To fail one is to fail us all

The authors reported no conflicts of interest.The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest.Peer Review of this Letter was handled by Associate Editor Stephen C. Yang. The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. Peer Review of this Letter was handled by Associate Editor Stephen C. Yang. We read with great interest the excellent expert opinion piece by Pasque.1Pasque M.K. Getting the most from your cardiothoracic surgical training: it's all about behavior.J Thorac Cardiovasc Surg. Jul 2, 2021; ([Epub ahead of print])https://doi.org/10.1016/j.jtcvs.2021.06.054Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar He touches on how trainees can optimize and make the most of their training in cardiothoracic surgery. In cardiac surgery training, the days may feel long, but certainly the years are short. Dr Pasque's advice is certain to be welcomed by senior-level trainees. We need to run toward the hard cases; be kind to our nonsurgeon colleagues; and, above all, take care of our fellow trainees. Pasque1Pasque M.K. Getting the most from your cardiothoracic surgical training: it's all about behavior.J Thorac Cardiovasc Surg. Jul 2, 2021; ([Epub ahead of print])https://doi.org/10.1016/j.jtcvs.2021.06.054Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar dedicates an entire section of his article to the topic of trainees as lightning rods for poor surgeon behavior in the operating room. In response to this section, Mohan and Okereke2Mohan N. Okereke I. Commentary: the behavior of leaders.J Thorac Cardiovasc Surg. July 6, 2021; ([Epub ahead of print])Abstract Full Text Full Text PDF Scopus (2) Google Scholar expand on how this poor surgeon behavior is unacceptable and that silence is not the best response. However, Pasque1Pasque M.K. Getting the most from your cardiothoracic surgical training: it's all about behavior.J Thorac Cardiovasc Surg. Jul 2, 2021; ([Epub ahead of print])https://doi.org/10.1016/j.jtcvs.2021.06.054Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar argues that silence may be the preferred solution in the operating room and that channels outside the operating room should be pursued. Herein, we expand on these other channels and the unique role of senior trainees in advocating for their fellow resident physicians. Cardiac surgery training programs are often small compared with other surgery training programs. Trainees may fear that reporting inappropriate behavior or actions by staff surgeons may lead to repercussions or being labeled a complainer. This is particularly worrisome in the small world of our specialty where a negative reputation in the eyes of supervisors might compromise a future career. We recently had a situation wherein a trainee was treated unfairly and inappropriately in an operating room. This was reported to the resident representative members of the residency program committee. The immediate actions were to support the affected resident and ensure that the individual continued to have a safe environment in which to train. The second step was to personally contact each resident member of the program to determine whether or not others had observed similar behavior by the same surgeon or other surgeons. Anonymity and confidentiality was assured. Ultimately, it was up to the individual resident to decide whether or not to escalate the issue. In the end, the issue went to the highest level of leadership within our division, which responded with unwavering support to resolve this issue. The surgeon in question had no idea the behavior in question was perceived as harmful and immediately apologized and promised to do better. We received assurance from multiple levels of leadership that this sort of behavior was completely inappropriate and that residents would be provided full support until resolution. All this is to say that trainees must support each other, recognizing that training is tough (as outlined by Pasque1Pasque M.K. Getting the most from your cardiothoracic surgical training: it's all about behavior.J Thorac Cardiovasc Surg. Jul 2, 2021; ([Epub ahead of print])https://doi.org/10.1016/j.jtcvs.2021.06.054Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar) and that no one knows better what you are going through than your peers. Senior-level trainees have a particularly important role in speaking up and advocating for their fellow trainees. Senior trainees have often spent the better part of a decade at their institution and likely developed individual reputations for integrity, honesty, and trustworthiness. As a senior member of the training program, your word has weight, and furthermore, you will likely be the first point of contact for your more junior colleagues. The failure to advocate for even 1 trainee will impact all other trainees in the program. Similarly, correcting unacceptable and inappropriate behavior will improve the lives of all trainees and make the program better for current and future members. We wholeheartedly agree with Pasque1Pasque M.K. Getting the most from your cardiothoracic surgical training: it's all about behavior.J Thorac Cardiovasc Surg. Jul 2, 2021; ([Epub ahead of print])https://doi.org/10.1016/j.jtcvs.2021.06.054Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar and Mohan and Okereke2Mohan N. Okereke I. Commentary: the behavior of leaders.J Thorac Cardiovasc Surg. July 6, 2021; ([Epub ahead of print])Abstract Full Text Full Text PDF Scopus (2) Google Scholar that silence is not an option and that speaking up is necessary to protect all trainees in these unfortunate situations. Getting the most from your cardiothoracic surgical training: It's all about behaviorThe Journal of Thoracic and Cardiovascular SurgeryPreviewThe 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). Full-Text PDF Reply: You are a leader as wellJTCVS OpenVol. 9PreviewWe read with enthusiasm the article by Tam and Rocha1 about available mechanisms to report abuse of trainees. They describe the resolution of a particular episode of abuse of a trainee at their institution. Ultimately, the problem was addressed appropriately and the offender was educated about harmful behavior in the operating room. We agree that dealing with inappropriate behavior requires tact and leadership. We would like to raise 2 important points in response to dealing with such situations. Full-Text PDF Open Access

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