Updated June 2019
CARDIOTHORACIC SURGERY – PGY-3 & 4 Resident
A. Medical Knowledge
Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of a variety of disease processes. The resident will be exposed to patients with a wide variety of medical and surgical conditions and become comfortable with the initial evaluation and stabilization of patients and be able to assess the surgical options.
Objectives: The resident will be able to…
1) Discuss the indications and contraindications for cardiac and thoracic surgery.
2) Discuss the surgical interventions including risks and technical details used to treat the following cardiovascular events:
a. Myocardial infarction
b. Arrhythmias
c. Unstable angina
d. Cardiogenic shock
e. Cerebrovascular accidents
f. Transient ischemic attacks
3) Discuss the surgical interventions including risks and technical details used to treat the following thoracic diseases:
a. Pulmonary malignancies
b. Esophageal malignancies
c. Refractory esophageal reflux
d. Empyema
e. Pleural effusion
f. Emphysema
4) Discuss the physiology and methodology of cardiopulmonary bypass.
5) Discuss the physiology and methodology of extracorporeal membrane oxygenation (ECMO) and describe the technical details and options for instating ECMO.
6) Discuss the circumstances in which cardiothoracic surgery can be performed off of cardiopulmonary bypass.
7) Recite the basic details including value and risks of various technical options of commonly performed cardiac operations, including:
a. Coronary artery bypass grafting
b. Cardiac valve replacement
c. Thoracic aneurysm repair
d. Cardiothoracic transplant
8) Recite the basic details including the value and risks of various technical options of commonly performed thoracic operations, including:
a. Pulmonary resections
b. Lung transplantation
c. Nissen fundoplication
d. Esophageal resection
e. Thymoma
9) Discuss the basic understanding of pacemakers and defibrillating devices and describe the various methods of placement including relative risks.
10) Discuss the pathophysiology, evaluation, and management of cardiogenic shock and describe the indications for the surgical intervention options for management of cardiogenic shock.
11) Recite the indications and contraindications for cardiac and pulmonary transplantation.
12) Discuss the details of immunotherapy for cardiac transplant surgery.
13) Discuss the diagnosis and treatment of acute and chronic rejection of heart and lung transplants.
14) Discuss the details of the processes of organ donation in the United States.
a. OPTN, UNOS, and CMS
b. Organ availability
c. Donor requirements
15) Discuss and interpret esophageal manometry, pH studies, spirometry, and measurement of diffusing capacity.
16) Recite the staging of esophageal and lung malignancies and discuss the role and timing of surgical intervention for those lesions.
17) Discuss the role and benefits of minimally invasive surgical approaches to:
a. Nissen fundoplication
b. Esophagectomy
c. Lung biopsy
d. Lung resection
18) Describe the operative procedure defined for these procedures:
a. Nissen fundoplication
b. Esophagectomy
c. Lung biopsy
d. Lung resection
19) Participate in the care of patients including management of arrhythmias and the anticoagulation of cardiac patients.
20) Describe the effectiveness, risks, and benefits of various arrhythmia treatments.
B. Patient Care Goals
Goal: The resident will provide patient care that is compassionate, appropriate, and effective for the treatment of cardiothoracic problems.
Objectives: The resident will be able to…
1) Perform pre-operative evaluation and prepare cardiac and pulmonary patients for surgery.
Assess the risks and benefits of the various surgical options and approaches applicable to the patient’s condition.
2) Interpret laboratory and diagnostic studies.
3) Interpret EKG changes specific for the operative patients including using atrial electrogram recordings to diagnose arrhythmias.
4) Care for patients with postoperative dysrhythmias.
Implement atrial pacing including rapid pacing for rhythm control when appropriate.
5) Maintain ACLS certification.
6) Care for patients with post-operative hemodynamic problems.
Choose appropriate pharmacological interventions for hemodynamic management.
7) Participate in the diagnosis and treatment of postoperative cardiac and thoracic complications.
8) Discuss the various treatment options for specific complications and their effectiveness and value.
9) Participate and perform under direct supervision in the operative therapy of acquired diseases of the lungs and mediastinum including the use of traditional operative therapy and endoscopic therapy, including:
a. Thoracotomies
b. Thoracostomies
c. Thoracoscopic and laparoscopic procedures
d. Bronchoscopies
e. Esophagoscopies
10) Interpret radiographic studies of the chest (e.g. x-ray, CT) for thoracic diagnoses.
11) Perform, with graduated surgical independence, the following thoracic surgical procedures:
a. Thoracentesis
b. Insertion of pleural drainage catheters
c. Placement of chest tubes
d. Bronchoscopy
e. Esophagoscopy
C. Practice-Based Learning and Improvement
Goals: The resident will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and improve patient care practices.
Objectives: The resident will be able to.
1) Use standard textbooks and available literature to determine the appropriate care for patients.
2) Routinely analyzes the effectiveness of own clinical practice and surgical outcomes in the care the cardiothoracic surgery patient.
3) Develops surgical technical skills and improves clinical outcomes by integrating appropriately gathered data and feedback.
4) Reports to faculty findings and suggestions regarding physical examination, diagnostic workup, and surgical management of cardiothoracic surgery patients.
5) Reviews patient clinical status including laboratory and radiologic studies with an appreciation of their value.
6) Exhibits appropriate use of library sources, office files, and space files, in the performance of research and literature searches.
7) Understand the principles of clinical research and the application of biostatistics.
D. Interpersonal and Communication Skills
Goal: The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, families, and other healthcare professionals.
Objectives: The resident will be able to…
1) Refine communication and interpersonal skills for effective exchange of information with patients and their families regarding follow-up strategies and rehabilitation in consultation with faculty.
2) Demonstrate communication and interpersonal skills required for effective communication with other members of the cardiothoracic surgery team.
3) Assume a leadership role in the management of the service while continuing to acknowledge and value the input of the other team members.
4) Exhibit confidence in ability to discuss various cardiothoracic diagnoses, treatment (surgical and non-surgical) options available, and the risks and benefits of each.
5) Attune to circumstances and/or patient characteristics that may require customized communication so patient gains adequate understanding of diagnosis, prognosis, and future care needs.
6) Function as a cardiothoracic surgery consultant with graduated independence.
7) Demonstrates compassion, sensitivity, and effectiveness in the delivery of bad news to patients and families.
E. System Based Practice
Goal: The resident will demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to optimize patient care and outcomes.
Objectives: The resident will be able to…
1) Independently coordinate all aspects of the preoperative and postoperative care and rehabilitation of the cardiothoracic surgery patient.
2) Demonstrate awareness of how health systems operate and utilize appropriate resources in the coordination of care.
3) Direct the rehabilitation of patients after cardiothoracic surgery through partnerships with other healthcare professions:
a. Physical therapist
b. Occupational therapist
c. Nurse practitioner
d. Physician assistant
e. Primary care/Consultant physicians
f. Social workers
g. Nutritionists/Dieticians
4) Demonstrates knowledge of cost-effective care practices in cardiothoracic surgery.
5) Develops a cost-effective, focused diagnostic work-up. Limit the use of unnecessary diagnostic tests/studies. Avoid duplication of previously performed studies (unless indicated) to minimize health care costs. Implements details of perioperative core protocols to achieve this goal.
6) Facilitate with faculty guidance the timely discharge and/or placement of cardiothoracic patients.
Goal: The resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
Objectives: The resident will be able to…
1) Develop sensitivity/awareness of unique stresses placed on the patient and families with cardiothoracic disease.
2) Exhibit unselfish regard for the welfare of patients.
3) Demonstrate firm adherence to a code of moral and ethical values.
4) Be respectful to patients and their families especially during times of stress.
5) Integrates other members of the cardiothoracic surgery team in patient care.
6) Provide appropriately prompt consultations when requested.
7) Demonstrate sensitivity to individual patient’s profession, life goals, and cultural background and how they apply to cardiothoracic surgery.
8) Is punctual, reliable, and accountable for actions in the operating room as well as inpatient and outpatient settings.
9) Understand the concepts of autonomy, beneficence, non-maleficence, justice and respect for life.
10) Maintain patient confidentiality.
Additional Objectives for the Intern level:
• Abdominal esophagectomy
• Nissen
• Interpretation of cath lab images
• Swan Interpretation and removal
• Second hand/spatial laparoscopic /thoracoscopic awareness