Motivations and demographics of I-6 and traditional 5+2 cardiothoracic surgery resident applicants: insights from an academic training program

Abstract

Background: The introduction of the integrated 6-year cardiothoracic surgery residency (I-6) has changed the training paradigm for future cardiothoracic surgeons. Increased interest in these programs emphasizes the need for an understanding of the applicant pool and of their differences from the traditional trainee (5+2).

Methods: National trends (National Resident Matching Program data), objective (Electronic Residency Application Services documents, United States Medical Licensing Examination [USMLE] scores, transcripts) and subjective metrics (interviews, personal statements, and recommendation letters) were evaluated for invited applicants for I-6 and 5+2 positions in 2010, 2011, and 2012. Demographics and motivations for specialty selection were determined. Statistical analyses were performed with Student's t test for continuous variables and Fisher's exact test for categoric variables.

Results: The number of applicants completing the match for I-6 positions each year was as follows: 2010, 74 (49 United States [US]); 2011, 74 (53 US); 2012, 80 (59 US). The number completing the match for 5+2 positions was as follows: 2010, 93 (67 US); 2011, 87 (55 US); 2012, 90 (63 US). For I-6 positions we interviewed 9 candidates in 2010, 17 in 2011, and 16 in 2012; for the 5+2 program we interviewed 14 candidates in 2010, 17 in 2011, and 13 in 2012. Both groups had a similar percentage of female applicants, number of US medical graduates, additional degrees, and membership in Alpha Omega Alpha. The I-6 applicants were younger (mean age, 27.4 years), were less likely to take time off for research (43.5% vs 72.7%), were less published, and had higher surgery clinical honors and USMLE scores. The 5+2 applicants were less likely to have done a cardiothoracic medical school rotation and had done senior-level rotations on general thoracic during residency; yet, only 29.5% had done a senior level cardiac rotation. The most frequently cited motivation was a clinical encounter during a cardiothoracic rotation for both (94.9% I-6 applicants, 88.6% 5+2 applicants). The I-6 applicants had more interest in minimally invasive techniques. There were no differences in the influence of a mentor or a desire for an academic career.

Conclusions: Institutional strategies to increase medical student and general surgery resident exposure to cardiothoracic surgery clinically will optimize our ability to attract and train the best candidates in our specialty.