YOUNG SURGEON’S NOTE

The cardiothoracic surgery trainee experience during the

coronavirus disease 2019 (COVID-19) pandemic: Global
insights and opportunities for ongoing engagement
Jacqueline K. Olive, BA,a Jessica G. Y. Luc, MD,b Rui J. Cerqueira, MD, MSc,c
urgen Eulert-Grehn, MD,d Jason J. Han, MD,e Kevin Phan, MD,f and
Jaime-J€
Ourania Preventza, MD, MBAg,h

From the aBaylor College of Medicine, Houston, Tex; bDivision of Cardiovascular Surgery, Department of Sur-
gery, University of British Columbia, Vancouver, British Columbia, Canada; cCardiovascular Research and
Development Unit, University of Porto, and Department of Cardiothoracic Surgery, University Hospital Center
of S~ao Jo~ao, Porto, Portugal; dDepartment of Cardiothoracic and Vascular Surgery, German Heart Center Ber-
lin, Berlin, Germany; eDivision of Cardiothoracic Surgery, Department of Surgery, Hospital of the University of
Pennsylvania, Philadelphia, Pa; fPrince of Wales Private Hospital, Sydney, Australia; gDivision of Cardiotho-
racic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; and
h
Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
Disclosures: The authors reported no conflicts of interest.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or re-
viewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article
have no conflicts of interest.
Received for publication April 17, 2020; revisions received June 11, 2020; accepted for publication June 13, 2020. Interconnected elements of cardiothoracic surgery
Address for reprints: Ourania Preventza, MD, MBA, BCM 390, One Baylor Plaza, Houston, TX 77030 (E-mail: trainee experience during the pandemic.
preventz@bcm.edu).
J Thorac Cardiovasc Surg 2020;-:1-6
0022-5223/$36.00 CENTRAL MESSAGE
Copyright Ó 2020 by The American Association for Thoracic Surgery
https://doi.org/10.1016/j.jtcvs.2020.06.060 The COVID-19 era presents
unique challenges and clear op-
The coronavirus disease 2019 (COVID-19) pandemic has portunities for trainees in
posed unprecedented challenges to the world’s health care
systems and society at large. In addition, the cardiothoracic cardiothoracic surgery.
surgical community faces the challenge of upholding its
PERSPECTIVE
educational imperative to provide learning for trainees dur-
Cardiothoracic surgery training is demanding of
ing the pandemic even as the scope of clinical experiences
time and commitment. The escalation of the
has changed. Here, we discuss relevant concerns of cardio- COVID-19 pandemic poses additional challenges
thoracic surgery trainees during the COVID-19 pandemic, to trainees’ education and potential risks to their
the potential downstream consequences of altered curricula, health, safety, and overall wellness. This has led to
and ongoing methods and opportunities for trainees to postponement of exams and licensure, and to
maximize their education and involvement during this more widespread use of virtual platforms in place
pandemic (Table 1). In times of public health emergency, of in-person interaction and other traditional
the trainee’s voice may too often be unheard, and a series educational methods.
of relevant interconnected elements of the cardiothoracic
See Commentary on page XXX.
surgery trainee experience should be addressed (Figure 1).
In this Young Surgeon’s Note, we provide a global perspec-
tive to better understand the scope of the pandemic’s effect
on cardiothoracic surgery learners and prepare their educa- general surgery residents might consider pursuing shadow-
tors during the evolving crisis and for the specialty’s future. ing opportunities and mentors during the first 2 years of
their respective programs in anticipation of unforeseen bar-
riers to adequate formal clinical elective time.
EFFECT OF COVID-19 ON THE TRAINEE Cardiothoracic surgery residents. With the international
EXPERIENCE surge in patients with COVID-19, many programs have
Academic Curriculum reallocated their cardiothoracic surgery house staff from
Medical students and general surgery residents. The surgical rotations to other areas of need, such as intensive
COVID-19 pandemic predominantly affects clinical experi- care units (ICUs) and emergency departments. A recent in-
ences in subinternships and elective rotations, during which ternational survey of cardiac surgery centers participating in
early surgical learners gain formal exposure to the cardio- the Randomization of Single vs Multiple Arterial Grafts
thoracic subspecialty. In the future, medical students and (ROMA) trial reported that during locally advanced phases

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Young Surgeon’s Note Olive et al

TABLE 1. Issues and potential action items for cardiothoracic surgery TABLE 1. Continued
trainees during the COVID-19 era Areas of impact Potential solutions
Areas of impact Potential solutions Examinations and job-seeking
Patient care Credentialing
Encourage the use of e-technologies and
Patient interactions
Ensure that all cardiothoracic surgical teleconferencing for examinations
(operating room, learning hospitals are adequately staffed
Reschedule examinations for the earliest
clinic, on call) with trainees as essential personnel date possible

Use advanced care practitioners or
Provide provisional licensing
operating room assistants
Board flexibility as outlined regarding

Avoid multiple proceduralists for completing case-volume and all other
interventions requirements

Postpone elective procedures to conserve
Use nonvoluntary offsite time for clinical
hospital space, PPE, resources, and or educational purposes to meet specialty-
personnel specific requirements

Create infrastructure for telehealth and
Allow flexibility with fee waivers and
remote rounds extension of eligibility periods

Configure rotations for social distancing Interviews
Encourage the use of e-technologies and
with flexibility and backup to conserve the teleconferencing
surgical workforce
Be flexible with trainee and faculty
Clinical
Seek volunteers for redeployment to direct schedules
redeployment patient care roles if needed but also Personal wellness
consider drafting those most qualified Safety
Ensure training and fit-testing for PPE

Reschedule junior residents with mandated
Provide adequate supervision and backup
intensive care, emergency department, or
Provide adequate PPE
medical rotations to whichever of these
Provide accommodation and food as
areas need more clinical workers needed for trainees who are wary of going

Ensure appropriate orientation and home because they fear infecting their
supervision during redeployment families

Consider redeployment an opportunity to Social
Promote social media networking
learn from other specialties
Ensure excellent communication among
Education team members
Didactic learning
Use virtual educational resources and Psychological
Have resources readily available for
curricula (eg, social media, CTSNet.org, trainees in distress
National Thoracic Online Curriculum,
Respect work-hour restrictions where
Thoracic Surgery Directors and Residents possible
Association resources, Journal of Thoracic Financial
Provide income support for trainees as
and Cardiovascular Surgery, Annals of needed
Thoracic Surgery, Multimedia Manual of
Offer loan-forgiveness
Cardiothoracic Surgery) PPE, Personal protective equipment; COVID-19, coronavirus disease 2019.

Encourage sharing of resources between
programs
Technical learning
Use simulation where feasible

Seek educational opportunities for trainees of the pandemic, one half of centers have still permitted res-
(eg, trainees still learning critical care idents to participate in cardiac operations, 18% relocated
procedures can benefit from volunteering fellows and residents from cardiac surgery to other depart-
to be on the “procedure team” in the care of ments, and one third relocated their personnel to other de-
patients with COVID-19) partments, chiefly to ICUs.1 Although these results are
Research
Participate in remotely accessible research
potentially subject to selection bias, it is evident that educa-
opportunities
tors and trainees face an increasing dilemma in preserving

Encourage societies that have cancelled
their academic conferences to resort to
the integrity of surgery training versus meeting front-line
virtual modalities clinical and service-oriented demands, all while protecting

Pursue alternative forms of academic limited human resources. Fortunately, redeploying cardio-
enrichment (eg, advanced degrees, thoracic surgery trainees to surgical ICUs and procedural
advanced coursework, research, career teams can not only maximize their value in the greater
planning, financial literacy) health care system but also provide relevant learning expe-
(Continued) riences, given their unique interdisciplinary skill sets.

2 The Journal of Thoracic and Cardiovascular Surgery c - 2020

Olive et al Young Surgeon’s Note

Safety Standards Amid COVID-19,” which offers recom-

mendations and guidance to new and volunteer physicians.4
Graduating cardiothoracic surgery residents. For
cardiothoracic surgery specialist certification examinations,
most countries worldwide have tentatively rescheduled
written and oral examinations to Fall 2020, if not Spring
2021. The European Board of Cardiothoracic Surgery has
shown flexibility and understanding regarding the sched-
uling of Level One and Level Two examinations for their
cardiothoracic surgeons, as has the American Board of
Thoracic Surgery.5
In addition, while the decrease in elective surgical cases
is allowing allocation of resources and residents to the
emergency care of patients with COVID-19, understand-
ably, there are concerns about whether trainees can meet
minimum case-volume requirements for graduation, espe-
cially opportunities for direct observation and autonomy.6
Health education committees may be forced to extend
training programs well beyond the end of the lockdown to
FIGURE 1. Interconnected elements of cardiothoracic surgery trainee give surgical trainees additional time for retraining after
experience during the pandemic. elective activity resumes. Alternatively, program directors
may need to play a larger role in deciding the readiness of
Ultimately, residents may need additional time to log or trainees for independent practice. It is critical to identify
double-scrub cases to gain adequate cardiothoracic surgery the specific requirements that a trainee may fall short of
experience. In the United States, the impact may be greatest meeting, to develop individualized plans to address those
on traditional fellows with 2-year training periods, inte- requirements, and to monitor progress on a regular basis.6
grated program residents because of their condensed The American Board of Thoracic Surgery, in conjunction
curricula, and residents who are currently in their dedicated with the Thoracic Surgery Directors Association (TSDA)
research period or who desire to perform future uninter- and the Thoracic Surgery Residents Association, demon-
rupted research.2 Once the pandemic subsides, the resulting strates flexibility and is proactive in ensuring that contin-
backlog of elective cases, projected to be as much as 216% gency plans are in place for senior cardiothoracic surgery
to 263% of monthly baseline cardiac surgery volume, may residents should they not meet their operative experience re-
provide residents with greater opportunity.3 quirements by the end of the academic year.5 Certainly, the
directors of all programs worldwide are committed to
ensuring that trainees meet all the requirements for profi-
Examinations and Graduation ciency and qualifying exams.
Medical students. The COVID-19 pandemic poses unique For trainees whose caseload does not meet the criteria to
challenges to the safe administration of licensing examina- sit for the examination, board organizations and accredited
tions and in-person clinical skills assessments throughout programs may need to coordinate to develop a flexible but
the world. Therefore, applicants to integrated cardiotho- fair solution. For trainees who have not completed their
racic surgery residency programs may need to submit their required caseload because of the recent COVID-19 crisis
applications without these scores. Program directors and but who have already accepted a job as an individual prac-
committees should be flexible in their initial review of ap- titioner outside their current institution, they might be al-
plications, as options for remote or staged examinations lowed a provisional period during which the cases they
may not be available in the immediate future. In addition, perform in their practice would count toward their required
several medical schools around the world have offered early caseload until they qualify for the exam. In this case, the
graduation to fourth-year students to provide additional chief medical officer of the hospital where the trainee prac-
support for the health care workforce, although these insti- tices or a supervising board-certified thoracic surgeon
tutions recognize that this solution is controversial. These would provide affirmation of the cases to the Board. For
newly minted interns’ work must be heavily supervised trainees who do not complete their required caseload by
by experienced senior residents and surgeons. the end of their academic year but have accepted a faculty
The Coalition for Physician Accountability, of which the job at their current institution, their program may allow
Accreditation Council for Graduate Medical Education is a them to continue and extend their training by a few months
member, released the statement “Maintaining Quality and to accumulate the rest of their cases; the trainees would

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Young Surgeon’s Note Olive et al

function at the instructor level without interfering with the conference virtually in both live and on-demand for-
training of incoming residents. Finally, depending on the mats—AATS 100th Annual Meeting: A Virtual Learning
extent to which the pandemic escalates, solutions may Experience—thereby providing cardiothoracic surgery pro-
need to be considered such as provisional licensure to prac- fessionals around the world with complimentary access to
tice, subject to appropriate oversight and supervision to some of the most exciting research, education, speakers,
ensure patient and trainee safety. and science in the field, in addition to a Virtual Expo.13
This effort demonstrates dedication to not only the aca-
Interviews and Job Applications for Residency and demic enterprise but also equity of access and global
Fellowship outreach for the future of education and subspecialty meet-
Shortened or repurposed elective clinical time poses a ings. Presenters can share their science via this virtual
unique challenge to those whose interest in cardiothoracic format, as well as social media platforms such as the
surgery developed late, or who must obtain letters of recom- Thoracic Surgery Social Media Network and the Cardiotho-
mendation and complete visiting rotations to be competitive racic Surgery Network.14 Finally, although many profes-
for surgery residency programs.7,8 Fewer opportunities to sional relationships begin at in-person meetings, we must
rotate on a cardiothoracic surgery service could dampen harness the capabilities of e-mail and social media to
prospective applicants’ interest in the specialty and in spe- remain connected with mentors and mentees.
cific training programs, as well as decrease the competitive-
ness of applicant pools for integrated residency and Trainee Safety and Health
fellowship programs. To anticipate these changes, program It is especially important to be sensitive to the vulnerabil-
directors and committees should support the recent post- ities of trainees during the COVID-19 pandemic, including
ponement of application deadlines and provide alternative the direct burden of illness and exposure, comorbidities,
means for external trainee engagement, such as holding vir- caregiver responsibilities, work-hour restrictions, and finan-
tual resident didactics and hosting virtual tours and social cial and personal considerations. Gaudino and colleagues1
gatherings.9 The Coalition for Physician Accountability reported that around one half of cardiac surgery programs
recommends that all programs commit to online interviews have mandated that trainees stay at home unless on call or
and virtual visits for applicants.10 critically needed. To protect vulnerable patients with car-
Candidates may feel at a disadvantage if they cannot diovascular disease, trainees should avoid working with
participate in on-site interviews. Our pediatric surgery col- both patients who are positive and negative for COVID-
leagues have reported that the virtual interview is an effec- 19 simultaneously or in close succession. Although the
tive screening tool for their highly competitive fellowship debate regarding trainee involvement leans toward limiting
match and has significant potential to modify rank lists.11 direct exposure to patients with COVID-19 and high-risk
Safety, financial, and logistical considerations may make environments, trainees and educators may view being
virtual interviews more favorable in future application shielded from serving as responders in hospitals as a missed
cycles.12 learning opportunity.
For residents and fellows seeking job opportunities, flex-
ibility is needed regarding the job application process, with OPPORTUNITIES FOR TRAINEE ENGAGEMENT
special attention to letters of intent and to any time-based DURING THE COVID-19 PANDEMIC
conditions of contracts, given the pandemic’s uncertain We have identified several means of supporting cardio-
timeline. In addition, coordination is needed among regula- thoracic surgery trainees and sustaining the intellectual
tory bodies so as not to delay credentialing of cardiothoracic and academic rigor of the specialty when in-person efforts
surgeons because of COVID-19. are less feasible.

Pursuing an Academic Career Without In-Person Contemporize Cardiothoracic Surgical Education

Conferences in the Near Future Remote clinical experience. Resident participation in vir-
Because of the risks associated with large gatherings, tual rounds and clinics permits ongoing involvement in pa-
numerous cardiothoracic surgery conferences have been tient care while ensuring social distancing and minimizing
cancelled, and others have been reformatted. Many confer- potential exposure. Programs in the United States like Per-
ences scheduled for the rest of the year are in limbo, await- fect Care, an Atrium Health initiative funded by The Duke
ing further clarity of circumstances. Because the prospects Endowment, and in Canada like the University of Ottawa
for rescheduling in-person conferences are unclear, we must Heart Institute’s Virtual Care Program have expanded their
innovate to continue to share scholarly work and provide services during the COVID-19 pandemic to aid cardiac sur-
trainees with alternative opportunities to build their resumes gical patients through virtual real-time monitoring and
and applications. The American Association for Thoracic wearable technologies, converting as many as 95% of visits
Surgery (AATS) adopted novel modalities and held its from in-person to virtual.15

4 The Journal of Thoracic and Cardiovascular Surgery c - 2020

Olive et al Young Surgeon’s Note

Didactics on COVID and ICU management. Focused should be given guidance and mock training on the virtual
learning in cardiothoracic surgery should continue while interview format, including techniques to minimize tech-
the COVID-19 pandemic necessitates instruction on caring nical failures, optimize physical space, and anticipate ex-
for infected patients and prioritizing our health care sys- pectations for evaluation, as well as pocket resources such
tems’ resources. Many training programs now require or the University of Utah Cardiothoracic Surgery Program’s
offer supplemental instruction on the presentation and diag- virtual interview primer.20
nosis of COVID-19, chest imaging, blood gas analysis, Technological innovation and development. Crisis often
airway management, circulatory support (eg, extracorpo- fosters the development of new technologies. We envision
real membrane oxygenation), percutaneous access, infec- an expanded role for 3-dimensional printing of health care
tion control, and other topics in critical care, crisis equipment such as masks and simplified mechanical com-
management, and leadership. Notably, the Society of ponents for ventilators, as well as the adaptation of house-
Thoracic Surgeons (STS) led a COVID-19 webinar series hold items for personal protective equipment. We
on numerous hot topics, including an hour-long session encourage trainees to collaborate in these efforts.
regarding the pandemic’s impact on residency and training,
with valuable program director and resident perspectives.
Expand Social Media Engagement
Virtual classrooms. Teleconferencing of grand rounds;
Now more than ever, as we rely on virtual communica-
educational and case conferences; morbidity and mortality
tion, we encourage other trainees and faculty of all genera-
rounds; debate-style journal clubs, as implemented by the
tions to create professional accounts on social media to
University of Texas MD Anderson Cancer Center16; and
facilitate learning and discussion about COVID-19 and
faculty-led and -scored mock orals, such as those at the Uni-
other topics in cardiothoracic surgery. Of course, merely
versity of Wisconsin17 allow academic instruction to
having a social media account does not necessarily guar-
continue. The role of virtual technical-skills training
antee positive academic or social engagement. As always,
through livestream, augmented and virtual reality, wearable
trainees should proceed with caution given the evolving na-
and head-mounted devices, and pocket vessel-anastomosis
ture of scientific evidence and the political sensitivity of
kits could be expanded to incorporate new dimensions, certain topics during the pandemic. Furthermore, social me-
audio and tactile feedback, and hands-on remote dia can pose ethical challenges for physicians and trainees.
simulations.18 The AATS and the STS have issued a joint statement
Virtual texts and resources. Cardiothoracic surgery is regarding ethical standards for cardiothoracic surgeons’
already at the forefront of supplemental e-learning re- use of social media.21
sources. These are crowdsourced at CTSNet.org, which
houses a broad range of video- and text-based educational
content. Other e-learning resources for cardiothoracic sur- Ensure the Safety and Health of Trainees
gery trainees include well-known academic textbooks and It is vital that programs proactively advocate for and pro-
journals including the Journal of Thoracic and Cardiovas- tect the health and safety of their trainees. Therefore, trainee
cular Surgery, Annals of Thoracic Surgery, Operative Tech- work schedules should be optimized to maintain health and
niques in Thoracic and Cardiovascular Surgery: A reserve in the overall pool of health care workers, such as by
Comparative Atlas, and the Multimedia Manual of Cardio- avoiding >24-hour shifts as much as possible, having
thoracic Surgery; the Thoracic Surgical Curriculum, a new blocks of days on and days off to minimize cross-
customizable learning management system available for all contamination of work cohorts, and not alternating days
Accreditation Council for Graduate Medical Education– and nights. Work-hour requirements should be honored
accredited programs, provided by the TSDA through the whenever possible to allow trainees to rest adequately be-
STS19; the Houston Methodist DeBakey Cardiovascular tween clinical duties. Decontamination efforts, adequate ac-
Education YouTube channel; and online question banks, commodation, and providing food and other essentials—
podcasts, and textbooks available through the Thoracic Sur- including psychological services and counseling—within
gery Residents Association. Furthermore, programs are the hospital may become necessary to protect colleagues
encouraged to share learning resources with each other and family from exposure should trainees become infected
and to collaborate to produce a virtual repository of educa- and to appropriately address any associated emotional re-
tion materials. percussions, as it is still too early to gauge the full scope
Virtual mentoring. Many trainees are technically equip- of these effects. In addition, the TSDA wellness guide for
ped to teach their mentors about advanced communication fighting fatigue provides specific guidance on preparing
technologies and online tools for teaching and simulation. for strenuous shifts, maintaining vigilance while on duty,
Residents may host virtual review sessions and residency- and recovering after difficult periods.22 Fostering expecta-
oriented panels for medical students, while students should tions, establishing routines, delegating tasks, and remaining
offer to assist residents with academic projects. Trainees connected with others are now more important than ever.23

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Young Surgeon’s Note Olive et al

Limitations 7. Smood B, Nguyen SN, Benkert AR, Han JJ. Integrated cardiothoracic surgery:
navigating interviews and the match. J Thorac Cardiovasc Surg. February 25,
We acknowledge that the issues and suggestions dis- 2020 [Epub ahead of print].
cussed here do not reflect the opinions of all trainees and 8. Smood B, Nguyen SN, Kelly JJ, Han JJ. Integrated cardiothoracic surgery: devel-
faculty, should not replace institutional guidelines and gov- oping a successful residency application. J Thorac Cardiovasc Surg. 2020;160:
167-74.
erning bodies’ policies, are not meant as a comprehensive 9. Department of Surgery, Massachusetts General Hospital. Virtual Q&A forums
survey, and are subject to change, given the pandemic’s about the surgical residency program. Available at: https://www.massgeneral.
rapid evolution. org/surgery/news-and-events/surgical-residency-program-virtual-informational-
forum. Accessed June 9, 2020.
10. The Coalition for Physician Accountability’s Work Group on Medical Students in the
CONCLUSIONS Class of 2021 Moving Across Institutions for Post Graduate Training. Final report
and recommendations for medical education institutions of LCME-accredited, U.S.
The COVID-19 era is a challenging time for health osteopathic, and non-U.S. medical school applicants. Available at: https://acgme.
care workers around the globe and hopefully will be a org/Portals/0/PDFs/ReportMovingAcrossInstitutions.pdf. Accessed June 8, 2020.
once-in-a-lifetime experience for many. This unprece- 11. Chandler NM, Litz CN, Chang HL, Danielson PD. Efficacy of videoconference
interviews in the pediatric surgery match. J Surg Educ. 2019;76:420-6.
dented time of pandemic crisis calls for modifications 12. Vining CC, Eng OS, Hogg ME, Schuitevoerder D, Silverman RS, Yao KA, et al.
to and greater flexibility of cardiothoracic surgery Virtual surgical fellowship recruitment during COVID-19 and its implications for
training requirements to address issues unique to trainees resident/fellow recruitment in the future. Ann Surg Oncol. May 18, 2020 [Epub
ahead of print].
and surgical education. A restructuring of the timeline 13. Moon MR, Jones DR, Adams DH, Starnes VA. American Association for
and curriculum for surgical learners is inevitable and Thoracic Surgery: maintaining the mission during the COVID-19 pandemic. J
ongoing. This review could serve a greater purpose as a Thorac Cardiovasc Surg. May 16, 2020 [Epub ahead of print].
14. Luc JGY, Ouzounian M, Bender EM, Blitz A, Stamp NL, Varghese TK Jr, et al.
widely available and peer-reviewed list of specific con- The Thoracic Surgery Social Media Network: early experience and lessons
cerns and clear opportunities as outlined by trainees learned. Ann Thorac Surg. 2019;108:1248-55.
around the globe. 15. Rose G. Tapping telemedicine for cardiac patients during the COVID-19
pandemic. US News & World Report. April 13, 2020. Available at: https://www.
usnews.com/news/healthiest-communities/articles/2020-04-13/tapping-telemed
Stephen N. Palmer, PhD, ELS, contributed to the editing of the icine-for-cardiac-patients-during-the-coronavirus-pandemic. Accessed July 8,
manuscript. 2020.
16. Luc JGY, Nguyen TC, Fowler CS, Eisenberg SB, Wolf RK, Estrera AL, et al.
Novel debate-style cardiothoracic surgery journal club: results of a pilot curric-
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6 The Journal of Thoracic and Cardiovascular Surgery c - 2020

Olive et al Young Surgeon’s Note

000 The cardiothoracic surgery trainee experience during the coronavirus disease
2019 (COVID-19) pandemic: Global insights and opportunities for ongoing
engagement
Jacqueline K. Olive, BA, Jessica G. Y. Luc, MD, Rui J. Cerqueira, MD, MSc, Jaime-J€
urgen Eulert-
Grehn, MD, Jason J. Han, MD, Kevin Phan, MD, and Ourania Preventza, MD, MBA, Houston, Tex;
Vancouver, British Columbia, Canada; Porto, Portugal; Berlin, Germany; Philadelphia, Pa, and
Sydney, Australia

The COVID-19 era presents unique challenges and clear opportunities for trainees in
cardiothoracic surgery.

The Journal of Thoracic and Cardiovascular Surgery c Volume -, Number -