The da Vinci dual-console system further enhances this experience, allowing a second console for residents or trainees to actively observe the procedure in 3D vision (Figure 1). As a result, this clinical observership provided an exceptional level of insight into surgical technique, intraoperative decision-making, and workflow.

The daily routine typically began with early morning rounds at approximately 6:30 AM, followed by operating room exposure on most days of the week. I was able to observe a high volume of cases and interact directly with the operating surgeon during procedures, which allowed for continuous discussion and clarification of technical aspects. Afternoons were usually dedicated either to additional cases or research activities. One day per week was spent in the outpatient clinic, providing further insight into perioperative patient management.

The structure of the elective allowed for a high degree of flexibility and personal responsibility. The extent of clinical and research exposure largely depended on individual initiative and motivation. While there were no requirements regarding working hours, the highly productive clinical and academic environment encouraged active participation and engagement. I was free to structure my day accordingly, which allowed me to maximize both surgical exposure and research output.

Integration into the team was very positive, with attendings and residents being approachable, supportive, and actively involved in teaching. In particular, Dr. Kaczorowksi, Residency Program Director, was very welcoming and enabled valuable insights into surgical training in the United States and close interaction with residents. This also enabled several research collaborations. In addition, structured educational activities were held weekly, including morbidity and mortality conferences, focused teaching sessions and simulation-based training. These sessions were extremely educational and contributed significantly to the overall learning experience.

Workplace and Clinical Elective Experience

The research component mainly focused on outcomes research after robotic coronary and mitral valve surgery. This involved working with a comprehensive database including all robotic cardiac surgery patients, performing data entry, and subsequently defining specific research projects. Due to the very productive research environment, it was possible to develop multiple manuscript drafts, which are currently in different stages of submission and publication. Through this work, I was able to contribute to, and in part also act as first author, on projects focusing on respiratory outcomes and chest tube management after robotic cardiac surgery, quality of life following robotic cardiac surgery, novel approaches such as robotic left ventricular assist device (LVAD) implantation, as well as several instructional videos and articles highlighting different techniques and technical aspects of robotic cardiac surgery.

In terms of clinical observation, I was able to observe all robotic cardiac surgery cases performed at UPMC during my stay. In total, this included more than 50 robotic cardiac surgery procedures, mainly robotic mitral valve surgery and robotic coronary surgery, including totally endoscopic coronary artery bypass grafting (TECAB). In addition, I was exposed to the broader spectrum of robotic cardiac surgery, including atrial septal defect closure, robotic tumor resection, tricuspid valve surgery, and surgery for endocarditis. Beyond robotic procedures, I also gained exposure to open cardiac surgery techniques such as cardiac transplantation, surgery for acute type A aortic dissection, and conventional valve and coronary surgery. In addition, I was able to observe minimally invasive and transcatheter approaches, including TAVR and TEVAR.