Super Fellowships Among Cardiothoracic Trainees: Prevalence and Motivations

Background: After completing traditional fellowship or integrated residency in cardiothoracic surgery, many trainees spend time in nonaccredited “super fellowships.” The prevalence and motivations for pursuing super fellowships are unknown. Methods: A survey was distributed to all 776 cardiothoracic surgery graduates who completed training between 2008 and 2019. The number of graduates was used as the denominator to calculate response rate. Comparisons between responses were made using Fisher's exact test. Results: Over an 8-week period, 261 surveys were completed with a response rate of 34%. The majority were traditional graduates (75%), for example, not integrated residents, and of those, 64% did a 2-year program. The majority (60%) did not pursue super fellowships. Among those who did complete a super fellowship, areas of training included congenital, transplantation, aortic pathology, valvular disease, and other. Among the 90 who completed super fellowships, reasons included “congenital” (34%), “felt training inadequate” (28%), “required for position” (24%), “personal” (6%), and “other” (8%). Among the 25 who selected “training inadequate,” 32% focused in general thoracic-related areas. There was no relationship between length of traditional training (2 vs 3 years) and completing additional training (P = .17), but there was a significant association between completing a traditional track versus integrated residency and pursuing a super fellowship (P = .02). Conclusions: Additional training in cardiothoracic surgery is common. The reasons for further instruction are varied but relate to readiness and need for specialized skills. Program directors should consider employers’ needs to ensure trainees graduate with the necessary skills for future practice.