News & Media

STS News, Summer 2018 -- Most cardiothoracic surgical practices have converted, are converting, or will convert from paper medical records to electronic health records (EHRs). The benefits of an EHR system include transparency, improved documentation and communication, reduced omissions, improved reporting, remote access to records, and increased collections. The improved documentation is reflected in both better legibility and content of notes. Transparency and communication impact care teams spanning both the inpatient and outpatient areas, as well as referring physicians and patients. The ability to customize and optimize the EHR to your practice is a powerful tool. Many teams decide to standardize their documentation. You can build templates that ensure you capture all relevant clinical data and succinctly communicate with referring providers. You also can capitalize on discrete fields to capture data required for database reporting and billing requirements. As more EHR systems offer the option of releasing notes to patients, you can establish protocols for how you want those notes to look. Although standardization can be time-consuming, especially if you have many stakeholders and require consensus for practice changes, it is a worthwhile investment that can really pay off. The benefits of an EHR system include transparency, improved documentation and communication, reduced omissions, improved reporting, remote access to records, and increased collections. The transition to electronic records is not without its challenges, however. Staff members tend to require “staged learning.” They need to be trained and allowed to use the EHR system, with subsequent ongoing training to evolve their electronic documentation and streamline their work. This implementation requires time, resources for ongoing evaluation, and a lot of patience. Another challenge is downtime. Paper charts never have downtime, but EHRs do. Generally, the frequency of downtime is not a significant issue, but you will need to develop procedures that accommodate downtime. One very important aspect to consider when implementing an EHR is exam room setup. Some feel an EHR reduces patient interaction by putting the physician’s focus more on the computer than on the person in the exam room. This perception can be minimized by paying close attention to where the physician and the patient will be seated in the exam room, as well as ensuring that templates are in place so that the physician can complete the required fields quickly. As with any transition, there will be challenges moving from paper records to an EHR. What you can count on needing is patience, time, and resources to build the system, to continually train your staff, and to tweak the setup. What you can expect in return are practice improvements that help with efficiency, communication, documentation, and reporting.

Keith S. Naunheim, MD, President STS News, Summer 2018 -- “Look, here comes Dr. Betty Crocker!” “What’s your favorite journal, honey … Good Housekeeping?” “What’s a pretty girl like you doing in surgery?” These are the types of remarks that several senior female cardiothoracic surgeons said they heard from their “mentors” during surgical training. Grossly offensive statements in the 21st century, these were pretty run-of-the-mill remarks 30 years ago.  It’s my belief that the environment for female trainees has markedly improved since those days, but we cannot yet claim complete enlightenment. Gender bias and sexual harassment are certainly not limited to the world of cardiothoracic surgery; the reality is that these unwelcome behaviors affect every facet of society in America. While they have been extant for centuries, the #MeToo movement has finally helped bring issues like sexual harassment to the forefront of the American consciousness. It is causing introspection among many men, and I—like many others—have forced myself to try and recall my own behavior, pondering if and when I crossed the line. What was once considered to be just “harmless fun” among the boys is now recognized as being a real injustice. Failure to appreciate the equal abilities and rights of women can lead not just to sexual harassment, but also to workplace discrimination in the form of gender bias. It’s hard to argue that this has not been true of cardiothoracic surgery in the past, but it’s also important to recognize that many within the specialty, male and female alike, have been battling this form of prejudice for years. Fortunately, there has been some success, as evidenced by the growth of the Women in Thoracic Surgery (WTS) organization, as well as the progressively increasing proportion of women in practice and in the training pipeline. Still, cardiothoracic surgery is far behind many other specialties with regard to gender equity; thus, STS leaders believe that our association has a responsibility to address it. Failure to appreciate the equal abilities and rights of women can lead not just to sexual harassment, but also to workplace discrimination in the form of gender bias. Member Survey As with most problems, the first corrective steps entail formal recognition and identification of scope. Accordingly, a survey was recently sent by the Society to all members of STS, WTS, and the Thoracic Surgery Residents Association requesting feedback on both sexual harassment and gender bias. These two issues, though perhaps stemming from similar origins, are not exactly the same. While both transgressions may occur consciously or unconsciously, sexual harassment refers to the making of unwanted sexual advances or sexually inappropriate remarks; gender bias refers to workplace discrimination based on gender that impedes the performance of one’s duties and/or the chances for professional advancement. Notably, this survey had the highest number of responses of any STS survey in recent history, a finding which suggests a great level of interest among the membership regarding these topics. Although the full survey results are still confidential because they will provide the basis for a paper that will be submitted to The Annals of Thoracic Surgery, the authors have kindly provided some preliminary results. I can share with you that, while not surprising, the result are nonetheless disappointing. More than 80% of female respondents reported that they were sexually harassed by other professionals in the form of crude sexual remarks, inappropriate touching, or repeated requests for sexual interaction within the past 10 years. More than 80% of such episodes occurred in the hospital or clinic setting, with the vast majority of such episodes coming from their superiors in the program. Just as discouraging is the fact that in the area of gender bias, only about 20% of female respondents believed that surgeons would be as comfortable with a female chair as with a male chair. It is true that limitations exist for such surveys; thus, while specific figures cannot be assumed to be perfectly accurate, these results are disconcerting. So is there a real problem in our specialty? Hell yeah! Should the Society have a role in addressing the issue? Damn straight! What steps should the Society take? Great question with no absolute “right” answer. The good news? Our specialty is improving. There are more women in CT surgery than ever before and they are filling leadership roles both regionally and nationally. Ongoing steps are under way to raise awareness. Moving Forward There are means for addressing issues of sexual harassment and gender bias through the enforcement of the Society’s Code of Ethics by our Committee on Standards and Ethics, and STS members having legitimate claims of wrongdoing should never hesitate to utilize the related complaint mechanism available. However, when addressing such broad issues within the specialty, our Society has always preferred the concepts of prevention and self-remediation rather than simply external punishment after the fact. In fact, such self policing has been our standard strategy for many years in the realm of quality improvement. To that end, we recognize that most health care entities already offer educational opportunities to their employed providers pertaining to sexual harassment and gender bias – and in fact, most already require such participation. (Even the STS staff has had mandatory training addressing these issues.) To augment and advance these existing efforts, it is hoped that when the STS/WTS sexual harassment and gender bias survey results are published, they will spark awareness of these widespread problems and aid in the process of changing attitudes. In addition, WTS will cosponsor a special session at the upcoming STS Annual Meeting in San Diego that will highlight these issues. So in conclusion, the bad news is that—to no one’s surprise—sexual harassment and gender bias are realities in the world of cardiothoracic surgery, just as they are elsewhere in America and in other places around the world. The good news? Our specialty is improving. There are more women in CT surgery than ever before and they are filling leadership roles both regionally and nationally. Ongoing steps are under way to raise awareness. The STS membership may not yet be entirely “woke” with regard to gender equity issues, but I am pleased to note that thanks to the age of #MeToo and other factors, we are now moving more quickly in the right direction.

STS News, Summer 2018 -- Every summer, the STS staff initiates the process of constructing a budget for the following year that reflects the organization’s financial resources and strategic plan, much like any other medical specialty society. Since 2013, however, the Society’s budgeting process has included a unique component that remains unusual among its peer group: a portion of the budget is specifically devoted to special projects, programs, and affiliated organizations (apart from regular STS operations) for purposes of “reinvesting in the specialty.” The annual amount available is dictated by a spending policy first proposed on behalf of the STS Finance Committee by Past President John E. Mayer Jr., MD that is dependent on the size of the organization’s investment portfolio. Five years after its adoption, and again at the recommendation of the STS Finance Committee, the Board of Directors recently amended the organization’s spending policy in order to make even more funding available for reinvestment in the specialty. As a result of this modification, STS spending policy funding will increase from $904,000 in 2018 to approximately $1,138,000 in 2019. “We wanted to be sure that we are good stewards of our money,” said Mark S. Allen, MD, Chair of the Finance Committee and an STS Past President. “The purpose is not only to grow an endowment to a large sum, but also to use it wisely in advancing the specialty. The revised policy will free up more money to be used without endangering the Society’s financial stability.” “The purpose is not only to grow an endowment to a large sum, but also to use it wisely in advancing the specialty.” Mark S. Allen, MD The original policy provided a guideline for the Society to spend 2% of its investment portfolio balance for purposes of reinvestment in the specialty. The updated policy relies on a hybrid calculation tied to both the Society’s investment portfolio and its budgeted expenses. One organization that STS has supported over the years is The Thoracic Surgery Foundation (TSF), which now functions as the Society’s charitable arm. TSF offers awards, scholarships, and fellowships to support research and education in cardiothoracic surgery. STS completely underwrites the Foundation’s management expenses so that every dollar donated to TSF directly supports its award programs. In addition, the Society has provided lump sums toward specific awards and participated in a matching gift challenge, whereby STS has matched up to $200,000 of surgeon donations in a given year. (See page 13 for details on the 2019 TSF awards program.) STS also has funded Women in Thoracic Surgery scholarships for female medical students and residents to attend the STS Annual Meeting and the Carolyn Reed Traveling Fellowship, the Thoracic Surgery Directors Association Boot Camp event, fellowships offered by the Thoracic Surgery Residents Association, and scholarships to attend the General Thoracic Surgical Club Annual Meeting.  “Although the formal spending policy is only about 5 years old, STS has given out approximately $6 million over the past 10 years,” Dr. Allen said. “This includes funding for electronic education and simulation and for research and fellowship grants to promote young investigators and surgeons. The Society is committed to its mission of enhancing the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy—and our revised spending policy offers a clear pathway to do just that.” With more than $230,000 of increased funding available under the STS Spending Policy for 2019, the Finance Committee has developed an innovative Request for Proposals that soon will be disseminated to the cardiothoracic surgery community. Proposals will be due by November 15, 2018, and it is anticipated that the STS Board of Directors will be acting on those initial requests at its January 27 meeting in conjunction with the 55th Annual Meeting. If you have any related questions, contact Keith Bura, Director of Finance and Administration.

STS News, Summer 2018 -- While a comprehensive knowledge of cardiothoracic diseases will undoubtedly remain essential in training the next generation of cardiothoracic surgeons, developing a focus on a particular area within the specialty is becoming more and more important—for both a surgeon’s career and optimal patient outcomes. During a roundtable discussion filmed at the STS Annual Meeting in Fort Lauderdale, Florida, earlier this year, John V. Conte, MD, Thomas E. MacGillivray, MD, Michael J. Mack, MD, and Wilson Y. Szeto, MD discussed how training programs could stay current and ensure that residents are prepared for the future. “The day of the generalist cardiac surgeon cannot continue,” said Dr. Mack, an STS Past President from the Heart Hospital Baylor Plano. “We need to be supersubspecialized—in heart failure surgery, in structural heart disease, and in coronary revascularization.” Transcatheter aortic valve replacement is one growing area of “supersubspecialization.” Dr. Conte, from Penn State University in Hershey, said that his institution would be modifying its residency program to address future manpower issues. The planned changes include adding a third year to its traditional residency program, which would function as a “mini fellowship” for those who wanted to gain specialized knowledge in areas such as aortic disease, transplant and mechanical circulatory support, structural heart disease, minimally invasive surgery, coronary revascularization, and robotic surgery. The updated program would allow residents to focus on just one area or several, depending on their interests. They also could travel to other institutions for part of the time. “With this dedicated experience, our residents will have clear pathways set up for them as they go forward in their careers,” Dr. Conte said. “It’s incumbent upon us to adapt our training programs and make sure that we’re training the residents for 2030 and beyond.” Supersubspecialization doesn’t mean that residents should concentrate on just one particular procedure. Dr. MacGillivray, STS Treasurer from Houston Methodist Hospital, stressed that focusing on the entire disease process is the best strategy. “If someone wants to focus on valvular heart disease, they’ll need to know about not just the surgical interventions, but also the transcatheter solutions and medical treatments,” he said. “If you focus only on one operation, and then one day it’s not the preferred therapy anymore, you won’t have any skills.” Dr. Conte concurred and added that cardiothoracic surgeons “need to own a disease,” which would help them as they look for jobs. “As I’m focusing my recruitment, I’m identifying people who can do regular cases, but we also want to hire people who can cover these subspecialty areas,” Dr. Conte added. “It’s incumbent upon us to adapt our training programs and make sure that we’re training the residents for 2030 and beyond.” John V. Conte, MD Patient Benefits “Data have shown that patients often have better outcomes when undergoing coronary artery surgery with a surgeon who has a lot of experience in that particular area,” Dr. MacGillivray said. “I think the same thing is true with valvular heart disease. Transcatheter therapies are a different skillset. In order to be good at them, you need to spend a lot of time learning and mastering them.” The trend for cardiothoracic surgeons to have specific areas of focus may lead to a transition in the way that medical care is made available to patients. “When you’re having subspecialization such as this, much of it is going to happen at larger centers,” Dr. Conte said. "So I do think that there is going to be more regionalization of health care in the future. The end goal, of course, is to ensure that patients get the maximum benefit from the technology and knowledge that’s out there.” Emphasis on the Heart Team During the roundtable, the cardiothoracic surgeons also emphasized the need to expose residents to the heart team approach.  “Integrate residents into the heart team culture at your current institution,” Dr. Szeto advised. “Our surgical residents at the University of Pennsylvania spend a significant part of their training with our cardiology colleagues, rotating through imaging, the cath lab, and the cardiac care unit.” Two cardiothoracic surgery residents in Dr. Szeto’s program recently published an article in the Journal of the American College of Cardiology about their experience in the I-6 residency program. Chase R. Brown, MD and Jason J. Han, MD noted that the program gave them a broad knowledge base in cardiovascular medicine and also enabled them to develop relationships with physicians across the medical spectrum—connections they may not have acquired had they not been immersed in the heart team approach from the beginning. “By coming to understand how both cardiologists and surgeons evaluate certain pathology and assess risks and benefits of their approach, we cultivate an intuition for shared decision-making and collaboration, which will undoubtedly benefit patients in the long run,” they wrote. “We learn to appreciate how they think, and they learn how we think.” "Residents need to learn the heart team approach from the start." Thomas E. MacGillivray, MD Dr. MacGillivray suggested that regular heart team conferences be a mandatory part of residency training. “When I was in training, the decisions were made more in silos,” he said. “Now, we know that the appropriate way to manage patients is by heart team evaluation. Residents need to learn this approach from the start.” Above all, those who lead training programs need to embrace change and frequently evaluate whether they’re adequately preparing their residents for the evolving demands of cardiothoracic surgery, Dr. Conte said. “One of the key things is to remain flexible in how you’re training the next generation,” he added. “The people who are tasked with that responsibility have to be committed to that, or your program is not going to be very successful.”