Portal de Periódicos da CAPES

Timeless lessons from the past and present leaders of cardiothoracic surgery part 2: Character development

2020; Elsevier BV; Volume: 160; Issue: 4 Linguagem: Inglês

10.1016/j.jtcvs.2020.02.075

1097-685X

Jason J. Han, John J. Kelly, William L. Patrick, Amit Iyengar, Marvin D. Atkins, Colleen Pietras,

Aortic Disease and Treatment Approaches

Central MessageProfessional excellence is a core component of a successful career in cardiothoracic surgery. The collective wisdom from leaders in the field is encapsulated here for aspiring surgeons.PerspectiveTraining in cardiothoracic surgery is a technically demanding experience that also requires constant reflection and introspection. This article highlights major themes from the words of past and present leaders in the field that emerged as salient topics for young surgeons. Their collective wisdom can be formative during training and deserves a place in resident education.See Commentaries on pages 998, 999, and 1000. Professional excellence is a core component of a successful career in cardiothoracic surgery. The collective wisdom from leaders in the field is encapsulated here for aspiring surgeons. Training in cardiothoracic surgery is a technically demanding experience that also requires constant reflection and introspection. This article highlights major themes from the words of past and present leaders in the field that emerged as salient topics for young surgeons. Their collective wisdom can be formative during training and deserves a place in resident education. See Commentaries on pages 998, 999, and 1000. Since 1917, the American Association for Thoracic Surgery (AATS) has promoted core values that define our professional standards. Each year, these messages are delivered in the form of the presidential address. Synthesized from a lifetime of operating and learning to navigate both personal and career-related challenges, the words of the AATS presidents are an invaluable resource for all. Our objective was to analyze these messages and reflect upon lessons that are particularly relevant to young surgeons. The first part of this series, which focused on professional accomplishment, has already been published.1Han J.J. Kelly J.J. Iyengar A. Patrick W.L. Sultan I. Timeless lessons from the past and present leaders of cardiothoracic surgery part 1: professional accomplishment.J Thorac Cardiovasc Surg. 2019; 158: 1602-1606Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Here, we present the second of the 2-part series, which discusses character development by exploring themes of humanism, maintaining well-being and life balance, leadership, and the future of cardiothoracic surgery (CTS) and resident education. The methods utilized in this project have been previously described.1Han J.J. Kelly J.J. Iyengar A. Patrick W.L. Sultan I. Timeless lessons from the past and present leaders of cardiothoracic surgery part 1: professional accomplishment.J Thorac Cardiovasc Surg. 2019; 158: 1602-1606Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Twenty-eight former AATS presidents were selected based on the availability of their presidential addresses and interviews from In the Words of the Presidents.2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar Qualitative analysis was performed by 4 integrated CTS resident physicians who independently read the presidential addresses and interviews, identified major themes relevant to young surgeons, and compiled salient quotations (Table 1).Table 1Analysis of thematic content of American Association for Thoracic Surgery (AATS) presidential addressesPresidentPresident No.YearTitle of presidential addressThemeHumanismBalanceLeadershipFutureFerguson621981The Crisis of Excellence✓✓Spencer631982Intellectual Creativity in Thoracic Surgery✓Malm661985New York: A Bellwether for Thoracic Surgery✓Austen891988Eight Former Presidents of the AATS. The Boston Connection∗Manuscript of the presidential address was not available for review, so In the Words of the Presidents2 was reviewed for thematic content information.✓✓Pearson701989Adventures in Surgery✓✓Waldhausen721991The Association at 75: The Challenge of the Future✓✓✓Ochsner731992Giants✓Castaneda741993The Making of a Cardiothoracic Surgeon: An Appolonian Quest✓✓Wallace751994Reflections—Projections!✓✓✓Loop781997The First Living and the Last Dying✓Cohn791998What the Cardiothoracic Surgeon of the 21st Century Ought to Be.✓✓Cosgrove801999The Innovation Imperative✓✓✓Cox812000Changing Boundaries✓✓✓Gardner822001Our Heritage and Our Future✓✓Crawford832002Thoracic Surgery Education—Responding to a Changing Environment✓✓Cooper842003Thank You for Being a Doctor✓✓✓David852004For Everything There Is a Season✓Jonas862006Rewards, Risks, and Responsibilities of Globalization for the Cardiothoracic Surgeon✓✓✓Lytle872006Who We Are—Who We Will Be✓✓Miller882007Anti-Memoirs of Rocinante∗Manuscript of the presidential address was not available for review, so In the Words of the Presidents2 was reviewed for thematic content information.✓Spray892008The Quality Conundrum✓Patterson902009Non solus—A Leadership Challenge✓✓Kron912010Surgical Mentorship✓✓✓Smith922011To Model Excellence✓✓Schaff932012Leadership and Scholarship: Unintended Consequences, Unexpected Benefits✓✓✓Sugarbaker942013Clarity of Purpose, Focused Attention: The Essence of Excellence✓del Nido952014Technological Innovation in Cardiothoracic Surgery: A Pragmatist's Approach✓✓Coselli962015Competition: Perspiration to Inspiration “Aut inveniam viam aut faciam”✓✓∗ Manuscript of the presidential address was not available for review, so In the Words of the Presidents2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar was reviewed for thematic content information. Open table in a new tab The modern surgical environment imposes many obstacles to humanistic care. Castenada observes that the hospital environment can be dehumanizing, placing gowns that are half exposed on patients' bodies, and shaving the hair off of their chests.2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar Sometimes the goal of the patient, which is to become well, free of pain, and to live autonomously, and the goal of the surgeon, which is to eradicate disease, do not always match. Lastly, the bureaucratic pressures that constantly drum up the bottom line can stand in the way of exercising compassion and patience. Cohn3Cohn L.H. What the cardiothoracic surgeon of the twenty-first century ought to be.J Thorac Cardiovasc Surg. 1999; 118: 581-587Abstract Full Text Full Text PDF Scopus (14) Google Scholar believed that no degree of technical and innovative excellence would suffice without our ability to touch and relate to patients in a humanistic manner, coining it among the 11 qualities that “the CT surgeon of the 21st century ought to be.” David2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar corroborated that certain things in surgery should never change, and included in them the value of “caring for your fellow man.” Young surgeons can commit to humanism in their day-to-day lives by recalling that patient care is fundamentally a privilege: Surgeons are blessed to have patients and their families who are willing to entrust them with the important task of healing their loved ones. This trust transforms our profession from a technical endeavor into one that is “both an art and a science,” one where we “enjoy the consummate satisfaction of applying physical skills and fundamentally humane activity of supporting [patients].”4Jonas R.A. Rewards, risks, and responsibilities of globalization for the cardiothoracic surgeon.J Thorac Cardiovasc Surg. 2007; 134: 1-14Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar In addition to simply being present at the bedside, Cooper5Cooper J. Presidential address 2003.J Thorac Cardiovasc Surg. 2006; 132: 747-752Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar states: “We must maintain the highest standards of ethical and moral behavior and avoid the temptation of putting self-interest ahead of that of our patients and our profession.” Patterson,6Patterson G.A. Non solus—a leadership challenge.J Thorac Cardiovasc Surg. 2010; 140: 495-502Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar whose primary focus was “to address the mandatory requirement for behavioral excellence,” considered surgeon behavior the most essential ingredient in successful team building and performance. He clarified that good behavior need not be a form of soft empathy, but rather a fair and balanced respect for the goals of the individuals as well as those of the enterprise. Perhaps Smith2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar summarized this principle most succinctly, saying that “without question, our character and our qualities are more important than what we do with our hands.” Castenada7Castaneda A.R. The making of a cardiothoracic surgeon: an Appolonian quest.J Thorac Cardiovasc Surg. 1994; 108: 806-812Abstract Full Text PDF PubMed Scopus (13) Google Scholar remarked that educating surgeons in the humanities can further buttress their character. He stated, “it is our responsibility as educators to not only train residents to cut here and put stitches there, but to teach respect for human life” by pursuing the humanistic tradition; that is, the Appolonian quest. This is what elevates surgeons to be the “true healers of mankind, rather than glorified technicians.”7Castaneda A.R. The making of a cardiothoracic surgeon: an Appolonian quest.J Thorac Cardiovasc Surg. 1994; 108: 806-812Abstract Full Text PDF PubMed Scopus (13) Google Scholar del Nido2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar said it this way: “Stick to the long-term view. Someday your babies are going to be big kids and adults and you want them to remember you not as a fleeting vision in the moment but as someone who had meaning in their life.” Many of the former AATS presidents describe marriage and family among the most rewarding elements of their lives. It was something that helped them find balance.6Patterson G.A. Non solus—a leadership challenge.J Thorac Cardiovasc Surg. 2010; 140: 495-502Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar However, they also shared that these endeavors required as much, if not more, hard work, flexibility, mutual support, respect, and patience as their careers.8Crawford Jr., F.A. Thoracic surgery education—responding to a changing environment.J Thorac Cardiovasc Surg. 2003; 126: 1235-1242Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar,9Gardner T.J. Presidential address: our heritage and our future.J Thorac Cardiovasc Surg. 2002; 124: 649-654Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Cosgrove2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar described it as a constant pull between things that are competing for time, energy and attention, causing guilt or a sense of not being able to do it right or be the best for everyone. Some shared more specific advice about relationships, such as the need for couples to truly understand each other's characteristics and career ambitions before marriage. Finding the right partner allows many to “without any sort of pressure or issues, pursue the time commitments that have been necessary to do the things that I have had to do.”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar Jonas2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar eloquently described a surgeon's family as being “part of a team that is helping care for your patients and your patients' families.” We have to be there for our families, but our family members must be prepared to be a part of the team balancing act. Regardless of the details, a sense of gratitude toward spouses was universal among the past presidents. “My wife devoted herself to my career and our family,” said Cooper.2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar “She has paid a very heavy price for being the helpmate and supporter without whom I could not have had both a family and a career.”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar With regard to balance, the mentors consistently commented on changes in work hour regulations that have taken place since their training eras2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar:•“Every other night and every other weekend for 7 years,”•“The training that we went through was draconian,”•“We almost never came home…It was the hardest thing I've ever done in my life,”•“It was 36 hours on and 12 hours off for 5 years,” and•“We never talked about work–life balance.” Many past presidents firmly believe that they derived positive attitudes and lessons from this degree of investment. According to Wallace2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar and Spray,2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar being with patients at the bedside as long as necessary was a nonnegotiable principle and commitment; a defining aspect of their training. Cooper2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar remarked that they used to “practically crawl into bed with a sick patient and not get out until that patient was better or died.” Coselli2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar agreed that previous work hours enabled young surgeons to be “immersed into the clinical aspect of patient care.” Yet, there was also a general sentiment that this was not conducive to balance2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar:•“Current surgeons-in-training will be able to receive excellent training despite duty hour regulations because of more selective teaching”;•“I think 80 hours is enough work for anybody in a week, and that comes from somebody who probably worked 120 to 130 each week during residency”; and•Although I never tired of working back then, “the reality is that [it] doesn't necessarily make you a better surgeon and it doesn't make you a better human being. I doubt I will say on my dying day, 'I wish I did 1 more operation!'” The presidents also commented on other aspects that helped them find greater balance and purpose:•“Work towards making work inherently purposeful and well-rounded because a greater sense of fulfillment at work leads to a better personal life”5Cooper J. Presidential address 2003.J Thorac Cardiovasc Surg. 2006; 132: 747-752Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,10del Nido P.J. Technological innovation in cardiothoracic surgery: a pragmatist's approach.J Thorac Cardiovasc Surg. 2015; 150: 755-761Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar,11Coselli J.S. Competition: perspiration to inspiration “Aut inveniam viam aut faciam.”.J Thorac Cardiovasc Surg. 2016; 152: 1215-1222Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar;•“A lot of master surgeons never went to ‘work,’ instead they went to do something they enjoyed”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar; and•“Find spirituality, which helps navigate difficult decisions and find hope and work with great, like-minded people.”12Kron I.L. Surgical mentorship.J Thorac Cardiovasc Surg. 2011; 142: 489-492Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar Several former AATS presidents touched on the qualities that define a leader2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar:•“If you expect certain things out of the people who work under you, you have to be willing to excel and lead the way”;•Leadership is something you emanate “somewhat with your brain… and somewhat with your hands, but mostly…with your heart”; and•True leadership takes work and practice to hone. In transitioning to chief executive officer, Cosgrove said, “I worked like hell for a while just trying to figure it out.” Many reflected on the leadership qualities of their predecessors. A theme that consistently emerged was gratitude toward mentors who displayed an ability and willingness to serve others. Cohn2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar recalled the story of “Dr Shumway's favorite expression [being] that he was the ‘world's best first assistant,’” which helped develop a culture of teaching under his leadership. del Nido2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar was reminded of the example that Dr Sabiston set for the department by always giving him the time of day even when he was extremely busy. He states that although they seem like minor gestures, they are critically important and “not really minor to the young individuals who want to get involved.” Patterson2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar describes Dr Pearson as the most academically generous person he has ever known, for whom “the success of his residents and colleagues was most important.” Lastly, Casteneda2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar describes leadership in its ultimate form: measuring one's legacy not by how much he or she accomplished, but rather by how much he or she helped others accomplish. He shares proudly that “there are 43 chiefs of pediatric cardiac surgery in the world right now that trained with us, an accomplishment that is perhaps most gratifying as an academic teacher.” In this model, leadership replaces ego. There is no fear of hiring those who are smarter than oneself because a true leader hopes that his successor will surpass him. At the level of the department, this means that a leader is responsible for supporting his or her juniors' careers and rewarding individuals fairly for their contributions. A leader helps individuals believe that they are vitally important to the entire operation:•“It is not the chief alone but rather the team that will create a vibrant clinical program”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar;•There should not be a penalty for sharing the case load, “which facilitates treating patients in a timely fashion and facilitates individuals developing special surgical [or other] interests, such as going to the laboratory or doing administrative work”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar;•Taking responsibility “for both successful and failed endeavors” shows you have their back, which makes them more likely to go along with the leader's decision3Cohn L.H. What the cardiothoracic surgeon of the twenty-first century ought to be.J Thorac Cardiovasc Surg. 1999; 118: 581-587Abstract Full Text Full Text PDF Scopus (14) Google Scholar;•“Everything else flows from surround[ing] yourself with colleagues that are outstanding and help[ing] them get what they need to create an environment where you all can be successful”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar;•“If we can lead the way toward solutions in a manner that places the patients' best interests foremost and is not considered as professional self-interest, we can do much to restore our relationship with the public and restore professionalism to our profession”13Wallace R.B. Reflections—projections!.J Thorac Cardiovasc Surg. 1995; 110: 1287-1290Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar; and•“Not everybody [needs to] be a triple-threat—instead, the division has to be a triple-threat.”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar Another quality consistent with promoting others is having a vision and tenaciously working toward making the vision a reality. Ochsner2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar reflected on his time with Dr Debakey, a leader who epitomized this concept, “who wanted perfection, and wanted you to do everything that he could do.” Sometimes this means taking risks, instead of blindly following bottom-lines or quality measures.14David T.E. For everything there is a season.J Thorac Cardiovasc Surg. 2005; 130: 961-965Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar In the words of Spray,2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar “If surgeons hadn't been willing to take risks, many of the congenital heart operations that are commonplace today never would have happened.” Having a vision is a good first step, but it is insufficient to stop there. A leader must clearly communicate a plan and follow through. Cosgrove did this quite literally by performing live broadcasts of minimally invasive procedures, which simultaneously educated the public on the new frontiers in CTS and promoted his institutional vision.2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar Smith recalled a lesson Dr Reemtsma taught him when he first joined the faculty.2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar Not only did he encourage his team to be creative and bold, “he wanted the world to know that we were the first to do something new” through publications.2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar The world is not going to magically discover your work—be proactive by writing and speaking up at meetings. Finally, leaders must be open to seeking out diverse ideas and models. Many of the past presidents spent a substantial amount of time learning at other institutions, either during or after their training, which significantly influenced the course of their careers9Gardner T.J. Presidential address: our heritage and our future.J Thorac Cardiovasc Surg. 2002; 124: 649-654Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar,14David T.E. For everything there is a season.J Thorac Cardiovasc Surg. 2005; 130: 961-965Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar:•“A surgeon was performing an upper lobectomy on a young woman… The surgeon had injected Novocaine… but used no anesthesia other than an acupuncture needle… she got up off the operating table and walked back to her room. It was just incredible”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar;•“Even when you've trained in an excellent program for several years with great mentors, it is still very helpful for young surgeons to see other programs, other great surgeons, and just observe”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar; and•“[If I] ever got to be a chief or chairman and could build [my] own department it would be built from representatives of the best programs around the country so that we would have several different ways.”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar There was consensus among many former AATS presidents that the future of CTS remains positive, perhaps now more than ever. There have been moments in history when the outlook of CTS was shrouded in pessimism.•“Surgery of the heart has probably reached the limits set by Nature to all surgery…”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar;•“Any surgeon who would attempt an operation on the heart should lose the respect of his colleagues”5Cooper J. Presidential address 2003.J Thorac Cardiovasc Surg. 2006; 132: 747-752Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar;•As new technologies have revolutionized our surgical treatment of CT diseases, there has been frequent doom-saying about “…no more TB surgery…no more CABG, then percutaneous valves”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar; and•“There has been a lot of skepticism about what has happened to surgical practice, including the bureaucracy that surrounds it, the automation that has crept its way in and concerns about economics.”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar Despite these predictions, the field has continued to thrive. To many, the practice of CTS remains profoundly rewarding and fulfilling because of the nature of the work and the backdrop of constant innovation.15Cosgrove D.M. The innovation imperative.J Thorac Cardiovasc Surg. 2000; 120: 839-842Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Cooper5Cooper J. Presidential address 2003.J Thorac Cardiovasc Surg. 2006; 132: 747-752Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar said it best: “It is a privilege and a responsibility to be a CT surgeon at this point in history. We have at our disposal unprecedented resources that empower us as never before to perform miracles for our patients.” Also, according to Schaff2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar there is increasing demand for CTS surgeons, “not only because of retirement…but the aging population that makes up the bulk of our patients.” At the other end of the spectrum, congenital heart surgery remains ripe for innovation because many current procedures are palliative rather than curative. In the words of del Nido,2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar this is the beginning of the “incremental stage of improving upon what the pioneers developed.” In fact, according to Spray,2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar “the biggest challenge will be to determine how we are going to deal with our success… we have created a very large population of adults [who would have otherwise died] who present a whole new set of therapies and…research opportunities.” In short, as Coselli stated,2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar “Our better days are ahead of us.” The challenges of the future will require innovative mindsets.16Lytle B.W. Who are we—who will we be?.J Thorac Cardiovasc Surg. 2008; 135: 965-975Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar In his presidential address, David5Cooper J. Presidential address 2003.J Thorac Cardiovasc Surg. 2006; 132: 747-752Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar shared, “Life is a dynamic process and the only certainty is change… Change is inevitable and is even desirable” because it implies progress and better outcomes. “Will thoracic surgery survive when the very operations we perform are being replaced by less invasive techniques practiced by other specialties?” asked Cosgrove.15Cosgrove D.M. The innovation imperative.J Thorac Cardiovasc Surg. 2000; 120: 839-842Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar “The answer is ‘yes’ if we are willing to innovate and change.”15Cosgrove D.M. The innovation imperative.J Thorac Cardiovasc Surg. 2000; 120: 839-842Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Gardner9Gardner T.J. Presidential address: our heritage and our future.J Thorac Cardiovasc Surg. 2002; 124: 649-654Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar stated, “If there is not the precise opportunity that you envisioned for yourself, make it happen at the next best place,” because some of the most valuable opportunities are unpredictable. Furthermore, as beneficiaries of a rich tradition, we must embrace our obligation “to attract, motivate, and mentor the next generation of CT surgeons.”5Cooper J. Presidential address 2003.J Thorac Cardiovasc Surg. 2006; 132: 747-752Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar There has been a decrease in the number of applicants and a contraction in CTS training programs recently, which has led to an increase in the average age of practicing surgeons. Crawford predicted a shortage of CTS specialists around 2020.2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar To inspire aspiring surgeons early on, the AATS presidents suggest that we2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar:•Continue to champion the academic mission, prioritizing excellent teaching and ensuring that new entrants receive the best possible training;•“…Show them how much we love doing what we do. Show them how much we enjoy taking care of patients, show them our dedication, and show them the positive impact we can have on our patients”; and•“Figure out a way to make the 50% of bright young medical students, who happen to be women, interested in thoracic surgery.” Our standards, however, should not change. The reason to join the ranks of CTS are not because it is “…a safe, stable field” or a safe harbor, said Smith.2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar Instead, future aspiring surgeons can glimpse the vision of something to aspire to throughout their lifelong commitment to the field, “…something exciting… making it a challenge that is worth overcoming… and a sense that every stitch mattered.”2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar Cox2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar invoked John F. Kennedy: “We choose to go to the Moon and do the other things not because they are easy but because they are hard.” Every aspect of a CTS specialist's career stems from his or her patients. As young surgeons, it is easy to view humanism or ethics as “soft” or “gray” areas of patient care. But on further reflection, we began to notice how powerful some of these humanistic elements can be among the surgeons at our institution. When they round on their patients every single day, including weekends, or make telephone calls from home to check on patients even late in the evening, we take note and aim to emulate them in our own careers. It was also profound to reflect on the notion of always remembering the sanctity and the privilege of patient care. It was evident these surgeons went on to accomplish monumental feats at a national level because of—not despite—their unwavering commitment to patient care. Although we are often pulled in many directions by competing duties as residents, their words help us remember that patients should remain the true center in CTS. Our own involvement in bedside patient and family counseling has evolved significantly as we have observed the limitless potential for expressing empathy and bridging communication. We have made a habit of rounding on patients multiple times in a day, even when it goes beyond our clinical duties, because doing so has rendered our work in the operating room more meaningful. Some of us now routinely sit down with patients and their families to go over the operation plan, including illustrations and other multimedia to aid in their understanding. We now make every effort to be present for some of our patients' most challenging experiences, such as end-of-life conversations and breaking bad news, recognizing that the captain of the ship analogy applies to all patient care, even out of the operating room. We derive inspiration and motivation for both technical and scholarly excellence from our patients. We practice technical skills at home to take better care of patients, and to find meaningful research questions, not just from the literature, but also out of genuine desire to help those in our care. This has also rendered our scholarly activities more personal and meaningful. To learn to take care of oneself is ultimately to learn to take better care of one's patients. With regard to balance, it was enlightening to read their words because the topic is seldom discussed among cardiothoracic surgeons at work. The reality is that as young surgeons we are simultaneously transitioning into cardiothoracic surgeons and into adults. Many of us began our program as individuals singularly focused on training, yet we may emerge at the end as a partner or a father who is also a surgeon. We may experience profound losses or changes. Therefore, we will inevitably experience the struggle to find balance between work and life/family as they compete for our limited time and energy. In a sense, it is reassuring to learn from our mentors that they have been able to be successful in their careers despite closely holding onto the values of family and balance. At the same time, it is humbling to hear that finding balance is far from easy, often leading to feelings of guilt or of being inadequate in either setting. We believe that embracing the tension and creating coping mechanisms early on in our training instead of postponing dealing with these issues until they become significant is prudent. Ultimately, we can only take care of patients as humane surgeons if we protect our own humanity deliberately. True leadership elevates others. With regard to leadership, advice by from Casteneda2Moon M.R. In the Words of the Presidents. American Association for Thoracic Surgery, Beverly, MA2017Google Scholar is particularly salient to all young surgeons: one's legacy is measured not by one's own accomplishments but rather by what one has helped others accomplish. This is a metric that young surgeons are often oblivious to because much of one's early professional aspirations consist of enlarging one's own repertoire of skills and accomplishments. For us, this has translated into regular informal orientations and simulation meetings among residents, where upper-level residents offer their juniors salient advice and teach operative techniques before beginning new rotations. Additionally, the former AATS presidents remind us that leadership is something to deliberately practice, like other surgical skills. Take the initiative to reach out to help others and build sustainable, mutually beneficial relationships with colleagues. At our program, we maintain a culture of sharing ideas instead of guarding against each other out of competition. We are actively trying to dispel notions of tit-for-tat while maintaining a healthy competitive spirit. The group's success supersedes that of any individual's success. Embrace technology. A defining characteristic of this field is continuous evolution, defined by the rapid implementation of transcatheter technologies, which may seem disorienting or bleak to young surgeons. We are caught within a transition within a transition because we must acclimate to the demands of residency, yet navigate the evolving landscape of surgical and interventional techniques.17Han J.J. Brown C. Swain J.D. Surgical training in an era of change and innovation.J Am Coll Cardiol. 2019; 74: 814-817Crossref PubMed Scopus (4) Google Scholar These optimistic passages from mentors who not only survived, but also thrived, through changes that seemingly threatened the future of our field—such as the emergence of percutaneous coronary interventions—reminds us that the future of CTS remains bright. We take to heart what the mentors prescribe as the necessary characteristic for success in this time of change: adaptability. To lead the evolution, we must remain abreast of the newest technologies and forge partnerships with other, multidisciplinary fields. The surgeons-in-training at our institution actively establish working relationships with fellows from other disciplines—such as interventional cardiology and heart failure—early on in our training by rotating through these services. We participate in weekly multidisciplinary conferences to discuss patient scenarios and also are in the process of establishing heart team research meetings. Lastly, having been inspired by these mentors to pursue the field of CTS, we are heavily engaged in the recruitment process to continue to recruit the best and the brightest into this vibrant field. We agree wholeheartedly that we have to actively reach out to aspiring surgeons as early as the first year of medical school and even during undergraduate years and show them how much we love doing what we do. Specifically, we have decided to utilize social media platforms for identifying these students and to that end created a Twitter account with more than 900 followers to date. We hope to engage these aspiring CTS specialists in the future by continuing to share inspiring and educational materials as well as provide an avenue through which we can converse with this group on their needs, concerns, and ideas. We are also dedicated to compiling and sharing important, timely advice for this community.18Smood B. Nguyen S.N. Kelly J.J. Han J.J. Integrated cardiothoracic surgery: developing a successful residency application.J Thorac Cardiovasc Surg. October 16, 2019; ([Epub ahead of print])Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Training in CTS is a technically demanding experience that also requires constant reflection and introspection. We have highlighted 8 major themes from the words of past and present leaders in the field of CTS that emerged as particularly salient topics for young surgeons to ponder during early development. The wisdom shared by past and current leaders in the field about their fascinating and influential careers can be formative during training, and certainly ought to have an important place in our education.