Objective(s): Trainee assessments aim to identify areas for improvement and address problems within training programs. However, effectiveness is limited by an inability to assess programs anonymously. We hypothesized concern for undesired repercussions may discourage honest responses. To test this, we conducted a comprehensive survey of trainees to assess their educational and work-related experiences anonymously.  Design: A 51-question survey was distributed electronically to the Thoracic Surgery Residents Association (TSRA) membership. Questions were multiple-choice. The Likert scale was utilized.  Setting: The survey was accessed electronically and was completed by participants nationwide. Participants: Trainees were incentivized to complete the survey with the opportunity to receive a $50 gift card or TSRA textbook. 109 of 551 cardiothoracic surgery trainees completed the survey. Results: 109 trainees (109/551, 19.8%) completed the survey. 57.8% of respondents reported complying with work hour restrictions, but 32.2% (n=35) did not feel comfortable reporting violations honestly. The majority of respondents agreed or strongly agreed that their program was preparing them to independently perform low risk cardiac (4.19 [1.22]) and thoracic (4.08 [1.13]) cases independently, 30.3% of chief residents reported planning to pursue additional training. 66% of respondents stated they would select the same program again. 33% reported having high morale, 47.7% moderate and 19.3% poor or declining morale. 84.4% of respondents did not feel their race or gender significantly impacted their training, 26.6% reported systemic bias in recruitment of new trainees or faculty, and 38.5% believed there was inadequate diversity among faculty and trainees. 30.3% reported experiencing verbal or physical harassment by an attending or fellow (14.7%).  Conclusions: Despite reporting an overall positive operative experience, a significant number of trainees plan to pursue additional training. The survey identifies important areas for attention including underreporting of issues related to diversity, as well as verbal and physical harassment by fellows and attendings.

Background and Aim: The P2Y12 platelet receptor inhibitor ticagrelor is widely used in patients following acute coronary syndromes or in those who have received coronary stents. Bentracimab is a monoclonal antibody-based reversal agent that is being formally evaluated in a Phase 3 clinical trial. Here, we probe the knowledge, attitudes, and practice patterns of cardiac surgeons regarding their perioperative management of ticagrelor and potential application of a ticagrelor reversal agent. Methods: A questionnaire was developed by a working group of cardiac surgeons to inquire into participants’ practices and beliefs regarding ticagrelor and disseminated to practicing Canadian cardiac surgeons. Results: A total of 70 Canadian cardiac surgeons participated. Bleeding risk was identified as the most significant consideration when surgically revascularizing ticagrelor-treated patients (90%). There is variability in the duration of withholding ticagrelor prior to coronary artery bypass graft procedure in a stable patient; 44.3% wait 3 days and 32.9% wait 4 days or longer. Currently, 14.3% of cardiac surgeons prophylactically give platelet transfusions and/or fresh frozen plasma intraoperatively following protamine infusion in patients who have recently received ticagrelor. Interestingly, 47.1% of surveyed surgeons were aware of a reversal agent for ticagrelor, 91.4% of cardiac surgeons would consider utilizing a ticagrelor reversal agent if available, and 51.4% acknowledged that the introduction of such an agent would be a major advance in clinical practice. Conclusions: The present survey identified ticagrelor-related bleeding as a major concern for cardiac surgeons. Surgeons recognized the significant unmet need that a ticagrelor reversal agent would address.