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VCU Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University VCU Division of Cardiothoracic Surgery

VCU Division of Cardiothoracic Surgery

Curriculum - overview

Introduction

The fundamental focus for the Thoracic Surgery residency training program is to provide an extensive clinical experience with progressively increasing depth in evaluation and management of adult and pediatric cardiothoracic conditions. Whereas it is recognized that resident performance will constantly be monitored by the faculty, and appropriate feedback rendered on an ongoing basis, formal written evaluation of resident performance will be conducted semi-annually.

Required Conferences

  1. Weekly Core Curriculum Conference – Thursday afternoon; with topics to be scheduled and assigned to a resident for presentation in advance.
  2. Departmental Conferences – (Thursday) including General Surgery Grand Rounds, Cardiology/Cardiac Surgery Cath Conference, and M&M Conference.
  3. Departmental Symposia:  Annual conference with visiting Brooks-Lower Professor where interesting cases and research will be presented by each resident.  There will also be a monthly
    Journal Club where the residents will discuss a topic using current literature

Required Reading

Sabiston and Spencer Surgery of the Chest. (Sellke, del Nido, Swanson editors. 2005).  Chapters will be assigned weekly to correspond to topics of discussion planned for weekly core curriculum conference.

 

Recommended Reading

  • Pearson’s Thoracic and Esophageal Surgery (Patterson et al.2008)
  • Comprehensive Surgical Management of Congenital Heart Disease (Jonas 2004)
  • Cardiac Surgery in the Adult (Cohn 2008)
  • Rutherford Vascular Surgery (Cronenwett, et al. 2000)
  • Braunwald Textbook of Cardiology
  • Journals – Must review current journals in cardiothoracic surgery (ATS, JTCVS)
  • Online Learning – CTSNet, theheart.org
  • SESATS IX or most current version – Electronic version will be available to residents in division library.

 

Required Products

  1. ABTS In Training Examination – given yearly
  2. Annual Grand Rounds Presentation – on research done by resident to visiting professor
  3. Monthly Practice-Based Learning Log – cases of unfavorable or unexpected outcomes, with focused literature search and plan for practice improvement and presentation at monthly M & M.
  4. CTSNET Operative Case Log – must be updated daily.
  5. Duty Hour Log – must be updated at least weekly.

 

PGY-6

Clinical Duties and Responsibilities

Outpatient Clinic: In the outpatient clinic the PGY-6 resident will get experience in the workup and treatment of a wide variety of common cardiothoracic surgical problems while under the direct supervision of departmental faculty.   

Inpatient Care: While being on service the PGY-6 will be expected to run the service with the assistance of the NPs and general surgery housestaff. They will be expected to perform daily team rounds where care plan will be formulated and communicated to the team as well as the respective attending.  They will also conduct daily attending rounds with the on-call surgeon.

Call Coverage:  The PGY-6 will be expected to take in house call for the 8 months that they are on CT surgery services.  The other 4 months will have no in house call coverage but may have other call requirements specific to the sub-specialty rotations.

Administrative/Academic Duties: Will be expected to teach the medical students, general surgery and anesthesia residents that are rotating in the CT services and in the intensive care units; also, to present at the designated conferences specific to their rotations.

Specific Competencies to be achieved  in the PGY-6 year.

Cardiac

  • Open and close a chest
  • Cannulation for bypass
  • Wean from CPB
  • Harvest GSV open and endoscopic
  • Takedown IMA
  • Harvest Radial artery
  • Insertion and removal of IABP
  • Interpretation of TTE and TEE
  • Perform proximal and distal bypass grafts
  • Basic principles of valve surgery
  • Preop and postop care
  • Basic endovascular techniques
  • Interpretation of cardiac cath
  • Pacemaker placement

 Thoracic

  • Bronchoscopy
  • Esophagoscopy
  • Diagnostic thoracoscopy
  • Perform thoracotomy
  • Pulmonary wedge resection
  • Lobectomy
  • Mediastinoscopy
  • Preop and postop care of thoracic patients

Vascular

  • Perform basic angiography
  • Open and endovascular aneurysm repair
  • Basic vascular examination of the patient
  • Interpret vascular ultrasonography

Cath Lab

  • Learn the skills and interpretation of coronary angiography
  • Perform coronary interventions
  • Place IABPs
  • Right and left heart catheterization

Pulmonary

  • Basic principles of bronchoscopy
  • Perform rigid bronchoscopy
  • Understand principles behind PFTs

Interventional Radiology (IR)

  • Place IVC filters
  • Perform and interpret venograms and arteriograms
  • Perform interventions
  • Develop advanced endovascular skills

PGY-7

Clinical Duties and Responsibilities

Outpatient Clinic: In the outpatient clinic the PGY-7 resident will get experience in the workup and treatment of a wide variety of common cardiothoracic surgical problems while under the direct supervision of departmental faculty

Inpatient Care: While at the VA and CNMC the resident will be expected to function at the Senior level; assuming more responsibility with regards to patient care and decision making processes, all under the direct supervision of the attending faculty.

Call Coverage: At the VA there is no in house call coverage but the resident will be available according to the ACGME duty hours guidelines. At CNMC in house call coverage may be required.

Administrative/Academic Duties:  The resident at the VA will be required to attend the weekly didactic sessions at VCUHS.  They will also be responsible for presenting at the required conferences at the VAMC and at CNMC.

Specific Competencies to be achieved  in the PGY-7 year.

McGuire VA

  • Advanced aortic and mitral valve surgery
  • Mitral valve repair
  • Principles of heart transplant
  • Complex coronary artery bypass
  • Care of the high risk coronary patient
  • Thoracotomy and pulmonary resection

DC Children’s Hospital

  • Physiologic principles of congenital heart defects
  • Interpretation of pediatric echocardiography and cardiac catheterization
  • Perform ASD repair
  • Perform PDA ligation
  • Establish CPB for neonate and infant
  • Preop and postop care of the pediatric heart patient
  • Establish ECMO
  • Assist in complex congenital heart defect correction
      • Hypoplastic left heart
      • Truncus correction
      • Transposition of the Great Vessels                                        
      • AV Canal

PGY-8


Clinical Duties and Responsibilities

Outpatient Clinic:  The PGY-8 resident will be assigned to the outpatient clinic under the supervision of the faculty, and there will be involved in the evaluation and treatment of outpatients, in addition to assuming a teaching role with the PGY-6 resident and medical students in the clinic.  It is expected that this experience will build upon the PGY-7 experience, so as such the PGY-8 resident will hone examination skills, and further develop the skills and knowledge required to evaluate and initiate treatment for patients with increasingly complex cardiothoracic complaints.

Inpatient Care: While on the VCUHS service, the PGY-8 resident will assist the attending surgeon/intensivist with oversight of the care provided by and teaching of the PGY-6 resident, general surgery resident and medical students on the service.  In addition, the PGY-8 resident will be primarily responsible for the transplant and mechanical assist devices including presentation of consults to the attending.  The PGY-8 resident will achieve proficiency in more advanced CT surgical procedures as listed below, including heart transplant and aortic surgery.

Call Coverage: No in-house call responsibilities, but the PGY-8 is responsible for the overall care of patients on the service and must be available for coverage according to ACGME guidelines.

Administrative/Academic Duties: The two PGY-8 residents will each be the administrative chief for 6 months; they will be responsible for the conference assignments, call schedule and case coverage.   

Specific Competencies to be achieved  in the PGY-8 year.

Cardiac

  • Plan and Perform complete operative procedure
  • Perform organ harvest for transplant
  • Perform cardiac transplant
  • Understands principles of mechanical assist devices
  • Assist in placing VADs and artificial heart
  • Complex aortic surgery
  • Placement of aortic stent grafts
  • Perform arrhythmia surgery both open and thoracoscopic
  • Valve repair and replacement
  • Perfect principles and techniques of cardiac surgery

Thoracic

  • Perform minimally invasive lobectomy
  • Pneumonectomy
  • Sleeve resection and tracheal surgery
  • Attend and run chest tumor board
  • Complex VATS procedures
  • Perfect principles of thoracic surgery

 

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