Thoracic surgery education--past, present, and future.

Organized thoracic surgery education began with the establishment of the first thoracic residency program at the University of Michigan in 1928. Subsequent changes and progress in thoracic education have included the development of the American Board of Thoracic Surgery, the Thoracic Surgery Residency Review Committee, the Thoracic Surgery Directors' Association, the Matching Program, the In-Training Examination, and the Joint Council on Thoracic Surgery Education. Current challenges in thoracic surgery education include (1) the declining interest in medical school and especially in surgery and cardiothoracic surgery, (2) changing demographics of medical students and residents, (3) lifestyle of surgical residents and practicing surgeons, (4) changes in societal expectation, and (5) the need for better tools to assess the outcomes of surgical education and the continued competency of practicing surgeons. Despite the recent difficulty with job availability for finishing cardiothoracic residents, there is evidence that this is temporary and that there will be an increased need in the future. Recent changes by the American Board of Thoracic Surgery, including making optional American Board of Surgery certification, new pathways for entry into the cardiothoracic surgery educational process, and the recent development of a joint training proposal (4/3) by the American Board of Surgery and American Board of Thoracic Surgery, clearly signal the need for further changes in the cardiothoracic surgery educational process so that thoracic surgery remains relevant in the future care of patients with cardiovascular disease.