Thoracic Surgery Residency Program

Second Year

GOALS AND OBJECTIVES: SECOND-YEAR RESIDENT
Narrative Description of Year Two Training: Adult General Thoracic Surgery
Goals and Objectives:
As chief resident for the general thoracic surgery service, the second-year resident:

Performs nearly the entire range of general thoracic operations.
Assumes responsibility for the preoperative, perioperative, and postoperative care of the patients on the thoracic surgery service and in directing the general surgery resident on the service.
Coordinates the outpatient thoracic clinic in the Allegheny Center for Lung and Thoracic Disease.
Assumes independent completion of very complex cases.
Refines decision processes for treatment of thoracic disease.
Directs the general thoracic surgery team.

Duties: The second year resident assumes senior responsibility for the general thoracic service at Allegheny General Hospital. The senior resident has no in-house call assignments but generally stays in the hospital until all operations are completed and all patients are stable.

In addition to the advanced surgical and patient care capabilities which the senior resident is expected to bring to the clinical service, the senior resident must acquire and demonstrate the didactic and administrative skills necessary for directing the entire patient care team during the surgical admission. This includes oversight of the day-to-day function of the thoracic surgery residency program and responsibility for the quality of patient care on the service. The senior resident supervises the year one thoracic surgery residents, general surgery residents, and any medical students on the service.
Each senior resident serves as the administrative chief of the service for six months and is responsible during that period for the administrative duties of the program which includes the scheduling of Tuesday academic teaching conferences, administering vacation and leaves of absence for the resident staff, and details relating to the completion of evaluations of the general surgery residents under their supervision. Each afternoon the chief resident reviews the operative schedule for the next day and adjusts assignments, if necessary, to cover temporary changes in personnel and case load (for example, in response to vacations or emergency cases).
The chief resident meets with all residents on the service each morning prior to going to the operating room to receive reports on the overall status of the patients and to discuss new admissions as well as any specific problems. In this way, the chief resident has continuous direct input into the management of patients and the supervision and instruction of all residents on the service. The Chief residents are responsible for coordinating the monthly mortality and morbidity conferences for the

Divisions of Cardiac and General Thoracic Surgery.
Types of Exposure: See Year One, above.

Preoperative Evaluation: The second year resident is expected to supervise the function of the physician assistants, the nurse practitioners, the thoracic surgery year one residents, and the general surgery residents in performing preoperative evaluations on all patients. In general, the chief resident is a resource for these subordinate individuals and is in the line of communication between the subordinate individuals and the attending surgeons. The subordinate individuals are free to discuss problems and issues with the attending surgeons, but they must make the second year resident aware of any important issues and decisions.

Operative Experience: The second year resident in general thoracic surgery has the opportunity to perform all of the index general thoracic procedures required by the American Board of Thoracic Surgery. These include operations on the lungs, pleura, and chest wall including pneumonectomy, lobectomy, and segmentectomy procedures. The chief resident also perform operations on the esophagus, mediastinum and diaphragm including esophageal resections, operations for reflux esophagitis and thymectomies. The second year resident is expected to participate in all of the most complex procedures.

Postoperative Care: The chief resident functions as the primary resource individual and supervisor for all postoperative care. S/he makes rounds on all patients in the intensive care unit twice a day and receives reports on patients who have been discharged from the intensive care unit with unresolved or potential problems. The second year resident will normally see and evaluate these patients.
Completion of the Program

At the conclusions of this residency education program in Cardiothoracic Surgery, the successful resident will:

Have a thorough understanding of all components of cardiac and thoracic diseases including diagnostic, therapeutic, and management options.
Be able to develop a diagnostic and therapeutic plan for a wide spectrum of surgical diseases.
Have the medical knowledge, operative skills and judgment, and leadership to perform common adult cardiac, pediatric cardiac and thoracic surgical procedures with minimal supervision and be the operating surgeon on complex procedures assisted by the surgical attending.
Organize staff conferences as well as departmental conferences as assigned.
Mentor to general surgery residents, thoracic surgery residents, medical students.
Critique personal practice outcomes and demonstrate recognition of the importance of lifelong learning in surgical practice.
Communicate effectively with other health care professionals, counsel and educate patients and families, and effectively document practice activities.
Maintain high standards of ethical behavior, demonstrate a commitment to continuity of patient care, and demonstrate sensitivity to age, gender and culture of patients and other health care professionals.
Practice high quality, cost effective patient care; demonstrate knowledge of risk-benefit analysis; and demonstrate an understanding of the role of different specialists and other health care professionals in overall patient management.

GOALS AND OBJECTIVES: SECOND-YEAR RESIDENT

Narrative Description of Year Two Training: Adult Cardiac Surgery

Goals and Objectives:
The resident will:

Refine skills in adult myocardial revascularization procedures, performing triple and quadruple bypass procedures in non-reoperative patients with facility.
Become expert in reoperative sternotomy B both opening and closing.
Become facile with valve operations, performing both aortic and mitral replacement and mitral valve repair procedures.
Participate as first assistant in the most complex cardiac procedures including multiple valve procedures combined with myocardial revascularization.
Be familiar and skilled with minimally invasive approaches to selected cardiac surgical procedures.
Participate in the majority of thoracic aorta replacement and repair procedures and should develop specific knowledge in this specialized area, including preoperative, perioperative, postoperative and intraoperative skills.
Demonstrate responsibility for the administration of the service including participation in the education of medical students, general surgery residents, and subordinate cardiothoracic residents.
Demonstrate the ability to direct the entire cardiothoracic surgical team in the preoperative, operative and postoperative care of the patient, including outpatient consultation.

Types of exposure: See Year One, above.

Duties: The second-year resident assumes senior responsibility for the thoracic surgery service at Allegheny General Hospital. The second year resident does not take in-house call assignments but normally stays in the hospital until all operations are completed and all patients are stable. In addition to the advanced surgical and patient care capabilities which the senior resident is expected to bring to the clinical service, the senior resident must acquire and demonstrate the didactic and administrative skills necessary for directing the entire patient care team during the surgical admission. This includes oversight of the day-to-day function of the thoracic surgery residency program and responsibility for the quality of patient care on the service. The senior resident supervises the year one thoracic surgery residents, general surgery residents, and any medical students on the service.

Each senior resident serves as the administrative chief of the service for six months and is responsible for the administrative duties of the program which includes the scheduling of Tuesday academic teaching conferences, administering vacation and leaves of absence for the resident staff, and details relating to the completion of evaluations of the general surgery residents under their supervision. Each afternoon the chief resident reviews the operative schedule for the next day and adjusts assignments, if necessary, to cover temporary changes in personnel and case load (for example, in response to vacations or emergency cases).

The chief resident meets with all residents on the service each morning prior to going to the operating room to receive reports on the overall status of the patients and to discuss new admissions as well as any specific problems. In this way, the chief resident has continuous direct input into the management of patients and the supervision and instruction of all residents on the service. The Chief residents are responsible for coordinating the monthly mortality and morbidity conferences for the Divisions of Cardiac and General Thoracic Surgery.

Preoperative evaluation: Chief resident responsibilities for preoperative evaluation and documentation for cardiac surgery patients are similar to those of the year one resident (above.) The second year resident supervises the function of the physician assistants and the residents on the service in performing preoperative evaluation on all patients. In general, the chief resident is the resource for the subordinate individuals and is in the line of communication between the residents and the attending surgeons. The first year residents are free to discuss problems and issues directly with the attending surgeons, but they must make the chief resident aware of any important issues and decisions. The cardiac chief resident is responsible for coordinating the outpatient cardiac clinic held each Tuesday.

Operative Experience: During the chief year, the resident refines skills in adult myocardial revascularization procedures, routinely performing triple and quadruple bypass procedures in non-reoperative patients. Facility in the use of alternative bypass conduits, such as the radial artery, is developed. The resident should rapidly develop facility with cardiac valve operations, performing both aortic and mitral valve replacement as well as mitral valve repair procedures.

The resident now begins to develop expertise in reoperative sternotomies B both opening and closing. The resident takes an increasing role in the most complex cardiac procedures including multiple valve procedures combined with myocardial revascularization. Minimally invasive approaches to cardiac surgical problems are explored, along with the criteria for patient selection and management. The resident also assists in thoracic aortic repair and replacement procedures and reviews the knowledge base in this specialized area. Residents are expected to work with the thoracic vascular team to develop experience with endovascular techniques for thoracic aorta repair.

The requirements for supervision of all residents on the cardiothoracic services during emergencies and postoperative care of the patient are summarized on a document provided to all residents and faculty and to the institution.

GOALS AND OBJECTIVES: SECOND-YEAR RESIDENT

Narrative Description of Year Two Training: Adult General Thoracic Surgery

Goals and Objectives:

As chief resident for the general thoracic surgery service, the second-year resident:

Performs nearly the entire range of general thoracic operations.
Assumes responsibility for the preoperative, perioperative, and postoperative care of the patients on the thoracic surgery service and in directing the general surgery resident on the service.
Coordinates the outpatient thoracic clinic in the Allegheny Center for Lung and Thoracic Disease.
Assumes independent completion of very complex cases.
Refines decision processes for treatment of thoracic disease.
Directs the general thoracic surgery team.

Each senior resident serves as the administrative chief of the service for six months and is responsible during that period for the administrative duties of the program which includes the scheduling of Tuesday academic teaching conferences, administering vacation and leaves of absence for the resident staff, and details relating to the completion of evaluations of the general surgery residents under their supervision. Each afternoon the chief resident reviews the operative schedule for the next day and adjusts assignments, if necessary, to cover temporary changes in personnel and case load (for example, in response to vacations or emergency cases).

Types of Exposure: See Year One, above.