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Commentary: Building culture: Pay it forward

Published:September 04, 2021DOI:https://doi.org/10.1016/j.jtcvs.2021.08.071
      Figure thumbnail fx1
      Alexander A. Brescia, MD, MSc, and Gorav Ailawadi, MD, MBA
      While cardiothoracic trainees must have the motivation to maximize their surgical training, faculty-led training programs have a responsibility to foster a culture that shapes behavior.
      See Article page e257.
      In an important expert opinion, Dr Pasque describes how trainee behavior is the most important factor in determining the value of one's cardiothoracic surgical training.
      • Pasque M.K.
      Getting the most from your cardiothoracic surgical training: it's all about behavior.
      Conversely, a training program's culture and treatment of residents are also linked to trainee behavior. One powerful theme from Dr Pasque's contribution is maintaining enough humility and positivity during training to endure “being stupid” to be amenable to learning and eliminating “black holes” in education that can exist during training but are expected by all those around you to be gone the day training ends.
      • Pasque M.K.
      Getting the most from your cardiothoracic surgical training: it's all about behavior.
      As Dr Pasque notes, “your reputation is only as good as your most recent performance.”
      • Pasque M.K.
      Getting the most from your cardiothoracic surgical training: it's all about behavior.
      In this regard, many parallels exist between cardiothoracic training and athletics. During the recent NBA Finals, Milwaukee Bucks star Giannis Antetokounmpo had this to add: “The mindset to have? When you focus on the past, that's your ego. ‘I did [this] in the past. I won [that] in the past.’ When I focus on the future, that's my pride. ‘I'm going to dominate.’ That's your pride talking. I try to focus on the moment. In the present. That's humility. That's being humble.”
      • Haden J.
      Want to embrace the humility mindset? Here's the best advice you'll read today. Inc.
      These lessons about ego, pride, and humility are also relevant to cardiothoracic trainees who must constantly focus on optimizing themselves as learners and surgeons in the present.
      Peer and faculty mentorship for incoming trainees are essential in the current era of cardiothoracic education. While as Dr Pasque concludes behavior is essential, many incoming interns have no idea how to behave—how would they? In reference to inappropriate behavior in the operating room for which cardiothoracic surgeons are well-known, Dr Pasque notes that for the sake of the patient, “There is only one way to respond. [The resident] need[s] to suck it up and take the hit.”
      • Pasque M.K.
      Getting the most from your cardiothoracic surgical training: it's all about behavior.
      Although Dr Pasque importantly admits that such behavior is indefensible and should be addressed after the operation, the same central message of this manuscript that is addressed to trainees should also apply to faculty: it is behavior, and not intentions, that determines outcomes. Dr Marc Moon, during his 2021 American Association for Thoracic Surgery Presidential Address, described the following behaviors of cardiothoracic surgeons that cannot and should not be acceptable: blaming, catastrophizing, inflammatory global labeling, misattribution, overgeneralization, and demanding. These thought processes and actions can destroy the team, mission, careers, and credibility. Rather than trainees being tasked with not emulating the bad behavior of their faculty mentors, faculty must carry the responsibility of eliminating bad behavior. The endless cycle of bad behavior that current faculty learned as trainees can only be broken for future generations if we model the collegiality we wish future generations to achieve.
      In conclusion, every cardiothoracic surgery trainee should heed Dr Pasque's advice, which has been developed over multiple decades of experience as a master educator. The changing landscape of cardiothoracic surgery presents challenges but provides even bigger opportunities for training programs to build a culture of camaraderie and excellence, which will then shape the behavior of all program members, including both trainees and faculty.

      References

        • Pasque M.K.
        Getting the most from your cardiothoracic surgical training: it's all about behavior.
        J Thorac Cardiovasc Surg. 2022; 164: e257-e262
        • Haden J.
        Want to embrace the humility mindset? Here's the best advice you'll read today. Inc.
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      Linked Article

      • Getting the most from your cardiothoracic surgical training: It's all about behavior
        The Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 6
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          The Accreditation Council for Graduate Medical Education works diligently to ensure that educational metric thresholds are consistently met in all cardiothoracic (CT) surgical training programs. You can be assured that an outstanding educational experience is available in yours. So, why do some trainees exit with so much more than others? The good news is that much is left in your hands. Although all trainees start out with the best intentions, it is behavior, not intention, that determines outcome (Figure 1).
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