Abstract
In the United States, training paradigms for cardiothoracic (CT) surgery have evolved over the past two decades. Currently, two main training pathways exist: the traditional pathway of general surgery residency followed by fellowship training and the integrated (I-6) model, a direct-entry residency emphasizing early specialization. Similar pathways exist internationally. This paper reviews the two training paradigms in terms of length, breadth, mentorship, and satisfaction among trainees. While both pathways produce capable practitioners, they possess different strengths. Today's training paradigms reflect the evolving landscape of CT surgery and thus define the identity of the modern CT surgeon.