The Cardiac Third Year Fellowship position in advanced Cardiac Surgery is designed as a true Fellowship and will not duplicate, but will expand the experience gained as a cardiac trainee during the two-year approved residency program. The Cardiac Third Year Fellow will not supplant the cardiac residents in their operative and clinical experiences but will augment the cardiac resident group as described below. The Cardiac Chief Resident (second year resident) will maintain responsibility for and authority over operating room case allocation in consultation with the attending surgeons and the Cardiac Division Chief.

1. The Cardiac Third Year Fellow will have priority on cardiopulmonary transplant cases. This includes lung and heart transplant procedures, including harvest. The role of the Cardiac Third Year Fellow during these procedures will be dictated by the Attending Surgeon. If heart and lung transplant occur simultaneously, then the Cardiac Third Year Fellow will have his choice of those cases depending on the complexity of his own UNOS certification priorities.
2. The Cardiac Third Year Fellow has priority for assisting on complex thoracic aortic procedures.

3. The Cardiac Third Year Fellow will assume the duties of the Cardiac Resident when one of the Cardiac Residents is away. As far as operating room responsibilities are concerned, this means:
   1. If the Thoracic Resident is away; Cardiac Third Year Fellow will assume the Chief Resident responsibilities of the Thoracic Surgical service including rounds, and assume the role of the main Thoracic Surgical resident and perform all major cases as necessary.
   2. If the Junior Cardiac Surgery Resident is away: the Cardiac Third Year Fellow will assume the position of junior Cardiac Surgical resident and will assume, including rounds, the operative case load of the “second” cardiac operating room after the Chief Cardiac Surgical Resident has chosen his case(s).
   3. If the Chief Cardiac Surgery Resident is away; the Cardiac Third Year Fellow will assume all the duties, including rounds, of the Cardiac Surgery Chief Resident and direct and assign operating room responsibilities for the Cardiac Surgical Service and will have operating room priority over the more Junior Cardiac Surgical Resident.

4. Overflow: If an overflow situation occurs on the cardiac surgical service (i.e. opening up a third room), then the Chief Cardiac Surgical Resident has both the responsibility and right to request operating room assistance on the Cardiac Surgical Service from the Cardiac Third Year Fellow. This situation is operative if the two regular Cardiac Surgical Residents are in the operating room. Other possibilities within this category include: a major cardiac trauma case during the day when all cardiac and thoracic residents are unavailable or a third room opening up on either the Cardiac or Thoracic Surgical Services. Note: It is the responsibility of the Chief Cardiac and Thoracic Residents to ask for overflow operating room assistance.

5. If a particularly difficult case is encountered on either the cardiac or thoracic surgical service which would otherwise require the presence of two attendings, then the attending may request the services of the Cardiac Third Year Surgical Fellow for this advanced type of case (i.e. double or triple redo operations, LVADs, complex multiple procedures, VIP, etc.).