January 24-25

Bavaria Urges Out-of-the-Box Thinking

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Joseph E. Bavaria, MD: ‘Innovation has become absolutely critical to the survival of our specialty.’

The fine line between delivering quality treatment and embracing innovation may sometimes make cardiothoracic surgeons feel trapped between conflicting goals. In his Presidential Address Monday, Joseph E. Bavaria, MD challenged that convention.

“What if these two fundamentally important obligations, which go so far as to almost define us, are at odds with each other? If they are in fact colliding, then this is a challenge that we must sort out,” he said.

Cardiothoracic surgeons have overcome similar challenges, such as when they refined training programs, adapted to the technological advances of minimally invasive surgery and transcatheter aortic valve replacement, and supported the growth of subspecialties, including thoracic aortic surgery.

“However, one of cardiothoracic surgery’s biggest and most pressing challenges, and indeed a challenge for the entirety of medicine at this point, is the colliding imperative of innovation and an unwavering commitment to quality,” Dr. Bavaria said.

There is even conflict within innovation and quality. Is it better to always be an innovator, adopting promising technology and navigating a difficult learning curve, or to wait for guidelines on that new technology?

“Innovation has become absolutely critical to the survival of our specialty. We must experiment. We must continually adapt. And I know we are up to the challenge,” Dr. Bavaria said.

Cardiothoracic surgery should work to build a culture of innovation by emphasizing democracy and freedom of inquiry within the specialty.

“Enlightened leadership is necessary in order to achieve a culture of innovation. Enlightened leadership requires at least some deviation from the principles of autocracy,” Dr. Bavaria said.

History shows that great progress comes with the growth of liberty among the commoners, not the leaders, he said.

“Is a culture that requires rigid conformity capable of significant innovation by its people?” Dr. Bavaria asked. “Liberated surgeons can be ingenious. So innovation—or importantly, early adoption of innovation—is an imperative.”

Moving to the issue of quality, STS has been a leader in this area with its long-established collection of raw outcomes metrics, risk-adjusted metrics, and updated risk-adjustment models.

“The STS National Database has had a long evolution toward improving its ability to generate meaningful measures that can discriminate and point to a ‘quality’ program,” Dr. Bavaria said, but he added that using complex data to create simple grades is a challenge. “Are the risk-adjustment models strong enough? Do they penalize or reward larger, tertiary institutions doing more complex cases?”

There is struggle within the conflict to measure quality that requires new adjustments, he said.

“We need simplicity in outcomes reporting, but the reality is that outcomes reporting is, indeed, very complicated and requires a certain sophistication for accuracy,” Dr. Bavaria said, while acknowledging the importance of public reporting.

“We will have to walk the fine line between the public’s increasing insistence on the right to know versus our duty and responsibility toward our cardiothoracic surgical tribe, as we cannot allow good surgeons and good programs to be misrepresented and perish in the public square,” he said, adding that poor outcomes can lead to risk aversion.

Dr. Bavaria suggested exploring the concept of patient-centered and patient-reported outcomes.

“The collision is not necessary if we keep the patient in mind. In this model, we convert the collision into a merger. The patients and their families become deeply involved with the decision making,” he said. “By discussing all the treatment options, with full consent, including high-risk and alternative options, we can affect a patient-centered outcome, and risk aversion can be moderated.

“Incorporation of patient-reported outcomes or even more advanced patient-centered outcomes into our quality metrics will be difficult. It will require a better understanding of this new concept, as well as proper execution. However, we must move in a direction that manages the conflict between quality outcomes and continued innovation.”

Dr. Bavaria concluded his address by urging cardiothoracic surgeons to continue embracing innovation and quality.

“I ask you to search for solutions for yourselves and your programs so that these two important imperatives don’t collide. This requires out-of-the-box thinking. But remember, we make the boxes. We construct those boxes that constrain our thinking,” he said.

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Richard Prager Elected 2017-2018 STS President

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Richard L. Prager, MD

Cardiothoracic surgeon Richard L. Prager, MD, from the University of Michigan in Ann Arbor, was elected by the STS membership yesterday evening as the Society’s 2017-2018 President.

“The STS presidency is something that I never considered as a goal or an expectation,” said Dr. Prager, Director of the Frankel Cardiovascular Center and the Richard and Norma Sarns Professor of Cardiac Surgery at Michigan Medicine. “This is very much an honor for me, and it represents the culmination of my career, as well as an opportunity.”

With a father who was an internist and a college job as an operating room scrub technician, Dr. Prager became interested in cardiothoracic surgery at an early age. “Cardiothoracic surgery seemed like a new frontier and had the biggest challenges,” he said. “There was no question what I wanted to do.”

After earning his medical degree from the State University of New York in Brooklyn, Dr. Prager trained in general and thoracic surgery at the University of Michigan. He began his surgical career in 1978 at Vanderbilt University in Nashville, Tenn., and eventually returned to Ann Arbor, initially joining the Cardiac and Thoracic Surgical Group at St. Joseph Mercy Hospital. There, Dr. Prager was Medical Director of the Health Care Financing Administration Coronary Artery Bypass Project and Director of Cardiac and Thoracic Surgery. In 1999, he joined the University of Michigan’s cardiac surgery faculty. 

“I spent half of my career in private practice, specializing in cardiac and general thoracic surgery, and half of my career in academics,” explained Dr. Prager. “So, I have experienced two distinct sides or aspects of cardiac and thoracic surgical practice. This experience has helped me understand both realities: complex academic medical centers and private practice scenarios. I’m fortunate to have an understanding of how the qualities of both are critical to our success as a specialty.”

An STS member since 1982, Dr. Prager has served on numerous committees and workforces. Most recently, he was the Society’s First Vice President. Dr. Prager also has chaired the Council on Quality, Research, and Patient Safety, the Adult Cardiac Surgery Database (ACSD) Task Force, the Task Force on Quality Initiatives, and the Database Audit Task Force. In addition, he has held leadership positions in other cardiothoracic surgery organizations, including President of both the Southern Thoracic Surgical Association and the Michigan Society of Thoracic and Cardiovascular Surgeons.

As STS President, Dr. Prager is committed to continuing the goals of his predecessors, while focusing on enhancing membership benefits and services. “We will work on becoming a more agile society that has a rich foundation of members and goals, making sure we are the best at representing and facilitating the specialty everywhere,” he said.

A longtime participant in and champion of the STS National Database, Dr. Prager said he will continue being one of the Database’s strongest advocates. For the future, Dr. Prager said that developing longitudinal follow-up for the ACSD is critical, the evolution of risk models for the Congenital Heart Surgery Database must continue, and increased participation in the General Thoracic Surgery Database will be a priority. “Using technology to facilitate data entry for all aspects of our Database also is a top priority, as is utilizing the Database for evaluating new technologies in our field,” he said.

With interests in adult cardiac surgery, health outcomes research, patient safety, organizational efficiencies, and education, Dr. Prager has authored or co-authored more than 140 peer-reviewed journal articles and book chapters.

“I’ve been rewarded in every way possible in my profession,” shared Dr. Prager. “Now, as President of STS, I have the opportunity, with a great team, to contribute and advance the Society’s goals for the benefit of our specialty. I would like cardiothoracic surgeons around the globe to know that The Society of Thoracic Surgeons is their society, and we want to represent and help them in the complex world in which we all practice. All of our members should feel comfortable getting in touch with any of the STS surgeon leaders with suggestions about ways to help the Society represent them better.”

Dr. Prager and his wife, Lauren, live in Ann Arbor. They have five children and five grandchildren.

New Officers, Directors Elected

In addition to electing Dr. Prager as the Society’s new President, STS members elected several new officers and directors yesterday evening.

Keith S. Naunheim, MD was elected First Vice President and Robert S.D. Higgins, MD, MSHA was elected Second Vice President. Joseph F. Sabik III, MD was elected Secretary, and Thomas E. MacGillivray, MD was elected Treasurer.

The following also were elected or re-elected by the STS voting membership last night:

Resident Director: Edo K.S. Bedzra, MD, MBA
International Director: A. Pieter Kappetein, MD, PhD
Canadian Director: Sean C. Grondin, MD, MPH
Public Director: Chris Draft
Historian: Douglas J. Mathisen, MD
Directors-at-Large: Shanda H. Blackmon, MD, MPH and Joseph C. Cleveland Jr., MD

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David M. Shahian Honored for Groundbreaking Contributions to Cardiothoracic Surgery Quality Improvement

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David M. Shahian, MD

Renowned quality improvement expert and public reporting advocate David M. Shahian, MD is the recipient of the STS 2017 Distinguished Service Award, presented yesterday evening at the Annual Membership (Business) Meeting.

“Dr. Shahian has been a visionary, persistent, and tactical genius, who has passionately taken quality improvement in cardiothoracic surgery to the next level,” said 2016-2017 STS President Joseph E. Bavaria, MD. “I think he’s an incredibly important part of the Society and our mission, with contributions that have been seminal.”

An STS member since 1985, Dr. Shahian has served the organization in many capacities, including his 6-year tenure as Chair of the STS Workforce on National Databases and his current role as Chair of the STS Council on Quality, Research, and Patient Safety. He also serves on the National Quality Registry Network, CMS Star Ratings Expert Panel, and the National Quality Forum Board of Directors and Executive Committee.

Dr. Shahian has been involved in health policy issues for more than 20 years, particularly in the areas of performance measurement and public reporting. He helped the Society develop and implement multiple cardiac and general thoracic surgery risk models and composite performance measures. He also has been a leader in the establishment of the Society’s acclaimed Public Reporting Program.

“Dr. Shahian is a thoughtful clinician and analytics expert with a sophisticated understanding of statistics and metrics. These qualities have allowed him to lead the evolution of the STS National Database to its position as the finest clinical outcomes registry in cardiothoracic surgery, if not all of medicine,” said 2017-2018 STS President Richard L. Prager, MD. “He recognizes the importance of data and has the ability to expand registries so that they meet surgeon, hospital, government, and industry needs. It’s a rare combination, and Dr. Shahian does it with a calmness, maturity, and thoughtfulness that few have.”

The STS National Database—which is widely regarded as the gold standard of clinical outcomes registries—was established in 1989 as an initiative for quality improvement and patient safety among cardiothoracic surgeons. STS Public Reporting Online enables Database participants to report, on a voluntary basis, their numeric scores on the surgical quality metrics that Dr. Shahian helped to develop and their corresponding star ratings.

“One of the most important and influential endeavors that the Society has ever embarked on is the STS National Database,” explained Dr. Bavaria. “The Database has evolved and improved considerably over the years. Dr. Shahian has been behind all of that, with his decisions and influences being spot on. His selflessness and total commitment regarding our mission toward quality has been unparalleled.”

A graduate of Harvard College and Harvard Medical School, Dr. Shahian trained in general surgery at Massachusetts General Hospital (MGH) and was a fellow in cardiothoracic surgery at Rush University Medical Center in Chicago. For nearly 20 years, he chaired the Department of Thoracic and Cardiovascular Surgery at the Lahey Hospital & Medical Center in Massachusetts. Dr. Shahian currently holds the positions of Professor of Surgery at Harvard Medical School, Vice President of the MGH Center for Quality and Safety, and Associate Director of the MGH Codman Center for Clinical Effectiveness in Surgery.

In addition to his clinical career, Dr. Shahian is the author or co-author of more than 200 peer-reviewed journal articles and book chapters. His research has focused on performance measurement, public reporting, and related health policy issues.

“Dr. Shahian is an enlightened man and surgeon—someone who has put in a lot of time and effort for the advancement of cardiothoracic surgeons and their patients,” said Dr. Bavaria.

The Distinguished Service Award, established in 1969, recognizes individuals who have made significant and far-reaching contributions to STS and the specialty.

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Ralph Muller to Give Ferguson Lecture

Thomas B. Ferguson Lecture

Tuesday

9:00 a.m. – 10:00 a.m.

Grand Ballroom

Ralph W. Muller, Chief Executive Officer of the University of Pennsylvania Health System, is the 2017 Thomas B. Ferguson lecturer. His talk is titled “Specialty Care in an Age of Population Health.”

Ralph W. Muller

Ralph W. Muller

Muller has had a distinguished career in health care. From 1985 to 2001, he was President and CEO of The University of Chicago Hospitals and Health System. He also has held senior positions with the Commonwealth of Massachusetts, including serving as Deputy Commissioner of the Massachusetts Department of Public Welfare, where he was the chief operating officer responsible for the state’s major welfare programs, including Medicaid. Muller also currently serves as a Director of the National Committee for Quality Assurance and a Commissioner of The Joint Commission.

In his lecture, Muller will examine how to manage complex, chronic patients and will emphasize how specialists, such as cardiothoracic surgeons, can take a broader role in patient care through service lines and disease team approaches to promote care standardization by developing disease protocols and pathways.

The Ferguson lecture was established in 2002 and recognizes Thomas B. Ferguson, MD, one of the few individuals to serve as President of both STS and AATS.

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Author and Quality Expert to Give Lillehei Lecture

C. Walton Lillehei Lecture

Tuesday

11:00 a.m. – 12:00 p.m.

Grand Ballroom

The 2017 C. Walton Lillehei lecturer will be Samer Nashef, MD, PhD, author of The Naked Surgeon: The Power and Peril of Transparency in Medicine. He will provide an overview of quality initiatives and their unintended consequences.

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Samer Nashef, MD, PhD

Dr. Nashef is a Consultant Surgeon at Papworth Hospital in Cambridge, United Kingdom. He practices all types of cardiac surgery, with a special interest in minimally invasive coronary bypass, mitral repair, and surgery for atrial fibrillation. He also is interested in surgery of the aorta and operations for congenital heart problems in adults.

He has many research interests, a major one being measuring and monitoring the quality of surgical treatment. Dr. Nashef co-developed the EuroSCORE risk-assessment system.

The Lillehei lecture honors C. Walton Lillehei, MD, one of the world’s preeminent cardiac surgeons who was considered to be the “father of open heart surgery.”

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CT Surgeons Highly Engaged in TAVR Procedures, Survey Shows

chartAn STS survey has found that 77% of cardiothoracic surgeons are actively involved if a transcatheter aortic valve replacement (TAVR) program exists at their institution.

2016-2017 STS President Joseph E. Bavaria, MD will present an overview of the survey findings at this morning’s General Session. The 16-question survey was sent to 2,594 surgeon participants in the STS Adult Cardiac Surgery Database between June 27 and July 7, 2016; 487 (19%) responded.

In 2012, the Centers for Medicare & Medicaid Services issued a National Coverage Determination (NCD) for TAVR procedures. That NCD includes a provision to the effect that “the heart team’s interventional cardiologist(s) and cardiac surgeon(s) must jointly participate in the intra-operative technical aspects of TAVR.” The goal of the survey was to assess whether—for those cardiothoracic surgeons operating at hospitals where TAVR procedures are performed—an environment exists in which all members of the heart team are able to contribute effectively to the well-being of their patients.

As it turns out, TAVR truly is a multidisciplinary endeavor. A total of 84% responded that both cardiologists and cardiothoracic surgeons bring in potential TAVR patients, and 89% reported that two cardiothoracic surgeons independently examine and evaluate potential TAVR patients. Most respondents reported a TAVR caseload of up to 9 per month (41% had 5-9 cases, and 36% had 0-4 cases).

The survey also provided insight into the technical aspects of the operation performed by surgeons. Respondents said that they most often obtain alternative access (89%), perform open repair of femoral vessels, as needed (85%), and obtain femoral artery access (71%). Additionally, 87% of respondents participated in the postprocedural care of TAVR patients.

“Surgeons have been an integral component of the TAVR phenomenon, but the challenge now is to increase our role and attain lead operator status in many cases,” Dr. Bavaria said.

For more on this important survey, make sure to attend the General Session at 8:45 a.m. in the Grand Ballroom. A roundtable discussion on the topic also will be available on the STS YouTube channel later this year.

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TEVAR Device Indications Expanded for All Type B Aortic Dissections

EACTS @ STS: Management of Distal Type B Aortic Dissection

Tuesday

1:00 p.m. – 3:00 p.m.

Room 330AB

The US Food and Drug Administration recently expanded indications for two thoracic endovascular aortic repair (TEVAR) devices for the treatment of all classifications of type B aortic dissections, even though TEVAR’s efficacy had been studied only for type B acute complicated dissections. A session developed by STS and the European Association for Cardio-Thoracic Surgery (EACTS) will examine how this ruling has created a seismic shift in the distal treatment of thoracic aortic dissection.

“The FDA usually studies safety and efficacy before approval. In this particular case, it went with safety only and did not have data showing efficacy, which is usually the European model,” explained STS 2016-2017 President and session co-moderator Joseph E. Bavaria, MD. “This is a different strategy by the FDA. That is why this session was designed.”

Outcomes from TEVAR on patients with residual type A and other type B dissections will be collected to determine when it is the best treatment option.

“The FDA probably did the right thing. It is reasonable to have the community of cardiovascular surgeons see these patients and perform these procedures to develop the evidence one way or the other,” said
Dr. Bavaria, who is with the University of Pennsylvania School of Medicine in Philadelphia.

The use of the frozen elephant trunk has been adapted over time for more complex type A and B dissections, and Heinz Jakob, MD will share his insights about the progression of this device and its applications. With a device trial starting in the United States for use in acute type A dissections, this talk is apropos because surgeons have been using off-the-shelf devices, Dr. Bavaria said.

Dr. Jakob, of the University of Essen in Germany, is a pioneer in the use of the frozen elephant trunk in acute type A and B dissections to modify remodeling of the distal aorta, minimizing the development of late chronic type B dissections.

G. Chad Hughes, MD, of Duke University Medical Center in Durham, N.C., will address the merits of open thoracoabdominal aortic aneurysm surgery versus TEVAR for chronic type B dissections. Dr. Bavaria noted that Duke is one of a few centers performing both procedures.

“This lecture is important because we have significant equipoise in North America and Europe regarding the use of these procedures in the setting of chronic type B dissecting aneurysms,” Dr. Bavaria said. “There is no consensus about which is right to do. Dr. Hughes will talk about the nuances and decision making for each solution.”

Davide Pacini, MD, of the University of Bologna, Italy, will give his perspective on TEVAR versus medical management for acute uncomplicated type B dissections.

“There is no real robust data to tell us which acute uncomplicated dissections should be treated with TEVAR and which should not be,” Dr. Bavaria said. “Dr. Pacini will describe the features that would be favorable for good long-term results.”

Dr. Bavaria also added that for the first time, there will be a presentation on the newly designed thoracic aortic surgery section of the STS Adult Cardiac Surgery Database.

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Caregivers Debate Treatment Options for Dying Down Syndrome Patient

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Minoo N. Kavarana, MD (left) and Jessica M. Turnbull, MD, debate the ethics involved in treating a child with Down syndrome.

The prognosis for 8-year-old Angela Downing is bleak. Born with trisomy 21, her severe heart disease has run the gamut with an atrioventricular canal defect, moderate mitral insufficiency, and a failing left ventricle. Seven days after her valve replacement, she failed to wean from extracorporeal membrane oxygenation (ECMO) due to her poor left ventricular function. She underwent re-exploration for bleeding, difficulty gaining adequate heparinization, and thromboemboli in several fingers and toes.

Her situation is tenuous, and her parents want “everything done.” Her surgeon must meet with the parents about whether to embark on a ventricular assist device (VAD)-transplant pathway or remove the child from life-sustaining therapy.

Minoo N. Kavarana, MD and Jessica M. Turnbull, MD took opposing views on this difficult situation during yesterday’s Ethics Debate: When a Child’s Heart Is Failing. Prior to their debate, they shared what they planned to discuss.

Dr. Turnbull, an ethicist and pediatric intensivist at Vanderbilt University in Nashville, advocated for withdrawing ECMO, and Dr. Kavarana, a pediatric cardiac surgeon at the Medical University of South Carolina in Charleston, argued to replace ECMO with a VAD as a bridge to heart transplantation.

“This is a horribly unfortunate situation,” Dr. Turnbull said. “Complicating the whole matter is that there is still equipoise in the transplant community about whether transplanting kids with chromosomal abnormalities is the right thing to do, given their limited life expectancies. They will be dependent on caregivers for probably the entirety of their lives.”

Dr. Turnbull speculated that the child would be left with a poor quality of life post-transplant.

“We sometimes don’t have time to consider when a kid’s not doing well, so we hedge our bets, and we put them on ECMO,” Dr. Turnbull said. “We try to do the right things for these kids, but that leads to a lot of harm without the potential of appreciable benefits. Instead of going to a VAD and a transplant, her course should be transitioning to one of comfort and likely withdrawal of life-sustaining therapy.”

Dr. Kavarana noted that children with Down syndrome live 50 to 60 years and often have good support from family at home.

“You have to decide if you withhold the same therapy that you would offer a non-Down syndrome 8-year-old,” said Dr. Kavarana, noting that the child’s size merits the use of an implantable intracorporeal VAD. “Until we determine futility, we would not withhold a heart transplant. We clearly have not demonstrated futility. She’s just 7 days from her surgery on ECMO, which would be a perfect time for a VAD transition.”

However, it is difficult for Angela to be compliant. She often removes the CPAP mask she was prescribed at age 4 to ameliorate her obstructive sleep apnea.

“I know her caregivers are doing the best they can, but when we’re talking about a VAD and a heart transplant, we’re asking our families to take on increasingly complicated levels of care at home,” Dr. Turnbull said. “I think it does a disservice to our kids and our families when we offer therapies that are arduous to carry out at home and then will not yield the best outcome possible. It’s a heart-breaking situation to have a patient like this.

“Despite the fact that she has lovely, amazing parents who love her very much, and despite the best efforts of the medical team, we’ve unfortunately run out of options. I think withdrawing life-sustaining therapy isn’t killing. I think it’s transitioning to comfort. Her path was set when she had a mitral valve that couldn’t sustain her for as long as we needed it to sustain her.”

For Dr. Kavarana, doing nothing would be wrong.

“I think you can improve this child’s heart failure symptoms and ease her suffering. It would be withholding care for a child who potentially could be resuscitated or weaned off ECMO,” Dr. Kavarana said. “Clearly, there is an ethical dilemma when it comes to solid organ transplantation and patients with disabilities. There is no doubt about that.”

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Quality Versus Access Dilemma

A. Pieter Kappetein, MD, PhD discusses challenges in delivering quality care to remote regions.

A. Pieter Kappetein, MD, PhD discusses challenges in delivering quality care to remote regions.

Bringing quality cardiothoracic surgical care to underserved regions is rife with challenges. Managing costs, staffing, training, equipment needs, and follow-up care are overwhelming concerns. These are compounded when a lack of access hinders patients from getting treatment. Quality, access, financial, and ethical considerations also are paramount issues when providing cardiothoracic surgical care in the midst of a humanitarian crisis.

Monday’s International Symposium examined the quality versus access debate for underserved regions and for countries responding to refugees who have fled en masse.

The Symposium kicked off with presentations comparing the costs and benefits of regionalized cardiothoracic surgical care and localized care in lower-volume centers.

“People in some areas of the world have a great distance between where they live and where they can access care,” moderator A. Pieter Kappetein, MD, PhD, of Erasmus Medical Center in Rotterdam, the Netherlands, said in an interview prior to the Symposium. “This is not limited to developing countries. It is also true for the Western world. You can strive for the best and the most excellent center of excellence, but that’s not always possible.”

Although some argue that low-volume centers have good outcomes, others say highly specialized centers are needed because cardiac surgery patients are complex, Dr. Kappetein said. The speakers shared their experiences setting up sustainable specialized centers in Nepal and South Africa.

Another speaker gave his take on the quality, access, financial, and ethical challenges involved in the Syrian refugee crisis.

“About 65 million people have been displaced from their homes; 21.3 million of them are refugees for whom flight is virtually necessary—involuntary victims of politics, war, or natural catastrophe. Surgeons face challenges in determining how we can help,” Dr. Kappetein said.

The session concluded with a presentation on the global challenge of treating noncommunicable diseases, including cardiothoracic diseases.

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STS Helps Standardize Curriculum Development

Electronic Learning and Innovation in Education

Tuesday

1:00 p.m. – 3:00 p.m.

Room 361A

A new Annual Meeting session will highlight the many features of the Society’s expanded learning management system (LMS), which incorporates the Thoracic Surgical Curriculum and can help program directors develop resident education curricula within their existing programs.

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Mark S. Allen, MD

“This is the future of cardiothoracic surgical education. This is an attempt to standardize the educational curricula and get everybody across the country on the same page,” said Mark S. Allen, MD, STS Past President and Chair of the STS Workforce on E-Learning and Educational Innovation.

Presentations will explain how program directors can use the LMS to create curricula, make assignments, and track resident progress. Dr. Allen, of the Mayo Clinic in Rochester, Minn., will moderate the session with Edward D. Verrier, MD, of the University of Washington in Seattle.

Ara A. Vaporciyan, MD, of the University of Texas MD Anderson Cancer Center in Houston, will explain how the LMS can be used to develop a curriculum.

Stephen C. Yang, MD, of Johns Hopkins University School of Medicine in Baltimore, will give a presentation focusing on the expansive content in the LMS, which has been developed from textbooks, videos, published articles, and lectures.

“The more than 3,000 multiple-choice questions have been tagged to various topics in the curricula. When a resident reads about a subject, such as mitral valve surgery, he or she can click a button, and the system will randomly assign a number of mitral valve questions to answer,” Dr. Allen said.

The LMS can be used to track the progress of residents in meeting Accreditation Council for Graduate Medical Education milestones. Nahush A. Mokadam, MD, also from the University of Washington, will discuss those features in a talk about the eMTRCS Milestone Application. Every 6 months, program directors are required to report each resident’s milestone status to the ACGME.

“When a resident reads something or takes a quiz, it is tagged into each milestone, and program directors are given a report on how each resident is doing,” Dr. Allen said.

Another presentation will review the Resident-Faculty Feedback Application, developed by Shari L. Meyerson, MD, of Northwestern University Feinberg School of Medicine in Chicago. She will share how faculty can use the iPhone app to follow up with residents and evaluate their performances.

“We don’t always do a good job giving feedback,” Dr. Allen said. “At the end of a surgery when we talk to the patient’s family and do paperwork, we don’t have a chance to sit down with the residents. Resident surgeons can use this app to send a text message to the staff working with them. The staff then can grade the residents on performance, which goes into milestones.”

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