Integrated Cardiothoracic Surgical Training Program

The field of Cardiothoracic Surgery has evolved tremendously over the decades, offering patients many more open and non-invasive treatment options for all intra-thoracic diseases.  It is clearly more complex and increasingly depends on a multi-disciplinary team approach.  Hence, the overarching objective of this novel training program is to provide a more comprehensive and rational total immersion in the diagnosis and management of all aspects of cardiovascular and thoracic diseases through multi-disciplinary training that better prepares the candidate for these new challenges. As technology relentlessly evolves, conventional open surgical treatments are giving way to less invasive strategies, more frequently involving percutaneous devices (such as coronary artery stents, peripheral arterial stenting, endovascular stent-grafts for aneurysmal disease, and placement of transcatheter aortic valves) or robotic or videoscopic/thoracoscopic/endoscopic tools for minimal access approaches. The next generation of cardiothoracic surgeons must be proficient in traditional open surgical procedures as well as be facile using these new approaches.

This unique integrated program curriculum, including rotations in interventional radiology, interventional cardiology, and endovascular surgery, will provide our residents with background and experience using these new tools in order to build a career as future "cardiovascular specialists." This integrated training program can be completed in less time than the current training paradigm that requires completion of general surgical training prior to commencing a two to three year cardiothoracic surgical residency.  Despite the fact that eight years of post-graduate residency specialty training still represents a major time investment, having the entire residency dedicated to what the trainees will be doing for the rest of their careers will produce better trained surgeons and be more gratifying for the trainees.

 

In addition to offering more rational, better focused, and more comprehensive training for future cardiothoracic surgeons in a more effective educational framework, this integrated curriculum will proffer less onerous work weeks and a healthier lifestyle balance for the residents. With the emphasis on multi-disciplinary training, enhanced teamwork, and less burdensome staffing demands, compliance with resident duty hour limitations* will be enhanced.

*The program will maintain compliance with the duty hour standard. The RRC-TS granted an 80 hour (average) work week restriction in July 2006.

In the first two years, the curriculum is based on broad training in both surgical and medical specialties.

R1 Objectives

• learn and practice the basic concepts of preoperative and postoperative patient care
• learn to identify and care for critically ill patients
• develop basic surgical technical competence

R1 Clinical Rotations

• adult cardiac surgery
• general surgery
• trauma surgery
• vascular surgery
• thoracic surgery
• CVICU
  
• cross-sectional (CT/MR) radiology imaging
• echocardiography

R2 Objectives

• gain increased responsibility in preoperative and postoperative patient care, specifically in diagnosing conditions and developing treatment plans
• become more technically proficient and skilled in basic surgical procedures

R2 Clinical Rotations

Integrated into the R2 year, residents will rotate on services that allow development of technical skill sets necessary to practice percutaneous interventions and endovascular surgery. 

• adult cardiac surgery
• general surgery
• cardiac anesthesia
• thoracic surgery
• transplantation
• perfusion/cardiac anesthesia

Location of Rotations (both R1 and R2)

• Stanford University Medical Center
• Palo Alto VA Medical Center
• Santa Clara Valley Medical Center
  

Conferences and Exams (both R1 and R2)

The first- and second-year trainees are expected to follow the cardiothoracic surgery core curriculum and attend mandatory teaching conferences including resident didactic teaching conferences, wet labs, journal club, and morbidity and mortality conferences. The residents will also participate in other service-specific teaching conferences while on any given rotation. In addition, the residents will take the yearly ABTS In-training Examinations, with the exception of the interns who take the ABSITE their first year in the program.

R3 Objectives

In the R3 year, the resident begins senior level training in cardiothoracic surgery and will:

• review preoperative patient history and physical findings and all relevant imaging studies with the attending staff
• participate in diagnosis and treatment planning
• learn and perform basic cardiovascular and thoracic surgical procedures under attending staff supervision (If the complexity of the operation is beyond the experience and ability of the resident, the attending surgeon will perform the operation with the resident functioning as first assistant.)
• be responsible for postoperative care of patients on their service
• spend two months on the Stanford Vascular Surgery Endovascular Rotation, which includes:
  • training in advanced catheter and guidewire skills
  • performance in diagnostic arteriography, angioplasty and stenting
  • selection and treatment of appropriate patients with abdominal or descending thoracic aortic aneurysms for endovascular stent-graft repair

R3 Clinical Rotations

• adult cardiac surgery
• thoracic surgery
  
• interventional cardiology service, participating in diagnostic catheterizations and angioplasty/stent placements.
• vascular and endovascular
• transplantation

The departmental goal is to train future world leaders in academic cardiothoracic surgery.

Objectives

The academic enrichment experience is designed to provide residents with a great deal of flexibility to pursue:

• scholarly research in basic science investigation
• clinical or clinical outcomes research
• or a variety of advanced degrees in epidemiology, basic science, education, or public health
  
  

Operative Simulator

The residents will have the opportunity to spend time using our operative simulator throughout the residency but will be expected to utilize this technical training facility during these academic enrichment years.

Conferences and Exams

The resident is expected to follow the cardiothoracic surgery core curriculum and attend all mandatory teaching and didactic conferences and take the yearly ABTS In-training Exam.

Note

These two years are not a formal part of the ACGME-mandated training program; financial support for the residents' stipends during these two years will be provided through research training grants or other, non-hospital, sources. The department supports a variety of advanced degrees, therefore, the years in research may vary.

The last three years of training are devoted to the surgical, percutaneous, and minimally invasive treatment of acquired and congenital cardiovascular disorders and non-cardiac thoracic diseases.

Part II Clinical Rotations

Residents rotate through services at both a junior and a chief resident level.  This strategy will foster progressive operative responsibility.

Part II Location of Rotations

In addition to rotations at Stanford University Hospital, Lucile Packard Children’s Hospital, and the Palo Alto Veteran’s Administration Hospital, we have added rotations at:

• Oakland Children’s Hospital for pediatric cardiac surgery
  
• Santa Clara Valley Medical Center for non-cardiac thoracic surgery
• Providence St. John’s Health Center for thoracic surgery (optional)
  

These additional hospitals provide the resident with high volume, common clinical cases, complementing the complex tertiary care cases seen at Stanford and Packard Hospitals. Each affiliate hospital is staffed with dedicated cardiothoracic surgery staff consisting of Stanford-affiliated, full-time faculty members.

Part II Conferences and Exams

All R4 through R6 residents are expected to follow the cardiothoracic surgery core curriculum and attend mandatory conferences including resident didactic teaching conferences, wet labs, journal club, and morbidity and mortality conferences. In addition, the residents will take the yearly ABTS In-training Examinations.

R4 Objectives and Clinical Rotations

In the R4 year, the resident will:

• assume chief resident level responsibility while rotating on the pediatric cardiac and non-cardiac thoracic surgery services
• assume primary responsibility in preoperative surgical planning and postoperative and outpatient patient management
• perform as the primary surgeon with direct attending supervision while on the thoracic surgery service
• on the pediatric cardiac service, perform cases appropriate for this level of training
• spend three months on the Stanford Vascular Surgery Endovascular Rotation, which includes:
  • training in advanced catheter and guidewire skills
  • performance in diagnostic arteriography, angioplasty and stenting
  • selection and treatment of appropriate patients with abdominal or descending thoracic aortic aneurysms for endovascular stent-graft repair
  • pediatric cardiac surgery

R5 Objectives and Clinical Rotations

In the R5 year, the resident will:

• assume chief resident level responsibility for adult cardiac and thoracic surgery, including preoperative planning and postoperative management
• act as primary surgeon on appropriate level cases and first assistant for complex cases
• spend three months on the transplantation service, participating in recipient and donor selection, operative and postoperative management, and the treatment of postoperative complications
• perform donor procurements, non-redo heart and lung transplants, and ventricular assist device management

R6 Objectives and Clinical Rotations

In the R6 year, the resident will:

• rotate as the chief resident on the three adult cardiac services at Stanford Hospital. In addition to basic and complex adult cardiac cases, residents will be exposed to specialized thoracic and thoracoabdominal aortic surgery, including open techniques and endovascular repairs
• develop technical skills in these areas, as well as understand:
  • the natural history of the disease processes
  • indications for treatment
  • treatment alternatives and options
  • complications
  • postoperative management

Wet lab training happens within our Falk CV Surgery Research laboratory. Training sessions are held quarterly and led by faculty instruction. The focus of training is on technical skills such as proper handling of surgical instruments, education on directional sewing and suture control,  valve replacement, root replacement, etc. The lab is also available for residents to use ad hoc whenever requested.

(SUNet ID required. Please contact StanfordCTSIMLab@stanford.edu for access)

To the right is a screenshot of examples of these teaching sessions.

For our current residents, please see the Didactic Schedule (SUNet ID required)