Residency Level:
Surgical Rotation:
Length of Rotation:
PGY 4
Thoracic/Foregut Surgery
Two Months
Goals and Objectives
Patient care:
 Evaluation and preparation of the pre-operative thoracic surgical patient in the outpatient setting
 Comprehensive care of the thoracic surgical patient, including pre-operative evaluation and postoperative management, including intensive care unit management.
 Management skills required to independently evaluate the thoracic surgical patient, develop your
own plan for the patient and communication of the plan to the appropriate level of supervision
 Take ownership in care of the patient
 Post-operative care of the thoracic surgical patient
 Mechanisms and criteria for minimally invasive surgery of the thorax and foregut
 Fluid and electrolyte management including indications for parenteral and enteral nutrition
 Understanding and utilization of diagnostic techniques including routine films, contrast studies,
ultrasound, CT scan, MRI and endoscopic procedures
 Clear and timely documentation of daily progress notes
 Develop a strong work ethic
 Develop appropriate safe hand offs
 Develop the ability to care for thoracic surgical emergencies in the role as the surgical resident on
call
Technical skill:
 With appropriate supervision, perform procedures for chest tube placement, etc.
 With appropriate supervision, take a greater role as surgeon in complex/advanced thoracic surgical
cases (including minimally invasive surgery) including pneumonectomy and chest wall
reconstruction
Medical knowledge:
 Advanced knowledge of the anatomy, physiology and pathophysiology of the thorax and foregut.
 Demonstrate evidence of continued increase in thoracic surgery core knowledge from basic
surgical texts, additional readings and the SCORE curriculum as noted below
 Obtain a broad knowledge base of thoracic surgery
 Study and prepare for the ABSITE
 Anatomy and physiology of the GI tract, as it applies to the esophagus, stomach and
gastroesophageal reflux disease
 Fluid and electrolyte management including management of parenteral and enteral nutrition
Practice-based learning and improvement:
 Participate actively in M and M conferences, daily chief conferences and journal clubs
 Learn to critically read the literature
 Master the IT resources available to you to develop a commitment to lifelong learning and
education
Interpersonal and communication skills:
 Develop the appropriate skills to provide efficient, concise, patient presentations
 Master text paging, emailing, etc.
 Develop strong doctor patient relationships using counseling and education of patients and their
families
 Learn to master EPIC to provide proper documentation in the electronic medical record
 Learn to properly consult other specialty services in a professional manner
Professionalism:
 Respect every patient regardless of social or other circumstances
 Log cases appropriately
 Log your duty hours using My Evaluations appropriately and in a timely fashion
 Complete all required clinical and residency documents in a timely fashion
 Demonstrate sensitivity to age, gender and culture of patients and other members of the health care
delivery team
 Learn to be punctual
 Always exemplify professional attire, appropriate grooming and hygiene
 Demonstrate honesty, integrity and leadership skills
Systems-based practice:
 Demonstrate the effective communication with referring physicians throughout the Swedish health
care system
 Keep patients’ safety foremost while discharging patients in a timely fashion
 Demonstrate time management and organizational skills while adhering to work hour regulations
 Gain an understanding of the importance of discharge planning and the writing of timely discharge
orders to the overall throughput of patients in our system
SCORE CURRICULUM CATEGORY 7: ALIMENTARY TRACT − ESOPHAGUS
Diseases/Conditions
Operations/Procedures
BROAD
ESSENTIAL − COMMON
• Gastroesophageal reflux and Barrett’s esophagus
• Laparoscopic antireflux procedure
• Hiatal hernia
• Dysphagia
ESSENTIAL − UNCOMMON
• Spontaneous esophageal perforation
• Open antireflux procedure
• Iatrogenic esophageal perforation
• Open repair of paraesophageal hernia
• Mallory-Weiss syndrome
• Laparoscopic repair of paraesophageal hernia
• Repair/resection of perforated esophagus
FOCUSED
• Achalasia
COMPLEX
• Zenker’s diverticulum
• Total esophagectomy
• Epiphrenic diverticulum
• Esophagogastrectomy
• Foreign bodies
• Cricopharyngeal myotomy with excision
• Schatzki’s ring
Zenker’s diverticulum
• Chemical burns
• Open Heller myotomy
• Benign neoplasms
• Laparoscopic Heller myotomy
• Adenocarcinoma
• Collis gastroplasty
• Squamous cell carcinoma
• Diffuse esophageal spasm
• Nutcracker esophagus
• Presbyesophagus
• Scleroderma connective tissue disorders
SCORE CURRICULUM CATEGORY 22: THORACIC SURGERY
Diseases/Conditions
Operations/Procedures
BROAD
• Pneumothorax
• Hemothorax
• Pleural effusion/empyema
FOCUSED
• Mediastinitis
• Chylothorax
• Adenocarcinoma of the lung
• Undifferentiated lung carcinoma
• Small-cell carcinoma of the lung
• Large-cell carcinoma of the lung
• Soft tissue sarcomas of chest wall
• Thymoma
• Teratoma of the medisastinum
• Neurogenic tumor of the mediastinum
• Enteric cyst of the mediastinum
• Pericardial cyst
• Bronchgenic cyst
• Superior vena cava syndrome
• Tracheoinnominate fistula
• Tracheoesophageal fistula
•Valvular heart disease
• Congestive heart failure
• Endocarditis
• Coronary artery disease
•Ventricular aneurysms
• Cardiomyopathy
• Pericarditis
ESSENTIAL − COMMON
• Chest tube placement
ESSENTIAL − UNCOMMON
• Exploratory thoracotomy
• Pericardial window for drainage
• Thoracoscopy with or without biopsy
• Thoracoscopic pleurodesis
• Thoracoscopic Heller myotomy
• Excision mediastinal tumor
• Transthoracic repair diaphragmatic hernia
• Open drainage of empyema
• Pneumonectomy
• Pericardiectomy
SCORE CURRICULUM CATEGORY 12: ENDOSCOPY
Operations/Procedures
ESSENTIAL − COMMON
• Esophagogastroduodenoscopy
• Bronchoscopy
• Laryngoscopy
COMPLEX
• Mediastinoscopy