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YEARLY EDUCATIONAL OBJECTIVES

 

PGY – 6 RESIDENT

 

The PGY – 6 year is divided into two blocks: 6 months General Thoracic Surgery (non-cardiac) and ICU responsibilities followed by 6 months of Adult Cardiac Surgery.

 

• R1: The PGY – 6 resident will do morning rounds on the thoracic surgery patients. On days that the resident rounds at LLUMC, he/she will do rounds jointly with the senior thoracic surgery resident on service (may be PGY – 7 or 8). The residents are encouraged to accompany the attending surgeon on his or her rounds and discuss the care plan for patients. He/she will be responsible for the preoperative and postoperative care of all thoracic (non-cardiac) patients and is expected to participate in all thoracic (non-cardiac) procedures in the operating room. He/she is expected to attend outpatient clinic as scheduled and to participate in the preoperative workup and management of postoperative patients. He/she will do all thoracic (non-cardiac) consults during weekdays and on-call nights. After completing the consultations, he/she will discuss the patient/case and the plan of management with the attending surgeon. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Tumor Board Conference (LLUMC and VA) or Wednesday Grand Rounds meeting.

• R2: The PGY – 6 resident will do morning rounds jointly with the senior thoracic surgery resident on service (may be PGY – 7 or 8). The residents are encouraged to accompany the attending surgeon on his or her rounds and discuss the care plan for patients. He/she will be responsible for the preoperative and postoperative care of the adult cardiac surgery patients and is expected to participate in all training level appropriate adult cardiac surgery procedures in the operating room. The resident is expected to evaluate preoperative patients and follow-up on postoperative patients in the outpatient clinic setting one day a week under the supervision of an attending. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Joint Adult Cardiac Surgery/Adult Cardiology Conference, Adult Congestive Heart Failure Conference, bi-monthly Aortic Aneurysm Conference, and the Wednesday Cardiothoracic Surgery Grand Rounds meeting.

 

At the completion of the PGY – 6 year, the Resident is expected to have full knowledge and surgical management skills of normal and pathologic conditions of the chest wall, mediastinum, esophagus, lung, diaphragm, trachea/bronchi, and pleura. He/she should be competent in managing critically ill patients with skills and knowledge to use invasive monitoring, intra-aortic balloon pump, ventilator support, and various pharmacologic therapies. He/she should strive to complete all index case requirements in the area of thoracic (non-cardiac) surgery including all endoscopies during this year of training. Moreover, the resident will be able to perform central cannulation for patients undergoing first time cardiac surgery. He/she will be able to harvest and prepare conduits for myocardial revascularization including vein grafts, radial artery or internal thoracic artery conduits. Throughout the PGY – 6 year, the resident will be involved in local and distant heart organ procurement and learn the principles of organ preservation.

Other responsibilities of the PGY – 6 resident include teaching and mentoring of general surgery residents and medical students who rotate on the Thoracic Service. The Program Director and Attendings will provide teaching and counseling to the PGY – 6 resident as he/she prepares for the General Surgery Board exams during the year.

Throughout this year the resident should complete reading a standard textbook on thoracic surgery or the section covering all thoracic topics (non-cardiac) in the two-volume book Surgery of the Chest 8th Ed. by Sabiston and Spencer provided to him/her by the program. The resident is encouraged to select a research project and work on a scholarly paper in collaboration with an attending or the Residency Program Research Director.

PGY – 7 RESIDENT

The PGY – 7 year includes: 1) three month Adult Cardiac Surgery rotation; 2) a three month Congenital Cardiac Surgery rotation; 3) a three month adult Cardiac Surgery Rotation; and 4) a three month General Thoracic Surgery rotation.

 

• R1: The resident will continue building upon the foundation of knowledge and skills learned during the PGY 6 Adult Cardiac Surgery Rotation. He/she will learn in-depth the techniques and complications of extracorporeal cardiopulmonary bypass and coagulation. The resident will

participate actively in the preoperative workup and postoperative management of adult patients undergoing cardiac surgery. He/she will be actively involved in the adult cardiac surgery procedures, and will be responsible for the daily care of those patients in the ICU under the supervision of the Chief Resident and the Attending Surgeon. Such cardiac procedures may include: coronary artery bypass grafting (CABG), surgery for valvular heart disease, surgery for aortic disease (including aneurysms, dissections, and aortic trauma), adult cardiac transplantation, ventricular assist devices, arrhythmia surgery, and surgery for pericardial disease. He/she is expected to attend outpatient clinic a minimum of one day per week where he/she will evaluate and manage patients with cardiac disorders. The resident is expected to attend the weekly joint cardiac surgery/adult cardiology conference and participate in the education and mentoring of medical students and residents on the service.

 

The resident will attend outpatient clinic (for preoperative and postoperative care of patients) at least one day per week while on this rotation. He/she will complete morning rounds jointly with the PGY 6 resident. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Joint Adult Cardiac Surgery/Adult Cardiology Conference, Adult Congestive Heart Failure Conference, bi-monthly Aortic Aneurysm Conference, and the Wednesday Cardiothoracic Surgery Grand Rounds meeting.

 

• R2: During the Congenital Cardiac Surgery Rotation the resident will learn the embryology and anatomy of the normal heart. He/she will develop a full understanding of the physiology, preoperative workup (echocardiography, cardiac catheterization, etc.), and surgical management of the various cyanotic and acyanotic heart defects. He/she will also participate in the procurement and implantation processes of pediatric cardiac transplantation. Responsibilities include daily rounds and postoperative care of all pediatric cardiac surgery patients, consultation requests during weekdays and nights on-call for pediatric cardiac surgery, participation in the operating room with pediatric cardiac procedures, and attendance of the weekly joint pediatric cardiac surgery/pediatric cardiology conference. The resident is expected present the patients to the attending surgeon on his or her rounds and discuss the care plan for patients. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Joint Pediatric Cardiac Surgery/Pediatric Cardiology Conference, bi-monthly Pediatric Cardiothoracic Surgery Mortality and Morbidity Quality Improvement Conference, and the Wednesday Cardiothoracic Surgery Grand Rounds meeting. The resident is expected to attend outpatient clinic one day a week to evaluate new patients with congenital heart disease and follow-up on the postoperative progress of other patients who have already had surgical repair.

• R3: The resident will continue building upon the foundation of knowledge and skills learned during the earlier Adult Cardiac Surgery Rotations. He/she will complete morning rounds jointly with the PGY 6 resident. The resident will learn in-depth the techniques and complications of extracorporeal cardiopulmonary bypass and coagulation. He/she will participate actively in the preoperative workup and postoperative management of adult patients undergoing cardiac surgery. The resident will be actively involved in the adult cardiac surgery procedures, and will be responsible for the daily care of those patients in the ICU under the supervision of the Attending Surgeon. Such cardiac procedures may include: coronary artery bypass grafting (CABG), surgery for valvular heart disease, surgery for aortic disease (including aneurysms, dissections, and aortic trauma), adult cardiac transplantation, ventricular assist devices, arrhythmia surgery, and surgery for pericardial disease. The resident is expected to attend clinic one day each week with an attending and participate in the evaluation and management of pre and postoperative patients. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Joint Adult Cardiac Surgery/Adult Cardiology Conference, Adult Congestive Heart Failure Conference, bi-monthly Aortic Aneurysm Conference, and the Wednesday Cardiothoracic Surgery Grand Rounds meeting.

• R4: The resident will continue building upon the foundation of knowledge and skills learned during the PGY 6 General Thoracic Surgery Rotation. The PGY – 7 resident will do morning rounds on the thoracic surgery patients. On days that the resident rounds at LLUMC, he/she will do rounds jointly with the senior thoracic surgery resident on service (may be PGY – 6 or 8). The residents are encouraged to accompany the attending surgeon on his or her rounds and discuss the care plan for patients. He/she will be responsible for the preoperative and postoperative care of all thoracic (non-cardiac) patients and is expected to participate in all thoracic (non-cardiac) procedures in the operating room. He/she is expected to attend outpatient clinic as scheduled and to participate in the preoperative workup and management of postoperative patients. He/she will do all thoracic (non-cardiac) consults during weekdays and on-call nights. After completing the consultations, he/she will discuss the patient/case and the plan of management with the attending surgeon. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Tumor Board Conference (LLUMC and VA) or Wednesday Grand Rounds meeting.

 

Throughout the PGY – 7 year, the resident is expected to cover the reading material on congenital and adult cardiac surgery in Sabiston and Spencer’s 8th Edition Surgery of the Chest.

The resident is encouraged to select a research project and work on a scholarly paper in collaboration with an attending or the Residency Program Research Director.

PGY – 8 RESIDENT

The PGY – 8 resident is the Chief Resident for the entire Cardiothoracic Surgery Service and has administrative and clinical responsibilities. He/she will oversee the management of patients in the ICU, assign residents to operating room cases, and provide teaching to medical students and other residents. He/she is encouraged to discuss the patient care plans and seek guidance from the Attending Surgeon when needed. The Chief Resident will be directly involved in the preoperative evaluation and decision making of all patients he/she will be operating on. He/she will attend the weekly conferences as dictated by rotation. He/she will complete reading the two-volume text 8th Edition Surgery of the Chest by Sabiston and Spencer during this year. The resident should be able to present his/her clinical research project anytime during this training year. The Chief Resident will have his/her clinic at the International Heart Institute to see new and returning patients (pre and post op). The Chief Resident Clinic will be one day per a week and will be under the supervision of an attending surgeon.

 

• Elective Adult Cardiac/Elective Rotations: Each resident may select a one to three month rotation (or combination of rotations not to exceed a total of three months) in any of the following areas:

 

1. E1 Adult Cardiac: Surgical experience will include complex CABG’s, redo cardiac operations, valve repairs/replacements, aortic surgery, combination cardiac procedures, surgery for heart failure, arrhythmia surgery, adult and pediatric left ventricular assist devices, and cardiac transplantation. He/she will complete morning rounds jointly with the PGY 7 resident. The resident will learn in-depth the techniques and complications of extracorporeal cardiopulmonary bypass and coagulation. He/she will participate actively in the preoperative workup and postoperative management of adult patients undergoing cardiac surgery. The resident will be actively involved in the adult cardiac surgery procedures, and will be responsible for the daily care of those patients in the ICU under the supervision of the Attending Surgeon. Such cardiac procedures may include: coronary artery bypass grafting (CABG), surgery for valvular heart disease, surgery for aortic disease (including aneurysms, dissections, and aortic trauma), adult cardiac transplantation, ventricular assist devices, arrhythmia surgery, and surgery for pericardial disease. The resident is expected to attend clinic with an attending one day per week and participate in the preoperative evaluation and postoperative management of cardiac surgery patients. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Joint Adult Cardiac Surgery/Adult Cardiology Conference, Adult Congestive Heart Failure Conference, bi-monthly Aortic Aneurysm Conference, and the Wednesday Cardiothoracic Surgery Grand Rounds meeting.

2. E2 Endovascular Surgery: The PGY – 8 resident may arrange for a one to two month elective rotation on the Endovascular Service (joint vascular/cardiothoracic surgery). The resident will learn the indications and selection criteria for endovascular stenting and will participate in all thoracic endografting procedures. He/she will gain understanding of the use of guidewords, dialators, stents, and various grafts available on the market. He/she will be responsible for postoperative care and future management of those patients. Residents will be allowed to join the vascular service during Endovascular Abdominal Aortic Repair (EVAR) procedures in order to further develop his/her endo skills. The resident will attend and present cases at the bi-monthly Aortic Aneurysm Conference. He/she is expected to attend one day of outpatient clinic with an attending and will participate in the preoperative evaluation and postoperative management of patients.

3. E3 Congenital Cardiac Surgery: During this rotation the resident will build upon the foundation acquired during the PGY 7 Congenital Cardiac Surgery Rotation. He/she will also participate in the procurement and implantation processes of pediatric cardiac transplantation. Responsibilities include daily rounds and postoperative care of all pediatric cardiac surgery patients, consultation requests during weekdays and nights on-call for pediatric cardiac surgery, participation in the operating room with pediatric cardiac procedures, and attendance of the weekly joint pediatric cardiac surgery/pediatric cardiology conference. The residents are encouraged to accompany the attending surgeon on his or her rounds and discuss the care plan for patients. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Joint Pediatric Cardiac Surgery/Pediatric Cardiology Conference, bi-monthly Pediatric Cardiothoracic Surgery Mortality and Morbidity Quality Improvement Conference, and the Wednesday Cardiothoracic Surgery Grand Rounds meeting. The resident is expected to attend one day per week of outpatient clinic under the supervision of an attending and will be expected to participate in the preoperative consultation and postoperative management of patients.

4. E4 General Thoracic Surgery: The resident will participate in morning rounds with the resident assigned to the General Thoracic Surgery Rotation. He/she will increase knowledge of general thoracic surgery and participate in more complex procedures. Resident is expected to participate in the evaluation and follow-up of patients in the outpatient clinic setting under the supervision of an attending. He/she will do all thoracic (non-cardiac) consults during weekdays and on-call nights. After completing the consultations, he/she will discuss the patient/case and the plan of management with the attending surgeon. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Tumor Board Conference (LLUMC and VA) or Wednesday Grand Rounds meeting.

 

• R1: Surgical experience will include complex CABG’s, redo cardiac operations, valve repairs/replacements, aortic surgery, combination cardiac procedures, surgery for heart failure, arrhythmia surgery, adult and pediatric left ventricular assist devices, and cardiac transplantation. He/she will complete morning rounds jointly with the PGY 7 resident. The resident will learn in-depth the techniques and complications of extracorporeal cardiopulmonary bypass and coagulation. He/she will participate actively in the preoperative workup and postoperative management of adult patients undergoing cardiac surgery. The resident will be actively involved in the adult cardiac surgery procedures, and will be responsible for the daily care of those patients in the ICU under the supervision of the Attending Surgeon. Such cardiac procedures may include: coronary artery bypass grafting (CABG), surgery for valvular heart disease, surgery for aortic disease (including aneurysms, dissections, and aortic trauma), adult cardiac transplantation, ventricular assist devices, arrhythmia surgery, and surgery for pericardial disease. He/she will run the Chief Resident Outpatient Clinic one day per week under the supervision of an attending and is responsible for preoperative and postoperative management of patients in that clinic. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Joint Adult Cardiac Surgery/Adult Cardiology Conference, Adult Congestive Heart Failure Conference, bi-monthly Aortic Aneurysm Conference, and the Wednesday Cardiothoracic Surgery Grand Rounds meeting.

• R2: The resident will continue building upon the foundation of knowledge and skills learned during the PGY 6 and 7 General Thoracic Surgery Rotations. The PGY – 8 resident will do morning rounds on the thoracic surgery patients. On days that the resident rounds at LLUMC, he/she will do rounds jointly with the senior thoracic surgery resident on service (may be PGY – 6 or 7). The residents are encouraged to accompany the attending surgeon on his or her rounds and discuss the care plan for patients. He/she will be responsible for the preoperative and postoperative care of all thoracic (non-cardiac) patients and is expected to participate in all thoracic (non-cardiac) procedures in the operating room. He/she is expected to attend outpatient clinic as scheduled and to participate in the preoperative workup and management of postoperative patients. He/she will do all thoracic (non-cardiac) consults during weekdays and on-call nights. After completing the consultations, he/she will discuss the patient/case and the plan of management with the attending surgeon. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Tumor Board Conference (LLUMC and VA) or Wednesday Grand Rounds meeting.

• R3: Surgical experience will include complex CABG’s, redo cardiac operations, valve repairs/replacements, aortic surgery, combination cardiac procedures, surgery for heart failure, arrhythmia surgery, adult and pediatric left ventricular assist devices, and cardiac transplantation. He/she will complete morning rounds jointly with the PGY 7 resident. The resident will learn in-depth the techniques and complications of extracorporeal cardiopulmonary bypass and coagulation. He/she will run the Chief Resident Outpatient Clinic one day per week under the supervision of an attending and is responsible for preoperative and postoperative management of patients in that clinic. The resident will be actively involved in the adult cardiac surgery procedures, and will be responsible for the daily care of those patients in the ICU under the supervision of the Attending Surgeon. Such cardiac procedures may include: coronary artery bypass grafting (CABG), surgery for valvular heart disease, surgery for aortic disease (including aneurysms, dissections, and aortic trauma), adult cardiac transplantation, ventricular assist devices, arrhythmia surgery, and surgery for pericardial disease. He/she is expected to attend and present complex cases requiring multi-disciplinary discussions in the weekly Joint Adult Cardiac Surgery/Adult Cardiology Conference, Adult Congestive Heart Failure Conference, bi-monthly Aortic Aneurysm Conference, and the Wednesday Cardiothoracic Surgery Grand Rounds meeting.

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