Cardiac surgery is changing, new catheter based technology, minimally invasive and robotic coronary artery bypass grafting (CABG) and mitral valve surgery, expanding surgical treatment of heart failure with mechanical support and stem cell transplantation and percutaneous aortic valve and mitral valve surgery are just some of the future endeavours in cardiac surgery. Training in cardiac surgery during these times is difficult. Trying to decide on the direction of one's training is not easy, gone are the times when an extra year in off-pump CABG was all that was needed to obtain a job in cardiac surgery. Not only are there a paucity of jobs these days but the amount of basic training and extra subspecialty training the current trainees have to do is enormous. With the cardiac surgery specialty changing so much residency training must change in parallel. It is with the following that I think cardiac surgery training in Canada is excellent. Years ago Canada began to train cardiac surgeons directly out of medical school, with two years of core general surgery training followed by focused training in cardiac surgery and its related subspecialties, like vascular surgery, thoracic surgery and pediatric cardiac surgery. This allowed the time for basic training to be completed in a shorter amount of time. It is with this in mind that many cardiac surgery programs in the USA are adopting a similar approach. This change was driven by the fact that it is not appropriate anymore to train cardio-vascular-thoracic surgeons. There is so much to learn that each division has branched out into its own entity. In my opinion the focused training in basic cardiac surgery and with it the earlier introduction of the trainees to the technical aspects of the specialty is the first strength of the cardiac surgery residency training in Canada. The next change I believe will be training in a division of cardiac sciences. This would be the close partnership between cardiac surgery and cardiology. Cardiac surgery training in Canada is already adopting this idea in the fact that in Canada cardiac surgery residents already perform 9 months of cardiology rotations, including, general cardiology, coronary care unit, electrophysiology, diagnostic interventional cardiology, interventional cardiology, echocardiography and heart failure rotations. This has grown in the last 3-4 years with the realization that bridging the gap between cardiologist and cardiac surgeons will only enhance both...


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