Thoracic Surgery 6-Year Integrated Training Program - Program Description

The 6-year Integrated Cardiothoracic Surgery Residency Program at the Medical College of Wisconsin accepts residents who have graduated from an LCME accredited medical school or are ECFMG certified. The program is divided into three parts based on level of training. The first two post-graduate years are considered the junior resident years, the third and fourth post-graduate years are considered the mid-level resident years, and the fifth and sixth post-graduate years are considered the chief resident years. The curriculum for each year is outlined below.

Post-graduate Years 1 and 2 (Junior Residents)
The first two years of the program are considered the junior resident years. During these two years the resident will receive a broad training in both medical and surgical specialties.

During the PGY-1 year, the resident is expected to learn basic concepts of pre- and postoperative patient care, learn to manage medical conditions common to the cardiothoracic surgical patient, learn to interpret diagnostic tests commonly ordered for the cardiothoracic surgery patient, learn to identify critically ill patients and understand concepts in their care, and learn and develop basic surgical technical skills. Rotations include adult cardiothoracic surgery, general surgery, trauma surgery, vascular surgery, pulmonary medicine, cardiology, and echo lab/cath lab.

During the PGY-2 year, the resident will continue to build on the skills learned during the first year and show the ability to accept increasing responsibility in the management of patients, specifically in the ability to diagnose conditions and develop management plans. Additionally, the resident will continue to develop technical skills and be expected to become more involved in performing cases. Rotations include adult cardiac surgery, general thoracic surgery, general surgery, transplant surgery, and medical intensive care and will expose the resident to high operative case volumes of straightforward cases as well as significant exposure to critically ill patients.

Post-graduate Years 3 and 4 (Mid-level Residents)
The third and fourth years are considered the mid-level resident years. By this point, the resident is expected to have mastered a basic surgical skill set and understand core concepts in the management of both straightforward and critically ill patients. During these years the resident will have increased exposure to cardiothoracic surgery and begin to hone the technical skills needed for this specialty. Additionally, responsibility will continue to increase and the resident will begin to develop the leadership skills needed to head a team and function as a chief resident.

During the PGY-3 year, the resident will spend two months on adult and congenital cardiothoracic surgery and begin learning and becoming more involved in cardiothoracic surgical procedures. Skills such as opening and closing sternotomies and thoracotomies, cannulation for cardiopulmonary bypass, and hilar dissection will be mastered over this period. If the complexity of the operation is beyond the experience of the resident, the attending surgeon will perform the operation with the resident functioning as first assistant. Additionally, residents will be more involved in the surgical decision making process and will review the preoperative patient history and physical findings and all relevant imaging studies with the attending staff, and participate in diagnosis and treatment planning. Four months of this year will be spent rotating on Interventional Radiology and the Cardiac Catheterization Lab. During these months, the resident will gain experience in catheter and guidewire based technique. They will perform diagnostic arteriography, angioplasty and stenting. They will also understand the selection of patients with abdominal or thoracic aortic pathology suitable for stent-graft repair and participate in the placement and deployment of these devices. Two months will be spent on the solid organ transplant service where the resident will gain experience in the management of transplant patients and learn transplant immunology. Additionally, as this is a high volume vascular access service, the resident will be allowed to perform a large number of vascular anastomoses.

During the PGY-4 year, the resident will spend the entire year rotating between dedicated general thoracic surgery, adult cardiac surgery, congenital cardiac surgery, and a mixed adult cardiothoracic surgery service at the VA. The resident will be expected to be able to independently review preoperative studies and develop a surgical treatment plan. The resident will assume primary responsibility for the postoperative and outpatient patient management. Residents will continue to develop their technical skills and they will perform as the primary surgeon with direct attending supervision or if the case is technically demanding they will function as first assistant. They are expected, especially when acting as first assistant, to understand the sequence of the operation and anticipate needs. On some of the services they will function as the chief resident and continue to develop leadership skills and demonstrate the ability to lead a medical team consisting of junior residents, physician extenders, and medical students.

Post-graduate Years 5 and 6 (Chief Residents)
During the PGY-5 and the PGY-6 years, the resident will assume chief level responsibility on all services they rotate on. Over these two years they will spend 6 months on adult cardiac surgery, 8 months on general thoracic surgery, 8 months on a mixed cardiac and thoracic surgery service at the VA, and 2 months on the pediatric cardiac surgery service. As chiefs, they will be expected to assume responsibility for all phases of patient care including the preoperative assessment, surgical planning, postoperative management, and outpatient follow-up. They will act as primary surgeon on all cases and even with more technically demanding cases they will perform the majority of the operation. When acting as primary surgeon, they will be expected to display the ability to confidently lead the operating room team and also display the ability to plan the sequence of operating room events so as to keep the operation moving. They will also continue to master the leadership skills necessary to lead the medical care team. The ultimate goal of these years is to ensure that the resident fully master the skills required of a cardiothoracic surgeon including mature surgical decision making and sound surgical technique. This will ensure that the resident can safely enter the discipline of cardiothoracic surgery and practice independently.

Conferences
In addition to conferences which are specific to the various rotations, there are three service wide weekly conferences; Thoracic Grand Rounds/M&M, Thoracic Pre-op Case Conference, and Thoracic Core Curriculum. During the first two years of residency the thoracic resident will also participate in the General Surgery Core Curriculum. Attendance at these conferences is mandatory regardless of rotation.

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
414-955-8296
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