CHAPTER 5

The Society of Thoracic Surgeons and the Thoracic Surgery Foundation for Research and Education John R. Benfield, MD David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California

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he Thoracic Surgery Foundation for Research and Education (TSFRE) was created to help perpetuate the pioneering cardiothoracic surgical tradition, highlighted by Dr Evarts A. Graham’s first successful pneumonectomy for lung cancer on April 4, 1932, Dr Robert A. Gross’ division of a patent ductus arteriosus in 1938, the first Blalock-Taussig shunt operation on November 29, 1944, and Dr Clarence Crafoord’s successful correction of coarctation of the aorta [1–4]. When Dr John H. Gibbons, Jr, successfully used cardiopulmonary bypass on May 6, 1953, it was the result of research started 23 years before to address an insoluble problem he had seen at the bedside [5]. Now, heart valve repairs and replacements and heart-lung transplants are regularly successful, and cardiothoracic surgeons are studying such things as genomics, molecular biology, and tissue engineering. How can we perpetuate this tradition? In the 1980s, Martin F. McKneally, MD, and others noted that “following a period of leadership and innovation . . . cardiothoracic surgeons had become more practice centered [and] . . . the emphasis had shifted away from science” [6]. He pointed out the need and proposed a research and education foundation to The Society of Thoracic Surgeons (STS) Council on June 4, 1984. However, little happened until 1988, when he and Dr Robert L. Replogle approached David S. Sheridan [7], a good friend of Ralph D. Alley, MD. Dave, as Sheridan preferred to be called, responded with a grant of $50,000 and a commitment for $1 million to honor Dr Alley, who had suffered a series of strokes. This crucial donation paved the way for incorporation of the STS Education and Research Foundation in Illinois on December 23, 1988. Loving consideration of the name “Ralph Alley Foundation” was outweighed by vision. On October 25, 1989, Dr Replogle, the fledging group’s first president and one of Dr Alley’s strongest admirers, wrote to Dr Robert G. Ellison, saying that the foundation’s name needed to express “a wider and more long-range objective.” On March 2, 1992, the organization, previously known as “The Foundation,” became self-sustaining, and the name was changed to the Thoracic Surgery Foundation for Research and Education. Administrative management services were provided by Smith, Bucklin and Associates until October 1, 2002. Thereafter,

Address correspondence to Dr Benfield, David Geffen School of Medicine at UCLA, 11611 Terryhill Pl, Los Angeles, CA 90049; e-mail: j.benfield@ ucla.edu.

Ó 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc

management services were provided by Professional Relations and Research Institute (PRRI) until February 1, 2012, when STS began to provide management services for TSFRE. The first Ralph D. Alley Lecture was presented at the STS 27th Annual Meeting in 1991. In the lecture, titled “The Future of American Thoracic Surgery,” Harry Schwartz, PhD, predicted much of what has happened and continues to happen in United States health care funding [8] and articulated a foundation for TSFRE’s public policy education program. The Foundation’s first Board of Directors (Table 1) envisioned that “surgeons educated in these programs will be able to serve as resources to the professional thoracic organizations, the government, and the community at large throughout their careers” [7]. In 1991, the STS Council authorized and encouraged Dr Harold V. Liddle, the second Foundation President, to invite the American Association for Thoracic Surgery (AATS), the Southern Thoracic Surgical Association (STSA), and the Western Thoracic Surgical Association (WTSA) to become sponsors of the Foundation. Each group joined, and on January 1, 1993, the TSFRE Board of Directors was expanded from 6 to 9 members, including representatives from AATS, STS, STSA, WTSA, and a lay member. The united support of four sponsors added strength to TSFRE by attracting funds from industry and additional leadership. For example, in 1994, Baxter Healthcare Corporation donated a $1 million unrestricted grant to celebrate the implantation of the one-millionth prosthetic valve. To convert the vision for an education program into reality was a challenge. In 1994, Dr Harold D. Urschel, Jr, introduced Drs McKneally and John E. Mayer, Jr, to Albert Carnesale, PhD, the Acting President of Harvard and Dean of its John F. Kennedy School of Government. Dr Carnesale said that Harvard was neither accustomed to nor disposed toward custom-made interdisciplinary programs. However, the reality that TSFRE had the capital to do what Drs McKneally and Mayer proposed resulted in the 1996 launch of the Kennedy School’s Executive Health Care Management Course. Dr Jack Matloff, then Chair of the STS/AATS Government Relations Committee, worked tirelessly and effectively with Dr Miles Shore at Harvard to create the substance of the program. Dr Paul Uhlig was the first TSFRE recipient of an Alley-Sheridan Scholarship, which allowed him to take a year-long sabbatical and earn a masters degree in Ann Thorac Surg 2014;97:S22–S24  0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2013.10.003

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Table 1. First Foundation Board of Directors—1989 Robert L. Replogle, MD, President Walter G. Purcell, Business Manager Martin F. McKneally, MD Harold V. Liddle, MD W. Gerald Rainer, MD Harold C. Urschel, Jr, MD

public administration that led to his current faculty appointment in preventive medicine and public health at the University of Kansas. Dr Uhlig later provided outstanding leadership to TSFRE’s Education Committee when it was decided to also fund education programs in the realms of simulation methodology, patient safety, and the education of interdisciplinary (hybrid) surgeons. Dr John Kirklin played a pivotal role by attracting a gift of $325,000 from Eugene Braunwald, MD, to honor his wife, Dr Nina Starr Braunwald, the first woman certified by the American Board of Thoracic Surgery. The Nina Starr Braunwald Fund later was enlarged to more than $1 million. Jennifer Walker, MD, became the first Nina Braunwald Scholar. Currently, awards of up to $40,000 per year for up to 2 years are made annually to support the work of a female cardiac surgeon early in her career. By 2011, 18 women had received Braunwald awards and 4 have progressed to National Institutes of Health (NIH) funding [9]. In addition to the Braunwald Scholarships, TSFRE has formed a valuable partnership with the National Heart, Lung, and Blood Institute (NHLBI) and the National Cancer Institute to match KO8 and K23 awards. Since 2001, 17 awards have been funded, providing up to $150,000 per year ($75,000 from TSFRE and $75,000 from NHLBI) to support 3-year, 4-year, or 5-year periods of didactic training and supervised research. All of these recipients are now funded by NIH [9]. TSFRE also has funded 40 Research Fellowship Awards, each for 2 years at $30,000 per year. These awards support cardiothoracic surgery residents who have not completed their training and are actively engaged in research. In 2012, TSFRE awarded $317,500 in fellowships, grants, awards, and scholarships to 13 surgeons. Projects included “Isolated Left Ventricular Restraint Therapy for Heart Failure” and “MicroRNA Profiling to Predict Recurrence after Resection of Early Lung Cancer.” Of those who receive the research fellowship awards, 96% practice in academic institutions, and nearly 50% have faculty appointments [9]. TSFRE has provided Research Grants for 34 individuals since 1995. These grants of $40,000 per year for up to 2 years support original research by cardiothoracic surgeons who have completed their formal education and are seeking initial support and recognition of their research program. More than 70% of these award recipients are assistant or associate professors, and 70% have their own laboratories [9]. Simulation has become an important tool for resident education. In 2009 simulation methodology was

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the first of three subjects recommended for TSFRE funding by a special committee that included broad representation of cardiothoracic surgery practitioners. Led by Dr A.J. Carpenter, who then headed the TSFRE Education Committee, a workshop on simulation methodology was conducted. Since 2009, TSFRE has supported 17 proposals for simulation projects totaling $250,000. As of 2011, TSFRE had awarded 107 grants, totaling more than $9.4 million [9]. To determine the effectiveness of these grants, Dr David Jones and three Past Presidents of TSFRE (Table 2) surveyed the 107 recipients to determine the effect of these grants on their careers [9]. They found that 88% reported that TSFRE funding was critical to launching their research careers. An overwhelming number (88%) planned to apply to NIH for future funding, and 58% had already successfully secured additional NIH funding. Forty-four percent of the cosponsored NIH/ TSFRE K awardees have R01 funding today. Now, 25 years after the Foundation was established, TSFRE has unequivocally been successful in fostering academic careers. It has been able to sustain interest in the discipline of cardiothoracic surgery—80% of general surgery residents funded have pursued a career in cardiothoracic surgery—and helped produce the next generation of extramurally funded cardiothoracic surgeon–scientists. A vigorous, ambitious, well-funded foundation fills an important role for our specialty. After weathering the difficult economic downturn in the United States, TSFRE took a critical look at its mission and strategic plan. That process pointed the organization in the right direction financially so that it can continue its important mission for our specialty. Operating expenses have been substantially reduced, and the supporting organizations (STS, AATS, WTSA, STSA) have increased their support to allow continued operation and support of the research grants, scholarships, and K awards. The overall goal is to ensure that the vast majority of contributions go directly to support research and education awards. An ambitious fundraising program has been developed to put TSFRE on a solid financial footing. These efforts include expanded membership contributions, a more proactive approach to estate planning gifts, outreach to corporate donors, and initiatives like the Past President’s Fund. The success of these efforts will ensure the viability of TSFRE for years to come. Dr Alley was and is honored. Table 2. Foundation and TSFRE Presidents 1989–1991 1991–1995 1995–1998 1998–2001 2001–2003 2003–2006 2006–2009 2009–2011 2011–

Robert L. Replogle, MD, Chicago, Illinois Harold V. Liddle, MD, Salt Lake City, Utah Martin F. McKneally, MD, Albany, New York Robert B. Wallace, MD, Washington, DC David B. Skinner, MD, New York, New York John R. Benfield, MD, Los Angeles, California Lawrence H. Cohn, MD, Boston, Massachusetts Michael J. Mack, MD, Dallas, Texas G. Alexander Patterson, MD, St. Louis, Missouri

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Priscilla S. Kennedy Executive Director of TSFRE, and the current leadership of TSFRE contributed to this chapter.

References 1. Graham EA, Singer JJ. Successful removal of an entire lung for carcinoma of the bronchus. JAMA 1933;101:1371–4. 2. Gross RE. Complete surgical division of the patent ductus arteriosus—a report of fourteen successful cases. Surg Gynecol Obst 1944;78:36–42. 3. Blalock A, Taussig HB. The surgical treatment of malformations of the heart. JAMA 1945;128:189–202.

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4. Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg 1945;14:347–61. 5. Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 1954;37:171–85. 6. McKneally MF. The Thoracic Surgery Foundation for Research and Education. Semin Thorac Cardiovasc Surg 1998;10:181–5. 7. Heinz WC, Sheridan DS. Inventor: the Dave Sheridan story. Albany, NY: The Albany Medical Center; 1988. 8. Schwartz H. The future of American thoracic surgery. Ann Thorac Surg 1991;52:1039–43. 9. Jones DR, Mack MJ, Patterson GA, Cohn LH. A positive return on investment: research funding by the Thoracic Surgery Foundation for Research and Education (TSFRE). J Thorac Cardiovasc Surg 2011;141:1103–6.

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