Residency Program

Thank you for inquiring about our Cardiothoracic Surgery Residency Training Program. We appreciate your interest in training at Loma Linda University Medical Center, and we hope that you will give serious consideration to the merits of our institution. Please visit our House Staff web site at www.llu.edu/llumc/residency to find out more about our institution.

The training program is specifically divided into three one-year blocks with each year encompassing a different area of the three major areas of thoracic surgery education as detailed below.

Year One

The first-year resident (PGY-6) is expected to complete a course in general thoracic surgery education at Loma Linda University Medical Center and Children’s Hospital. This resident sees all thoracic surgery consults both in adults and pediatrics. As such, he is responsible for the preoperative evaluation and presentation to a faculty member for management. General surgery residents and medical students are present on the thoracic surgery service. The thoracic surgery resident is considered senior in authority and responsible for the thoracic surgery service. In the responsibility for the teaching of residents and students under his supervision, he shares some aspects of patient care and of surgery with the general surgery resident. The thoracic surgery resident has a separate rotation of two weeks in GI medicine with special emphasis on esophageal motility studies, manometry, and esophageal and gastric endoscopy. The thoracic surgery resident (PGY-6) also interfaces with the pulmonary medicine service and presents complex cases in the Tumor Board. He/She also performs all flexible bronchoscopies in the intensive care unit. The thoracic surgery resident (PGY-6) will also first assist in open cardiac surgery procedures and become efficient in the preparation and procurement of vascular conduits: saphenous veins, radial arteries, or internal mammary artery grafts. He/She will gain first-hand experience in open cardiac surgery procedures by opening and closing sternotomies; he may cannulate the patients for cardio-pulmonary bypass and become familiar with the management of cardio-pulmonary bypass complications. He/She along with the chief resident (PGY-8) will provide post-operative care for cardiac patients in the intensive care unit. The first-year thoracic resident (PGY-6) will perform and participate in the management of video-assisted lead placements for bi-ventricular pacing and implantable cardioverter defibrillators. He/She will also participate in the management of adult organ donors and the procurement of adult hearts for transplantation. And finally, the first-year thoracic resident (PGY-6) will be allowed time during his first year of training to study, prepare, and pass his/her general surgery board exam.

Year Two

The second year of thoracic residency (PGY-7) is devoted primarily to congenital heart disease and the management of these patients. As such, the resident’s primary responsibility is at Loma Linda Children's Hospital which is an integrated part of the larger Medical Center. The second year thoracic surgery resident manages the postoperative pediatric cardiac surgery intensive care unit, step-down unit, and the basic ward. He/She is responsible for the pre- and postoperative care of these patients in consultation with two cardiac surgeons, who have received fellowship training in Pediatric Cardiac Surgery. The second-year thoracic surgery resident is also responsible for all pacemaker interventions in pediatrics within the Children’s Hospital. The second-year thoracic surgery resident is also required to attend the Pediatric Cardiology/Cardiac Surgery Conference where cases are presented, echocardiograms are shown, and catheterization data are discussed. The thoracic surgery resident on the pediatric heart surgery rotation also receives extensive exposure and operative experience in pediatric cardiac transplantation in one of the world's largest infant and pediatric heart transplantation service.

Year Three

The final and chief year of thoracic surgery residency is spent on adult cardiac surgery as the chief resident of adult cardiac surgery at the University Hospital. Here the chief resident is responsible for preoperative and postoperative evaluation and care of the cardiac surgery patients, including a wide variety of ischemic and acquired valvular heart disease patients. He/She is also exposed to, performs, and participates in the management of left ventricular assist devices including implantation and removal of HeartMate, Thoratec or Abiomed LVAD's as well as a busy adult cardiac transplantation service. Participation in outpatient postoperative visits is encouraged and expected on a weekly basis.

When a particular resident is not involved with an operation as designated in his normal year of coverage, it is expected that the resident will assist and/or perform an operation in another area of thoracic surgery specialty, i.e. if the resident assigned to pediatric heart surgery has no cases for that day, it is expected that he will perform or assist in an adult cardiac operation or a thoracic surgery operation if the respective residents in those services are already performing or assisting in an operation of their specialty. As such, although each resident has a specific area he concentrates on each year, exposure to the full variety of thoracic surgery is obtained each year rather than operating in isolation during each year of training.

An active outpatient clinic is maintained in the University Hospital. At the University Hospital, the outpatient clinics are run by individual faculty members and the resident on that faculty member’s service is expected to attend clinic for postoperative follow-up of his patients.

At Loma Linda University Medical Center, the senior cardiothoracic surgery resident administers resident responsibilities. Any clinical or research fellows and the junior thoracic residents are distributed according to the discretion of the senior resident in thoracic surgery. The senior and junior thoracic residents have preference in case selection over fellows.

The thoracic surgery resident always has the option of first assisting if he/she does not perform the operation as the primary surgeon. The only exceptions to this are when two attending surgeons may perform a very difficult or unusual case. Even then, the thoracic surgery resident second assists.