Prerequisite Training in Cardiothoracic Surgery (PGY 1-3)
The first three years of the curriculum are designed to provide broad training in both surgical and medical specialties, with a graduated level of responsibility and patient complexity. Rotations during the PGY 1, 2, and 3 years are selected at UNC Hospitals (Chapel Hill ) and at WakeMed Medical Center (Raleigh, NC). These rotations were selected on the basis of high clinical volume and excellent hands-on experience. The UNC General Surgery program has a long-standing relationship with the WakeMed program. The length of the rotations are designed to coincide with the general surgery training program, typically 4 week rotations during the PGY-1 year, 6 week rotations during the PGY-2 year, and either 6- or 12-week rotations during the PGY-3 year.
In the PGY-1 year, the resident is expected to learn and practice the basic concepts of preoperative and postoperative patient care, learn to identify and care for critically ill patients, and develop competence in basic surgical skills. Clinical rotations include adult cardiac surgery, thoracic surgery, general surgery (WakeMed), surgical oncology, pediatric cardiac surgery, vascular surgery, cardiothoracic anesthesia, and gastrointestinal surgery.
In the PGY-2 year, the resident is expected to gain increased responsibility in preoperative and postoperative patient care, specifically in diagnosing conditions and developing treatment plans. There is an emphasis during this year specifically on pre and post operative care of the critically ill patient. The resident will be expected to become more technically proficient and skilled in basic surgical procedures. Clinical rotations include extensive intensive care experience in the cardiothoracic surgery intensive care unit (CTICU), the surgical intensive care unit (SICU), and the Respiratory/Medical ICU (RICU); further rotations on surgical rotations such as abdominal transplant, general surgery (WakeMed), GI surgery, and thoracic surgery; as well as an experience with upper and lower GI endoscopy.
In the PGY-3 year, the resident will begin to function at a more senior level, with continued responsibility in preoperative and postoperative patient care, but with increasing responsibility in the operative setting. The resident will be expected to become more technically proficient and skilled in more advanced surgical procedures. Clinical rotations include a senior level experience in general surgery at WakeMed, as well as senior level experiences on surgical oncology and pediatric surgery. Residents will gain basic endovascular skill as well as learn the basics of operative vascular surgery. They will also continue to rotate on both the thoracic and cardiac surgery services learning fundamentals of operative thoracic and cardiac surgery. There is also a rotation in cardiac catheterization and cardiac echocardiography.
In all years (PGY 1-3), the resident is expected to follow the cardiothoracic surgery core curriculum (as per the Thoracic Surgery Directors Association) and attend mandatory teaching conference including resident didactic teaching conferences, simulator labs, journal clubs, and morbidity and mortality conference. The resident will also participate in service specific teaching conferences. The resident will take the annual American Board of Surgery Intraining Examination for his or her level of training.
Requisite Clinical Training in Cardiothoracic Surgery (PGY 4-6)
The last three years of training are devoted to the surgical, percutaneous, and minimally invasive treatment of acquired and congenital cardiac disease, thoracic and esophageal disease, and vascular disease. The rotations are designed so that the residents rotate through cardiac and thoracic surgery each year with progressive responsibility at the senior resident and, finally, chief resident level. In addition, there is a three-month block in the PGY-5 year for the resident to focus on an area of his or her choosing for addition training in either adult cardiac, congenital cardiac, thoracic/esophageal surgery, or vascular/endovascular surgery. The resident will have extensive exposure to heart and lung transplantation during this time period as well. All rotations during the PGY 4-6 years are at UNC Hospitals. The length of rotations are either three or six months during the PGY 4-6 years.
In the PGY-4 year, the resident will serve as a senior resident on GI surgery and vascular surgery, gaining experience with open and minimally invasive esophageal surgery and more complex open and endovascular surgery, respectively. On thoracic and cardiac surgery, senior level training will begin. On these services, the PGY-4 will go over the preoperative patient history and physical findings and all relevant imaging studies with the attending staff, and participate in diagnostic and treatment planning. Residents will learn and perform basic cardiovascular and thoracic surgical procedures. If the complexity of an operation is beyond the experience and ability of the resident, the attending surgeon will perform the operation with the resident functioning as the first assistant. During the thoracic and cardiac rotations, residents will also participate in thoracic transplantation in the areas of donor and recipient selection, as well as donor procurements. The resident will be responsible for the postoperative care on his or her respective service.
In the PGY-5 year, the resident will function at the senior level, with continued levels of increasing operative expectations. The resident will function as the primary surgeon with direct attending supervision while on the thoracic surgery service. On the pediatric cardiac service, residents will function as first assistants, and perform cases appropriate for their level of training. On cardiac surgery, residents will act as primary surgeon on appropriate level cases and first assistant for complex cases. Residents will also participate in thoracic transplantation in the areas of donor and recipient selection, operative and post-operative management, and the treatment of postoperative complications. Furthermore, residents will continue to perform donor procurements, as well as non-redo heart and lung transplants, and participate in ventricular assist device management. In addition, the PGY-5 year affords three months of elective time for a rotation of the resident’s choosing in adult cardiac surgery, thoracic surgery, vascular surgery, or pediatric cardiac surgery.
In the PGY-6 year, the resident will function, for six months each, as the chief resident on adult cardiac surgery and on thoracic surgery. In addition, the resident will be the administrative chief resident for the residency program. Residents will be involved in all aspects of patient care, including preoperative planning and postoperative management. Residents will function as primary surgeon on both basic and complex level thoracic and adult cardiac surgical cases.
In all years (PGY4-6), the resident is expected to follow the cardiothoracic surgery core curriculum and attend mandatory teaching conference including resident didactic teaching conferences, simulator labs, journal clubs, and morbidity and mortality conference. The resident will also participate in other service specific teaching conferences, such as the heart and lung transplant selection conferences, ventricular assist device conference, and multidisciplinary tumor conference. The resident will take the annual American Board of Thoracic Surgery (ABTS) Intraining Examination.