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Training Program
THORACIC SURGERY

Roles and Responsibilities
Thoracic Track
1st Year Cardiothoracic Surgery Resident
For ease of presentation, these goals will be grouped based-upon the core-competencies
  1. Medical Knowledge
    1. Anatomy, embryology, physiology and pathology of the pericardium, heart, great vessels, trachea, lungs, esophagus, and mediastinum.
    2. Intricate understanding of congenital cardiothoracic pathophysiology and the routine perinatal, intensive care, and peri-operative management of the conditions.
    3. The pharmacology, indications and complications of drugs commonly used in the specialty.
    4. The principles of preoperative assessment, anesthetic management, and postoperative management of cardiothoracic surgical patients.
    5. The natural history of treated and untreated cardiac surgical conditions, including ischemic heart disease and its complications, valvular heart disease, thoracic aortic disease, heart failure and transplantation of heart and lung, conduction system disturbances, pericardial disease.
    6. The natural history and progression of thoracic surgical diseases, including medistinal masses, lung masses, esophageal diseases (benign and malignant), thoracic infections, tracheal stenosis and masses, and penetrating thoracic injuries.
    7. Advanced surgical issues as they apply to the specialty, such as wound healing, hemostasis, electrolytes/fluid management, surgical nutrition, hyperalimentation, and ventilatory mangement.
    8. The technology, interpretation and complications of invasive and noninvasive diagnostic methods, including CT, PET and MRI scanning, cardiac catheterization, coronary angiography, and echocardiography.
    9. The physiology, technology, indications and complications of cardiac pacemakers and defibrillators.
    10. Principles and complications of extracorporeal circulation.
    11. Principles and complications of techniques for myocardial and cerebral protection.
  2. Clinical Skills
    1. Perform an appropriate relevant history and physical exam in the ward, ambulatory, and emergency department settings.
    2. Arrive at an appropriate differential diagnosis.
    3. Order appropriate laboratory, radiological, and other diagnostic procedures; demonstrate proper interpretation of the results.
    4. Arrive at an acceptable plan of management, demonstrating knowledge in the operative and non-operative management of the disease process.
    5. Manage the patient throughout the hospital stay, including management in an intensive care unit setting, demonstrating knowledge and ability to anticipate, recognize, and manage potential complications of the disease processes and operative procedures.
    6. Provide a plan for patient follow up.
    7. Management of cardio- and cerebral-protection; demonstrate appropriate understanding of methods and indications for cardioplegia strategies, cardiopulmonary bypass methods, and deep hypothermic circulatory arrest.
    8. Management of post-pneumonectomy syndrome, prolonged air-leak, esophageal anastomotic leak, and post-pulmonary resection respiratory failure.
    9. Management of post-operative bleeding (medical and surgical).
    10. Management of low-cardiac output syndrome (medical and surgical).
    11. Outpatient work-up and management of thoracic surgical patients.
    12. Troubleshooting pacemakers.
    13. Assessment and treatment of post-operative arrhythmias.
    14. Appropriate interpretation of intra-operative echocardiography and application to surgical plan.
    15. Identification of critically ill and major complications of patients on the ward with appropriate acute management.
  3. Patient Care
    1. As the operating surgeon or first assistant, demonstrate an ability to anticipate surgical maneuvers, to take direction well, to make reasonable suggestions, and to contribute to a positive operating room atmosphere.
    2. Perform sternotomy and cannulation in preparation for CPB.
    3. Independently harvest the left internal mammary artery.
    4. Perform anterolateral and muscle sparing thoracotomies.
    5. Perform minimally invasive thoracic techniques including: diagnostic thorascopy, lung biopsy, wedge resection, decortications, esophagectomy.
    6. Insertion and removal of intraaortic balloon pump.
    7. Insertion of central lines, PA catheter, arterial lines, chest tubes in the operative and ICU setting.
    8. Demonstrate ability to recognize errors in technique and possible consequences of specific technical mistakes.
    9. As the operating surgeon, demonstrate the ability to perform, with supervision: coronary artery bypass on cardiopulmonary bypass, aortic valve replacement, mitral valve replacement, mitral valve annuloplasty, and insertion of pacemaker.
    10. As the operating surgeon or first assistant, demonstrate the ability to perform patent ductus arteriosus and vascular sling repair, ASD and VSD repair.
    11. Demonstrate the ability to assist on complex congenital heart surgery including: hypoplastic left heart syndrome, tetralogy of fallot, truncus arteriousus, total anomalous pulmonary venous return, transposition of the great vessels.
    12. As the operating surgeon demonstrate the ability to perform pulmonary resections (lobectomy, pneumonectomy, sleeve resections), chest wall resections, mesothelioma, thymic resections, mediastinoscopy, bronchoscopy (flexible and rigid), esophagectomy (transhiatal and ivor-lewis), resection of mediastinal masses.
    13. Exposure, cannulation, and subsequent closure of femoral vessels for CPB.
    14. Reoperation for acute post-cardiotomy bleeding (chest re-exploration).
  4. Professionalism
    1. The ability to be honest, reliable and respectful of the religious, racial, and gender characteristics of patients, their families and other members of the health care team.
    2. The ability to give and receive advice in a manner that is consistent with the harmonious operation of a health care team.
    3. The ability to recognize when to seek assistance from more experienced colleagues.
    4. Deliver highest quality care with ethics, integrity, honesty and compassion.
    5. Exhibit appropriate personal and interpersonal professional behaviors.
    6. Understand the professional, legal and ethical codes to which physicians are bound.
  5. Interpersonal and Communication Skills
    1. Listen effectively.
    2. Establish therapeutic relationship with patients and families.
    3. Obtain and synthesize relevant history from patients and family.
    4. Inform patients and families about their condition at an appropriate and understandable level.
    5. Write clear consultation notes, progress notes, discharge summaries, and clinic notes.
    6. Prepare and present ward rounds in an organized manner.
    7. Participate actively in scheduled rounds.
    8. Communicate effectively with allied health care professionals.
  6. Systems-based Practice
    1. Utilize resources effectively to balance patient care and learning needs.
    2. Allocate finite health care resources wisely.
    3. Understand the importance of and mechanisms to safely utilize resources in a cost-effective manner to benefit all patients.
    4. Demonstrate the ability to work and navigate through all hospital systems
  7. Practice-Based Learning and Improvement
    1. Develop effective self-directed learning strategies for continuing education and assessment of knowledge base.
    2. Critically appraise sources of medical information and be aware of resources available.
    3. Read around clinical cases.
    4. Prepare and present scheduled rounds.
    5. Participate actively in scheduled morbidity and mortality conferences.
    6. Participate effectively in facilitate learning of patients, teaching house staff/students, and other health professionals.
Method of assessment of resident academic performance
  1. End of rotation online evaluation
  2. Yearly in-service training exam
  3. Bi-annual case log review
  4. Regular meetings with Program Director
 
2nd Year Cardiothoracic Surgery Resident (Thoracic Track)
For ease of presentation, these goals will be grouped based-upon the core-competencies.
  1. Medical Knowledge
    1. Anatomy, embryology, physiology, and pathology of the pericardium, heart and great vessels.
    2. The pharmacology, indications, and complications of drugs commonly used in the specialty.
    3. The principles of preoperative assessment, anesthetic management, and postoperative management of cardiovascular surgical patients.
    4. The natural history of treated and untreated cardiovascular surgical conditions, including: ischemic heart disease, valvular heart disease, thoracic aortic disease, surgical options for end-stage heart failure (transplant and non-transplant options), conduction system disturbances, cardiac tumors, pericardial disease, and trauma.
    5. Natural history of advanced thoracic pathophysiology – superior sulcus tumors, tracheal stenosis, chest wall resections, mesothelioma, benign esophageal disease.
    6. Pathology of chest wall deformities
    7. Advanced principles of surgery as they apply to the specialty, such as wound healing, hemostasis, surgical nutrition and hyperalimentation, electrolytes/fluid management, oncology, and principles of transplant immunology.
    8. The technology, interpretation, and complications of invasive and noninvasive diagnostic methods, including PET scanning, CT and MRI scanning, cardiac catheterization, coronary angiography, pulmonary biopsies, endoscopic ultrasound, and echocardiography.
    9. Principles and complications of techniques for myocardial and cerebral protection.
  2. Clinical Skills
    1. Perform a focused history and physical exam, arrive at an appropriate differential and working diagnosis, and order and interpret the appropriate investigation, in the ward, ambulatory, and emergency department settings.
    2. Arrive at an acceptable plan of management, demonstrating knowledge in the operative and the non-operative management of the disease process.
    3. Manage the patient throughout the hospital stay, including management in an intensive care unit setting, demonstrating knowledge and ability to anticipate, recognize, and manage potential complications of the disease processes and operative procedures.
    4. Provide a plan for patient follow-up.
    5. Management of cardio- and cerebral-protection; demonstrate appropriate understanding of methods and indications for cardioplegia strategies and cardiopulmonary bypass methods.
    6. Demonstrate a keen understanding of the management of pulmonary resections for malignant and benign disease, including post-operative follow-up and surveillance.
    7. Management of post-operative esophageal disease and follow-up.
    8. Management of complex chest wall pathology.
    9. Management of benign and malignant pleural pathology (pneumothorax, fibrothorax, empyema, mesothelioma, chylothorax).
    10. Management of post-operative bleeding (medical and surgical).
    11. Management of low-cardiac output syndrome (medical and surgical).
    12. Troubleshooting pacemakers.
    13. Assessment and treatment of post-operative arrhythmias.
    14. Appropriate interpretation of intra-operative echocardiography and application to surgical plan.
    15. Identification of critically ill and major complications of patients on the ward with appropriate acute management.
  3. Patient Care
    1. As the operating surgeon, demonstrate appropriate situational awareness, management/interaction with first/second assistants, perfusionists, anesthetist, scrub technicians, and circulating nurses.
    2. As the operating surgeon or as a first assistant, demonstrate an ability to anticipate surgical maneuvers, to take direction well from experienced assistants, to make reasonable suggestions, and to contribute to a positive operating room atmosphere.
    3. As the operating surgeon, demonstrate independent ability to perform midline sternotomy, dissect the mediastinum appropriate for the procedure, and place the patient on cardiopulmonary bypass.
    4. As the operating surgeon, demonstrate the independent ability to perform standard thoracotomies (anterolateral and muscle sparing) and perform pulmonary resections (lobectomy, pneumonectomy, wedge, sleeve resections), esophagectomy, resection of mediastinal masses, chest wall deformity correction, thymectomy, chest wall resection, superior sulcus tumor resection.
    5. As the operating surgeon or as a first assistant perform tracheal resections, transcervical thymectomies.
    6. As the operating surgeon or first assistant, ability to safely perform redo-sternotomy and mediastinal dissection.
    7. As the operating surgeon, demonstrate ability to perform: coronary artery bypass on and off cardiopulmonary bypass, aortic valve replacement, aortic composite valve graft, mitral valve replacement and repair mitral valve annuloplasty, tricuspid valve replacement, tricuspid valve annuloplasty, and atrial fibrillation surgery.
    8. As the operating surgeon or 1st /2nd assistant, participate in pericardiectomy, heart and lung transplantation, insertion of pacemaker, Type A dissection repair, resection of cardiac tumors, myotomy/myectomy for HOCM,
  4. Professionalism
    1. The ability to be honest, reliable and respectful of the religious, racial, and gender characteristics of patients, their families, and other members of the health care team.
    2. The ability to give and receive advice in a manner that is consistent with the harmonious operation of a health care team.
    3. The ability to recognize when to seek assistance from more experienced colleagues.
    4. Deliver highest quality care with ethics, integrity, honesty and compassion.
    5. Exhibit appropriate personal and interpersonal professional behaviors.
    6. Understand the professional, legal, and ethical codes to which physicians are bound.
  5. Interpersonal and Communication Skills
    1. Listen effectively.
    2. Establish therapeutic relationship with patients and families.
    3. Obtain and synthesize relevant history from patients and family.
    4. Inform patients and families about their condition at an appropriate and understandable level.
    5. Write clear consultation notes, progress notes, discharge summaries, and clinic notes.
    6. Prepare and present ward rounds in an organized manner.
    7. Participate actively in scheduled rounds.
    8. Communicate effectively with allied health care professionals.
  6. Systems-based Practice
    1. Utilize resources effectively to balance patient care and learning needs.
    2. Allocate finite health care resources wisely.
    3. Understand the importance of and mechanisms to safely utilize resources in a cost-effective manner to benefit all patients.
  7. Practice-Based Learning and Improvement
    1. Develop effective self-directed learning strategies for continuing education and assessment of knowledge base.
    2. Critically appraise sources of medical information and be aware of resources available.
    3. Read around clinical cases.
    4. Prepare and present scheduled rounds.
    5. Participate actively in scheduled morbidity and mortality conferences.
    6. Participate effectively in facilitate learning of patients, teaching house staff/students and other health professionals.
Method of assessment of resident academic performance
  1. End of rotation online evaluation
  2. Yearly in-service training exam.
  3. Bi-annual case log review
  4. Regularly schedule meetings with program director
 

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