New UK research has addressed some of the biggest challenges for doctors in training.
Conducted by the cardiac surgery department at a UK hospital, the study supports the safety of supervised, resident doctor-led operations in adult cardiac surgery.
The 10-year, propensity-matched analyses have both been published in the European Journal of Cardio-Thoracic Surgery (EJCTS) and were featured at the European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting in Copenhagen in October 2025.
Dr Ujjawal Kumar, who led this work as an aspiring cardiothoracic surgeon at Royal Papworth Hospital NHS Foundation Trust, said: ‘Cardiac surgical training faces significant challenges. There are many contributing factors, including reduced volumes of surgical operations, partly driven by increased transcatheter interventions (for example, TAVI for aortic valve stenosis), increasingly complex cases, a patient population with more comorbidities, and shorter mandated training programmes.
‘Previously, cardiac surgical residents’ training lasted more than 10 years. With the national standardisation of training curricula, this became eight years, and now seven years as of the 2021 curriculum.
‘Then there is the European Working Time Directive, which is a good thing to prevent fatigue and burnout, but it does have an impact on exposure to surgery. In the past, surgical residents would work far longer hours and spend far more time in the hospital per week than they do today. This all contributes to a reduction in the amount of surgical training for resident doctors.’
The first study is the world’s largest and most comprehensive primary research study investigating patient outcomes in resident-led adult cardiac surgery.
It explains that cardiac surgery departments must balance training surgeons of the future without compromising patient safety.
This study assessed the impact of resident-led operating on outcomes in some of the most common adult cardiac surgical procedures (isolated coronary artery bypass grafts, isolated aortic valve replacement, and the two combined) between 2015 and 2024.
It demonstrated that resident-led cases had in-hospital mortality, postoperative complications, and long-term survival comparable to those of consultant-led cases.
Mr Shakil Farid, consultant cardiac and aortic surgeon, and East of England regional cardiothoracic surgical training programme director, said: ‘It is worth noting that even when a resident doctor is “leading” the surgery, the consultant is ultimately always in charge and responsible for the patient’s care.
‘The consultant is usually directly supervising, standing next to the resident, providing feedback and ready to step in at any point if patient safety is a concern. However, having the resident perform the operation has a significant and positive impact on their training. There is nothing quite like hands-on training in a real-life scenario when it comes to cardiothoracic surgery.’
The second study is the first in the world to focus exclusively on resident doctors and emergency cardiac surgery. It showed equivalent in-hospital mortality, major complications, and long-term survival up to 10 years between resident-led and consultant-led cases.
Mr Farid said: ‘These findings support supervised exposure to emergency cardiac surgery with progressive autonomy, ensuring patient safety while at the same time preparing resident doctors for independent practice. We have to provide training in a targeted way due to reduced training time.’
By the time they have completed training, residents typically achieve some of the highest case numbers across the UK, with a particularly wide variety, including more complex cases than are usually expected of residents completing training.
