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THORACIC SURGERY
3rd YEAR RESIDENT
CURRICULUM GOALS AND OBJECTIVES
for the
CARDIAC SURGERY ROTATION
PEDIATRIC CARDIAC SURGERY ROTATION
THORACIC SURGERY ROTATION
RESIDENT EDUCATION IN THORACIC SURGERY
Provided below are the specific educational objectives, and clinical skill acquisition goals for residents within the
Vanderbilt University Medical Center Residency Program in Thoracic Surgery. The program is under the auspices of the
Residency Review Committee for Thoracic Surgery of the Accreditation Council for Graduate Medical Education
(ACGME), and supported by faculty and staff within the Department of Thoracic Surgery and the Department of Cardiac
Surgery.
Medical Knowledge (Learner Objectives) and Clinical Skills (Patient Care) follow. This list is meant to be a starting point
for the Thoracic Surgery Resident and is not meant to preclude additional reading or independent study nor limitation of
time within the operating room, general care wards, or the outpatient clinic.
Learner Objectives will be taught / learned through various means including:
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The TSDA (Thoracic Surgery Directors Association) Comprehensive Requisite Thoracic Surgery Curriculum
o specific lectures pertaining to these topics. The web address is: http://67.94.140.20/navigation/crc_toc.htm
Didactic and other conferences
o posted in the Thoracic Surgery departmental area
o posted on the web site http://www.mc.vanderbilt.edu/surgery/thoracic
Perioperative and operative management
Self-education and reading
Faculty demonstration of ACGME core competencies coupled with resident counseling on a daily, or as needed, basis
EVALUATION
Evaluation of the Thoracic Surgery Resident’s understanding of the topic will be reviewed (in part) at the time of operation,
or resident-faculty interaction, which exemplifies these topics. Feedback will be verbal and immediate.
Faculty will evaluate the Thoracic Surgery Residents based upon stated objectives as part of the ACGME core
competencies. These portions of the curriculum will be viewed as “Medical Knowledge” and “Patient Care [e.g. operative
skills, and perioperative management, etc.]. Faculty will evaluate residents at the end of the rotation, in writing, based
upon these objectives and the ACGME core competencies. Additional evaluations will be conducted for operative skill
performance (faculty evaluating residents), and operative skill education (residents evaluating faculty).
The remaining core competencies will be taught and evaluated as per the Goals and Objectives for Thoracic Surgery
Residents.
Residents will evaluate faculty teaching and education efforts as well as the rotation. Both will occur at the conclusion of
the rotation. The program will be evaluated annually.
Questions or comments can be directed to the Residency Coordinator or to Dr. Putnam, Program Director.
-2EVALUATION INSTRUMENTS:
The evaluation instruments are completed in the GME System. The evaluation instruments include:
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Faculty evaluation of Resident
Resident evaluation of Faculty
Resident evaluation of rotation
Resident evaluation of program
Daily feedback from faculty to resident
Didactic lectures
Patient care settings
o Operating room
o Intensive care unit
o General care wards
o Outpatient clinics
o Other
Non-patient care settings
o Other
OTHER COMMENTS / RESPONSIBILITIES
Daily rounds and patient care responsibilities will be assigned specific to the individual service. In general for the Adult
Services, daily rounds will include the General Care Wards and the Intensive Care Unit at the VA and the Vanderbilt
University Hospital.
Our residents are required to participate in
• Journal Club
• Resident Teaching Conference
• Cardiac Surgery Conference
• Thoracic Surgery Practice Management Improvement and Quality Improvement Conference
• Additional rotation specific didactic conferences
Residents are required to attend the Outpatient Clinic for their respective service at least one day per week which may
include either the VA, or Vanderbilt University Hospital, or both. This opportunity for outpatient clinic may be assigned.
EDUCATIONAL GOALS / CURRICULUM
Provided below are the specific educational goals for you in your specific year of training as it pertains to your individual
and residency education related acquisition of knowledge in the specialty of Thoracic Surgery. Each listing represents a
section of the Comprehensive Requisite Thoracic Surgery Curriculum.
-3I. CHEST WALL
A. Anatomy, Physiology and Embryology
Clinical Skills: During the training program the resident:
• Performs operations utilizing major chest wall flaps and the correct application of prosthetic materials.
B. Acquired Abnormalities and Neoplasms
Learner Objectives: Upon successful completion of the residency program:
• Knows the indications for and methods of prosthetic chest wall reconstruction (e.g., methyl-methacrylate,
Marlex®, Gortex®, Vicryl®, and Dacron® mesh);
• Knows the management of osteoradionecrosis of the chest wall.
Clinical Skills: During the training program the resident:
• Identifies the need for prosthetic replacement of the chest wall;
• Performs surgical reconstruction of chest wall defects.
C. Congenital Abnormalities and Thoracic Outlet Syndrome
Clinical Skills: During the training program the resident:
• Manages intraoperative and postoperative complications associated with the repair of congenital chest wall
abnormalities and thoracic outlet syndrome;
• Performs re-operations for thoracic outlet syndrome.
II. LUNGS AND PLEURA
B. Non-Neoplastic Lung Disease
Learner Objectives: Upon successful completion of the residency program:
• Knows the complications of lung resection and their management.
C. Neoplastic Lung Disease
Learner Objectives: Upon successful completion of the residency program:
• Understands the principles of bronchoplastic surgery.
Clinical Skills: During the training program the resident:
• Performs operations to extirpate neoplasms of the lung (e.g., segmental resection, pneumonectomy, sleeve
lobectomy, carinal resection, chest wall resection).
D. Congenital Lung Disease
Clinical Skills: During the training program the resident:
• Performs operations for congenital lung abnormalities and their complications.
E. Diseases of the Pleura
Learner Objectives: Upon successful completion of the residency program:
• Understands the treatment of benign and malignant diseases of the pleura.
Clinical Skills: During the training program the resident:
• Performs pleural stripping for mesothelioma.
III. TRACHEA AND BRONCHI
B. Congenital and Acquired Abnormalities
Learner Objectives: Upon successful completion of the residency program:
• Understands the etiology, presentation, diagnosis and management of tracheoesophageal fistulas and
tracheoinnominate artery fistulas;
• Knows the operative approaches to the trachea and techniques of mobilization;
• Knows the methods of airway management, anesthesia and ventilation for tracheal operations;
• Understands the complications of tracheal surgery and their management.
Clinical Skills: During the training program the resident:
• Performs tracheal resection and reconstruction for tracheal stenosis;
• Performs placement of tracheal T-tubes;
• Performs the operations for tracheo-esophageal fistula, tracheo-innominate fistula, subglottic stenosis, and
traumatic airway injury.
-4C. Neoplasms
Learner Objectives: Upon successful completion of the residency program:
• Understands the radiologic evaluation and operative management of tracheal neoplasms;
• Understands the methods of airway management.
Clinical Skills: During the training program the resident:
• Performs resection of tracheal tumors;
• Manages patients and their airways after tracheal resection.
IV. MEDIASTINUM AND PERICARDIUM
B. Congenital Abnormalities of the Mediastinum
Learner Objectives: Upon successful completion of the residency program:
• Knows the indications for operations involving the mediastinum and the anatomic approaches.
Clinical Skills: During the training program, the resident:
• Performs operations for congenital abnormalities of the mediastinum.
C. Acquired Abnormalities of the Mediastinum
Learner Objectives: Upon successful completion of the residency program:
• Understands mediastinal infections and their management;
• Understands the diagnostic tests available;
• Recognizes the histologic appearance of benign and malignant mediastinal neoplasms;
• Understands the neoplastic and non-neoplastic mediastinal diseases;
• Understands the operative management of benign and malignant mediastinal neoplasms;
• Understands chemotherapy and radiotherapy in mediastinal neoplasm management.
Clinical Skills: During the training program the resident
• Manages patients with mediastinal tumors.
V. DIAPHRAGM
B. Acquired Abnormalities, Neoplasms
Learner Objectives: Upon successful completion of the residency program:
• Understands reconstruction methods for the diaphragm;
• Understands the indications for and techniques of diaphragmatic pacing.
Clinical Skills: During the training program the resident:
• Performs diaphragmatic mobilization for exposure of the spine and aorta;
• Performs operative removal of diaphragmatic tumors;
• Inserts permanent diaphragmatic pacemakers.
VI. ESOPHAGUS
C. Acquired Abnormalities
Learner Objectives: Upon successful completion of the residency program:
Understands the presentation and management of complications of esophageal operations.
VII. CONGENITAL HEART DISEASE
D. Left-To-Right Shunts
Clinical Skills: During the training program the resident:
• Manages postoperative care.
E. Cyanotic Anomalies
Clinical Skills: During the training program the resident:
• Participates in or performs operative repair of tetralogy, TGA, Truncus arteriosus, TAPVR, Ebstein's anomaly, and
Fontan-type operations.
F. Obstructive Anomalies
Clinical Skills: During the training program the resident:
• Participates in or performs aortic valvotomy, repair of supravalvular and subvalvular aortic stenosis, pulmonary
valvotomy, correction of subvalvular pulmonary stenosis, correction of vascular rings;
• Participates in or performs operations for left ventricular outflow obstruction and interrupted aortic arch.
-5G. Miscellaneous Anomalies
Learner Objectives: Upon successful completion of the residency program:
• Understands the role of corrective and palliative operations for the above anomalies and of cardiac
transplantation for appropriate cardiac pathology.
Clinical Skills: During the training program the resident:
• Develops treatment plans for the above anomalies;
• Participates in or performs operative treatment for the above anomalies.
VIII. ACQUIRED HEART DISEASE
A. Coronary Artery Disease
Learner Objectives: Upon successful completion of the residency program:
• Understands the rationale for and techniques of coronary artery bypass operations as well as the use of various
conduits.
Clinical Skills: During the training program the resident:
• Participates in or performs surgery for the complications of myocardial infarction.
B. Myocarditis, Cardiomyopathy, Hypertrophic Obstructive Cardiomyopathy, Cardiac Tumors
Learner Objectives: Upon successful completion of the residency program:
• Understands the types of cardiac tumors (frequency, anatomic location, physiologic and pathologic
derangements, diagnostic methods and surgical management);
• Understands myocarditis (causes, physiologic changes, treatment, prognosis, and radiographic, EKG and
echocardiographic changes);
• Understands hypertrophic cardiomyopathy (genetic linkage, pathologic and anatomic changes, physiologic
derangements, clinical features, diagnostic tests, natural history, medical and surgical treatment);
• Knows the types of cardiomyopathies (causes, natural history, diagnostic methods, operative and nonoperative
treatment);
• Understands cardiac transplantation (immunology/rejection and treatment, physiology, indications, operative
techniques, diagnostic techniques in followup).
Clinical Skills: During the training program the resident
• Participates in or performs operative excision of cardiac tumors;
• Participates in or performs operations for the treatment of HCM when indicated;
• Participates in or performs heart transplants and provides preoperative and postoperative care.
C. Abnormalities of the Aorta
Clinical Skills: During the training program the resident:
• Participates in or performs operative and non-operative management of thoracic aortic disease, including
aneurysms, dissections, and occlusive disease;
• Plans and directs the use of extracorporeal bypass, hypothermia, and circulatory arrest for aortic diseases.
D. Cardiac Arrhythmias
Learner Objectives: Upon successful completion of the residency program:
• Understands operative and non-operative management;
• Knows the indications for and techniques of electrophysiologic studies and the application of this information to
patient management.
X. TRANSPLANTATION
B. Lung Transplantation
Learner Objectives: Upon successful completion of the residency program:
• Knows the techniques of single and double lung transplantation.
C. Heart-Lung Transplantation
Learner Objectives: Upon successful completion of the residency program:
• Knows the operative techniques of heart-lung transplantation.
Clinical Skills: During the training program the resident:
• Performs heart-lung transplantation;
• Performs endobronchial biopsy, thoracoscopic biopsy of the lung, and endocardial biopsy of cardiopulmonary
transplantation patients, as indicated.
-6XI. EXTRACORPOREAL BYPASS AND COAGULATION - BLOOD PRODUCTS
B. Techniques of Extracorporeal Bypass
Clinical Skills: During the training program the resident:
• Uses left and right heart bypass.
C. Mechanical Support
Learner Objectives: Upon successful completion of the residency program:
• Understands Federal regulations that apply to the use of these devices.
Clinical Skills: During the training program the resident:
• Uses appropriate mechanical cardiac support and ECMO;
• Weans patients from mechanical support and ECMO;
• Manages patients bridging to transplantation.
XII. MINOR PROCEDURES
C. Permanent Pacemakers
Learner Objectives: Upon successful completion of the residency program:
• Understands phrenic nerve pacing;
• Understands cardiomyoplasty pacing techniques.
Clinical Skills: During the training program the resident:
• Implants diaphragmatic pacemakers.
XIII. THORACIC SURGERY AND RESEARCH
Research Skills: During the training program the resident:
• Reads published material and listens to presentations critically;
• Demonstrates understanding of the essential steps of the research process by preparing and submitting a
manuscript for publication in a peer-reviewed journal or gives a presentation at Grand Rounds which meets the
satisfaction of his/her teachers. Either an oral or a written presentation is appropriate.
• Demonstrates competence by:
a. Defining an analyzable problem or scientific question
b. Assembling an appropriate literature review
c. Synthesizing and analyzing available data
d. Formulating an informed and insightful discussion
e. Composing a properly constructed, critically reviewed bibliography or list of literature citations
• Shows an understanding of the appropriate application of statistical tests to the problem;
• Demonstrates an understanding of the appropriate application of other commonly used statistical tests such as
univariate analysis, multivariate analysis, analysis of variance, and the use of T-tests for paired data and multiple
comparisons. (Residents should know the limitations, deficiencies and proper applications of these commonly
used statistical tests);
• Shows evidence of ability to critically analyze major clinical research papers in the thoracic literature which guide
practice;
• Applies knowledge of the scientific method to design and execute at least one formal analysis to solve a problem
related to thoracic surgery.
XIV. NON-CLINICAL ELEMENTS OF THORACIC SURGICAL PRACTICE
Learner Objectives: Upon successful completion of the residency program:
• Understand organizational structure and mechanics of solo practice, group specialty practice, multi-specialty
practice, and academic practice;
• Knows the structure, responsibilities and requirements of managed care, capitation payment, contractual
agreements, physician-hospital organizations, and independent Practice agreements.