. As explained by Dr. Vaporciyan, "the learning objectives of the ABTS provide the structure of the tree – its trunk and main branches – while the content components, provided by the topic editors, serve as the leaves on the ends of the branches."

So what exactly makes up those leaves at the end of the branches? The multi-media material is 100% pre-existing, coming from six different textbooks, up-to-date literature, online presentations created by the TSDA, and societal guidelines. In addition to the WebBrain content management system, the new curriculum utilizes a Moodle-based (Moodle Pty. Ltd., Perth, Australia) platform for organizing specific lessons plans and weekly curricular goals. Moodle (modular object-oriented dynamic learning environment) is an e-learning software platform, also known as a virtual learning environment.

With features such as assignment submission, quiz completion, discussion forums, file download capabilities, and opportunities for instructors to track individual trainee use, the potential opportunities for future growth are enormous. Within the new TSDA curriculum, trainees will receive a weekly email (as they have with the previous version of the curriculum). This email will direct them to a Moodle course for that week, such as "cardiac disease 1," which will provide to direct links within the WebBrain to all of the topics expected to be covered that week, ultimately providing access to the relevant multi-media materials. Once one has accessed the WebBrain, he or she can surf anywhere within the content tree.

The curriculum will be released in two phases. Phase I entails releasing the content which has been populated onto the WebBrain, utilizing Moodle as the access point. Phase II, which is expected to occur over the coming year, will include a more robust Moodle site. These courses will be fleshed out to each include a multiple-choice quiz with feedback, a wiki page, opportunities for commentary, and a means of gathering feedback from end-users regarding the curriculum. Access to these courses will be free of charge to thoracic surgical residents in the United States and Canada, as well as to program coordinators and faculty. Graduating residents will have access for 1 additional year in order to use the curriculum as a tool to prepare for Boards.

Dr. Edward Verrier, JCTSE Surgical Director of Education, explains that "the curriculum revision is a number of years in conception, preparation, organization, and now implementation. It is the combined effort of a number of dedicated educators and societies with some financial support from industry."

Referencing Salman Kahn in The One World Schoolhouse: Education Reimagined, Dr. Verrier continues: "We believe that this educational tool, using both a learning management and content management electronic based platform, has the potential to ‘flip the classroom.’ With work hour restrictions for residents, a constantly increasing body of knowledge, and the challenges of teaching in the operating room, we believe the new Thoracic Surgery Curriculum has the potential to transform our current approach to surgical education."

So what does this mean for trainees? As stated by Dr. Vaporciyan, "the biggest benefit to the trainees is that, with this content and related quizzes, individuals will have the ability to assess their own needs, have immediate access to relevant content that is free of charge, and, importantly, it is the ABTS intent to ultimately derive the examination material from this new electronic curriculum." Yes, it’s true. The board has agreed that the new curriculum will serve as a template of the content for both the written and oral examinations, making this curriculum the ideal study source for trainees. Dr. John Calhoon, chair of the ABTS, reports that "it is our goal to make sure that we draw questions in the future from the content that is called for in our outline and encompassed by the efforts of this new curriculum’s editors." (And did I mention that it’s free and immediately accessible on the Internet?)

And what about for the educators out there – what does this mean for you? Vaporciyan highlights three key advantages for the teachers: 1) the curriculum is completely malleable, so you can take whatever topic you want your learners to focus upon, and you can add to it or separate topics in any way, such as rotation preparation or linear knowledge acquisition; 2) through learner management aspects of Moodle, you can track all of your learners’ progress; 3) the curriculum is linked to Milestones, which should dramatically assist with meeting this requirement of the ACGME.

As mentioned by Dr. Vaporciyan, the Milestones Project is an important recent endeavor of the ACGME, mandating that all specialty groups develop outcome-based goals for resident performance within the six domains of clinical competence. The milestones will be used by the ACGME to demonstrate accountability of effectiveness of education within ACGME-accredited programs, and, looking ahead, resident performance on milestones will become a source of normative data for the RRC to use in assessing residency programs and facilitating improvements. Linking the new curriculum to milestones will render it a great tool to program directors in ACGME-accredited programs. As explained by Dr. Calhoon, "the RRC is working with the Milestones effort to align the individual curricular modules so that residency training programs will find further synergy and utility in adapting or frankly using the curriculum ‘right off the shelf.’"

When asked about the new curriculum, President of the TSDA Dr. David Fullerton shares with us that "along with the other organizations within our specialty, the TSDA is committed to the education of our residents. The TSDA feels that the consolidation of our specialty’s curricular efforts in this way is a significant advance in thoracic surgical education." Further, Dr. Fullerton acknowledges that the new curriculum "will afford our residents immediate electronic access to important educational materials and will be flexible enough for adaption in individual programs." With gratitude on behalf of the TSDA, Dr. Fullerton congratulates all of the individuals who have contributed to making the Thoracic Surgery Curriculum a reality.

Clearly, this new curriculum has much to offer, for both the teacher and the student. It will be of significant interest to track use and observe associated relationships with subsequent board examination success.

In anticipation of an Aug. 1 launch, notifications regarding accessing the site were provided to residents and program directors via email throughout the month of July. More information on the new curriculum, as well as an introductory video, is found at www.tsda.org/education/thoracic-surgery-curricula.

And we will continue to follow and discuss the new curriculum in these pages of the Residents’ Corner.

Much anticipated by many, exciting to the tech-savvy among us, and unbeknownst to others, yet equally relevant to all: The new curriculum is here. Whether you are a trainee, an educator, or a thoracic surgeon interested in the future of our specialty, the unveiling of the new curriculum is of key significance.

In 1992, at the Joint Conference on Graduate Education in Thoracic Surgery, significant emphasis was placed upon curricular change for thoracic surgical education. In response, the Thoracic Surgery Directors Association (TSDA) initiated the comprehensive thoracic surgery curriculum project in order to develop a consensus as to the content that ought to be learned during thoracic surgical training. Published in 1994, and available online, the TSDA Curriculum was intended to serve as a study guide to individual trainees and a useful resource for Program Directors. While of enormous utility over the last 2 decades, the curriculum is getting a makeover.

Being released this July is a brand-new curriculum, with updated topics and an excitingly novel platform, as a collaborative project from several organizations committed to thoracic surgical education. The Joint Council on Thoracic Surgery Education (JCTSE) has been working closely with the TSDA, with significant input from the American Board of Thoracic Surgery (ABTS), the Society of Thoracic Surgeons (STS), and the Residency Review Committee (RRC) for Thoracic Surgery. Dr. Ara Vaporciyan, Program Director at the University of Texas MD Anderson Cancer Center and 2013 Secretary/Treasurer of the TSDA, has been a key player in the development of the new curriculum.

When asked about the impetus for developing a new curriculum, Dr. Vaporciyan acknowledges that the old curriculum was an enormous advantage when first introduced, but that, now, it is somewhat outdated, and, further, new technology allows us to deliver the content better and more efficiently. Further, Dr. Vaporciyan highlights the valuable aspect of the new curriculum that links its content to expectations of the ABTS for board certification and the requirements of the Accreditation Council for Graduate Medical Education (ACGME) Milestones project.

Similar to the old curriculum, the basic architecture of the new curriculum contains 88-90 separate topics. However, within the new curriculum, the topics have been selected to cover each element of the published learning objectives provided by the ABTS.

Specific topics were identified by appointed section editors (Cardiac: Drs. James Fann and Craig Baker, Thoracic: DRs. Stephen Yang and Ara Vaporciyan, Congenital: Drs. Ram Subramanyan and Winfield Wells). Approximately 20 topic editors from all over the country have helped populate the new curriculum with content, and have additionally provided some input toward the division of topics.

For many, the most exciting feature of the new curriculum relates to the way that the educational materials will be delivered. Using WebBrain software (TheBrain, Los Angeles) for content management, all topics are organized like a mind map. For example, on the main tree, one can click on Thoracic Surgery, then neoplasm of the lung, which then explodes into three related topics: medical knowledge, patient care, and technical skills, which each branch out further. As explained by Dr. Vaporciyan, "the learning objectives of the ABTS provide the structure of the tree – its trunk and main branches – while the content components, provided by the topic editors, serve as the leaves on the ends of the branches."

So what exactly makes up those leaves at the end of the branches? The multi-media material is 100% pre-existing, coming from six different textbooks, up-to-date literature, online presentations created by the TSDA, and societal guidelines. In addition to the WebBrain content management system, the new curriculum utilizes a Moodle-based (Moodle Pty. Ltd., Perth, Australia) platform for organizing specific lessons plans and weekly curricular goals. Moodle (modular object-oriented dynamic learning environment) is an e-learning software platform, also known as a virtual learning environment.

With features such as assignment submission, quiz completion, discussion forums, file download capabilities, and opportunities for instructors to track individual trainee use, the potential opportunities for future growth are enormous. Within the new TSDA curriculum, trainees will receive a weekly email (as they have with the previous version of the curriculum). This email will direct them to a Moodle course for that week, such as "cardiac disease 1," which will provide to direct links within the WebBrain to all of the topics expected to be covered that week, ultimately providing access to the relevant multi-media materials. Once one has accessed the WebBrain, he or she can surf anywhere within the content tree.

The curriculum will be released in two phases. Phase I entails releasing the content which has been populated onto the WebBrain, utilizing Moodle as the access point. Phase II, which is expected to occur over the coming year, will include a more robust Moodle site. These courses will be fleshed out to each include a multiple-choice quiz with feedback, a wiki page, opportunities for commentary, and a means of gathering feedback from end-users regarding the curriculum. Access to these courses will be free of charge to thoracic surgical residents in the United States and Canada, as well as to program coordinators and faculty. Graduating residents will have access for 1 additional year in order to use the curriculum as a tool to prepare for Boards.

Dr. Edward Verrier, JCTSE Surgical Director of Education, explains that "the curriculum revision is a number of years in conception, preparation, organization, and now implementation. It is the combined effort of a number of dedicated educators and societies with some financial support from industry."

Referencing Salman Kahn in The One World Schoolhouse: Education Reimagined, Dr. Verrier continues: "We believe that this educational tool, using both a learning management and content management electronic based platform, has the potential to ‘flip the classroom.’ With work hour restrictions for residents, a constantly increasing body of knowledge, and the challenges of teaching in the operating room, we believe the new Thoracic Surgery Curriculum has the potential to transform our current approach to surgical education."

So what does this mean for trainees? As stated by Dr. Vaporciyan, "the biggest benefit to the trainees is that, with this content and related quizzes, individuals will have the ability to assess their own needs, have immediate access to relevant content that is free of charge, and, importantly, it is the ABTS intent to ultimately derive the examination material from this new electronic curriculum." Yes, it’s true. The board has agreed that the new curriculum will serve as a template of the content for both the written and oral examinations, making this curriculum the ideal study source for trainees. Dr. John Calhoon, chair of the ABTS, reports that "it is our goal to make sure that we draw questions in the future from the content that is called for in our outline and encompassed by the efforts of this new curriculum’s editors." (And did I mention that it’s free and immediately accessible on the Internet?)

And what about for the educators out there – what does this mean for you? Vaporciyan highlights three key advantages for the teachers: 1) the curriculum is completely malleable, so you can take whatever topic you want your learners to focus upon, and you can add to it or separate topics in any way, such as rotation preparation or linear knowledge acquisition; 2) through learner management aspects of Moodle, you can track all of your learners’ progress; 3) the curriculum is linked to Milestones, which should dramatically assist with meeting this requirement of the ACGME.

As mentioned by Dr. Vaporciyan, the Milestones Project is an important recent endeavor of the ACGME, mandating that all specialty groups develop outcome-based goals for resident performance within the six domains of clinical competence. The milestones will be used by the ACGME to demonstrate accountability of effectiveness of education within ACGME-accredited programs, and, looking ahead, resident performance on milestones will become a source of normative data for the RRC to use in assessing residency programs and facilitating improvements. Linking the new curriculum to milestones will render it a great tool to program directors in ACGME-accredited programs. As explained by Dr. Calhoon, "the RRC is working with the Milestones effort to align the individual curricular modules so that residency training programs will find further synergy and utility in adapting or frankly using the curriculum ‘right off the shelf.’"

When asked about the new curriculum, President of the TSDA Dr. David Fullerton shares with us that "along with the other organizations within our specialty, the TSDA is committed to the education of our residents. The TSDA feels that the consolidation of our specialty’s curricular efforts in this way is a significant advance in thoracic surgical education." Further, Dr. Fullerton acknowledges that the new curriculum "will afford our residents immediate electronic access to important educational materials and will be flexible enough for adaption in individual programs." With gratitude on behalf of the TSDA, Dr. Fullerton congratulates all of the individuals who have contributed to making the Thoracic Surgery Curriculum a reality.

Clearly, this new curriculum has much to offer, for both the teacher and the student. It will be of significant interest to track use and observe associated relationships with subsequent board examination success.

In anticipation of an Aug. 1 launch, notifications regarding accessing the site were provided to residents and program directors via email throughout the month of July. More information on the new curriculum, as well as an introductory video, is found at www.tsda.org/education/thoracic-surgery-curricula.

And we will continue to follow and discuss the new curriculum in these pages of the Residents’ Corner.

Much anticipated by many, exciting to the tech-savvy among us, and unbeknownst to others, yet equally relevant to all: The new curriculum is here. Whether you are a trainee, an educator, or a thoracic surgeon interested in the future of our specialty, the unveiling of the new curriculum is of key significance.

In 1992, at the Joint Conference on Graduate Education in Thoracic Surgery, significant emphasis was placed upon curricular change for thoracic surgical education. In response, the Thoracic Surgery Directors Association (TSDA) initiated the comprehensive thoracic surgery curriculum project in order to develop a consensus as to the content that ought to be learned during thoracic surgical training. Published in 1994, and available online, the TSDA Curriculum was intended to serve as a study guide to individual trainees and a useful resource for Program Directors. While of enormous utility over the last 2 decades, the curriculum is getting a makeover.

Being released this July is a brand-new curriculum, with updated topics and an excitingly novel platform, as a collaborative project from several organizations committed to thoracic surgical education. The Joint Council on Thoracic Surgery Education (JCTSE) has been working closely with the TSDA, with significant input from the American Board of Thoracic Surgery (ABTS), the Society of Thoracic Surgeons (STS), and the Residency Review Committee (RRC) for Thoracic Surgery. Dr. Ara Vaporciyan, Program Director at the University of Texas MD Anderson Cancer Center and 2013 Secretary/Treasurer of the TSDA, has been a key player in the development of the new curriculum.

When asked about the impetus for developing a new curriculum, Dr. Vaporciyan acknowledges that the old curriculum was an enormous advantage when first introduced, but that, now, it is somewhat outdated, and, further, new technology allows us to deliver the content better and more efficiently. Further, Dr. Vaporciyan highlights the valuable aspect of the new curriculum that links its content to expectations of the ABTS for board certification and the requirements of the Accreditation Council for Graduate Medical Education (ACGME) Milestones project.

Similar to the old curriculum, the basic architecture of the new curriculum contains 88-90 separate topics. However, within the new curriculum, the topics have been selected to cover each element of the published learning objectives provided by the ABTS.

Specific topics were identified by appointed section editors (Cardiac: Drs. James Fann and Craig Baker, Thoracic: DRs. Stephen Yang and Ara Vaporciyan, Congenital: Drs. Ram Subramanyan and Winfield Wells). Approximately 20 topic editors from all over the country have helped populate the new curriculum with content, and have additionally provided some input toward the division of topics.

For many, the most exciting feature of the new curriculum relates to the way that the educational materials will be delivered. Using WebBrain software (TheBrain, Los Angeles) for content management, all topics are organized like a mind map. For example, on the main tree, one can click on Thoracic Surgery, then neoplasm of the lung, which then explodes into three related topics: medical knowledge, patient care, and technical skills, which each branch out further. As explained by Dr. Vaporciyan, "the learning objectives of the ABTS provide the structure of the tree – its trunk and main branches – while the content components, provided by the topic editors, serve as the leaves on the ends of the branches."

So what exactly makes up those leaves at the end of the branches? The multi-media material is 100% pre-existing, coming from six different textbooks, up-to-date literature, online presentations created by the TSDA, and societal guidelines. In addition to the WebBrain content management system, the new curriculum utilizes a Moodle-based (Moodle Pty. Ltd., Perth, Australia) platform for organizing specific lessons plans and weekly curricular goals. Moodle (modular object-oriented dynamic learning environment) is an e-learning software platform, also known as a virtual learning environment.

With features such as assignment submission, quiz completion, discussion forums, file download capabilities, and opportunities for instructors to track individual trainee use, the potential opportunities for future growth are enormous. Within the new TSDA curriculum, trainees will receive a weekly email (as they have with the previous version of the curriculum). This email will direct them to a Moodle course for that week, such as "cardiac disease 1," which will provide to direct links within the WebBrain to all of the topics expected to be covered that week, ultimately providing access to the relevant multi-media materials. Once one has accessed the WebBrain, he or she can surf anywhere within the content tree.

The curriculum will be released in two phases. Phase I entails releasing the content which has been populated onto the WebBrain, utilizing Moodle as the access point. Phase II, which is expected to occur over the coming year, will include a more robust Moodle site. These courses will be fleshed out to each include a multiple-choice quiz with feedback, a wiki page, opportunities for commentary, and a means of gathering feedback from end-users regarding the curriculum. Access to these courses will be free of charge to thoracic surgical residents in the United States and Canada, as well as to program coordinators and faculty. Graduating residents will have access for 1 additional year in order to use the curriculum as a tool to prepare for Boards.

Dr. Edward Verrier, JCTSE Surgical Director of Education, explains that "the curriculum revision is a number of years in conception, preparation, organization, and now implementation. It is the combined effort of a number of dedicated educators and societies with some financial support from industry."

Referencing Salman Kahn in The One World Schoolhouse: Education Reimagined, Dr. Verrier continues: "We believe that this educational tool, using both a learning management and content management electronic based platform, has the potential to ‘flip the classroom.’ With work hour restrictions for residents, a constantly increasing body of knowledge, and the challenges of teaching in the operating room, we believe the new Thoracic Surgery Curriculum has the potential to transform our current approach to surgical education."

So what does this mean for trainees? As stated by Dr. Vaporciyan, "the biggest benefit to the trainees is that, with this content and related quizzes, individuals will have the ability to assess their own needs, have immediate access to relevant content that is free of charge, and, importantly, it is the ABTS intent to ultimately derive the examination material from this new electronic curriculum." Yes, it’s true. The board has agreed that the new curriculum will serve as a template of the content for both the written and oral examinations, making this curriculum the ideal study source for trainees. Dr. John Calhoon, chair of the ABTS, reports that "it is our goal to make sure that we draw questions in the future from the content that is called for in our outline and encompassed by the efforts of this new curriculum’s editors." (And did I mention that it’s free and immediately accessible on the Internet?)

And what about for the educators out there – what does this mean for you? Vaporciyan highlights three key advantages for the teachers: 1) the curriculum is completely malleable, so you can take whatever topic you want your learners to focus upon, and you can add to it or separate topics in any way, such as rotation preparation or linear knowledge acquisition; 2) through learner management aspects of Moodle, you can track all of your learners’ progress; 3) the curriculum is linked to Milestones, which should dramatically assist with meeting this requirement of the ACGME.

As mentioned by Dr. Vaporciyan, the Milestones Project is an important recent endeavor of the ACGME, mandating that all specialty groups develop outcome-based goals for resident performance within the six domains of clinical competence. The milestones will be used by the ACGME to demonstrate accountability of effectiveness of education within ACGME-accredited programs, and, looking ahead, resident performance on milestones will become a source of normative data for the RRC to use in assessing residency programs and facilitating improvements. Linking the new curriculum to milestones will render it a great tool to program directors in ACGME-accredited programs. As explained by Dr. Calhoon, "the RRC is working with the Milestones effort to align the individual curricular modules so that residency training programs will find further synergy and utility in adapting or frankly using the curriculum ‘right off the shelf.’"

When asked about the new curriculum, President of the TSDA Dr. David Fullerton shares with us that "along with the other organizations within our specialty, the TSDA is committed to the education of our residents. The TSDA feels that the consolidation of our specialty’s curricular efforts in this way is a significant advance in thoracic surgical education." Further, Dr. Fullerton acknowledges that the new curriculum "will afford our residents immediate electronic access to important educational materials and will be flexible enough for adaption in individual programs." With gratitude on behalf of the TSDA, Dr. Fullerton congratulates all of the individuals who have contributed to making the Thoracic Surgery Curriculum a reality.

Clearly, this new curriculum has much to offer, for both the teacher and the student. It will be of significant interest to track use and observe associated relationships with subsequent board examination success.

In anticipation of an Aug. 1 launch, notifications regarding accessing the site were provided to residents and program directors via email throughout the month of July. More information on the new curriculum, as well as an introductory video, is found at www.tsda.org/education/thoracic-surgery-curricula.

And we will continue to follow and discuss the new curriculum in these pages of the Residents’ Corner.