Thoracic Surgery Residency Program

Curriculum

Curriculum Purpose

The general purpose of the thoracic surgery curriculum is derived from the definition of thoracic surgery provided by the American Board of Thoracic Surgery. This definition states:

"Thoracic Surgery encompasses the operative, perioperative, and surgical critical care of patients with acquired and congenital pathologic condition within the chest. Included is the surgical repair of heart lesions, and congenital and acquired conditions of the coronary arteries, valves, and myocardium. It also includes pathologic conditions of the lung, esophagus and chest wall, abnormalities of the great vessels, tumors of the mediastinum, and diseases of the diaphragm and pericardium. Management of the airway and injuries to the chest are also within the scope of the specialty." 1

In addition, the Board's definition of clinical competence in thoracic surgery also guided the development of the curriculum. That definition states:

"Clinical competence in thoracic surgery requires factual knowledge and technical skills in the preoperative evaluation, operative management, and postoperative care of patients with pathologic conditions involving thoracic structures. Precise definition of the scope of thoracic surgery as well as the current methods used to assess clinical competence have been developed to ensure that an individual who is certified by the American Board of Thoracic Surgery has met certain standards and qualifications. In addition, the ability to establish a precise diagnosis, an essential step toward proper therapy, requires familiarity with diagnostic procedures such as cardiac catheterization, angiography, electrocardiography, imaging techniques, endoscopy, tissue biopsy, and biologic and biochemical tests appropriate to thoracic diseases. It is essential that the thoracic surgeon be knowledgeable and experienced in evolving techniques, such as laser therapy, thoracoscopy, and thoracoscopic surgery." 2

Further guidance was obtained from the Board evaluation of operative case criteria regarding application for certification. The Board states:

" Even though emphasis on one or another facet of thoracic surgery (pulmonary, cardiovascular, esophageal, thoracic, trauma, etc.) may have characterized a candidate's residency experience, the candidate is nevertheless held accountable for knowledge concerning all phases of the field, including extracorporeal perfusion (physiologic concepts, techniques, and complications), cardiac devices, management of dysrhythmias, and thoracic oncology. In addition, a candidate should have had responsibility for the care of pediatric general thoracic surgical patients and be competent in video-assisted thoracoscopic surgery. The candidate should also have an in-depth knowledge of the management of acutely ill patients in the intensive care unit. This requires an understanding of cardiorespiratory physiology, respirators, blood gases, metabolic alterations, cardiac output, hyperalimentation, and many other areas. By virtue of his or her residency in thoracic surgery, the candidate is expected to be fully qualified in the surgical care of critically ill patients." 3

The scope of thoracic surgery encompasses the following:

CARDIOVASCULAR (knowledge of normal and pathologic conditions)
CONGENITAL (heart, blood vessels)
ACQUIRED LESIONS (infections, trauma, tumors, and metabolic disorders)

GENERAL THORACIC (knowledge of normal and pathologic conditions)
LUNGS
PLEURA
CHEST WALL
MEDIASTINUM
ESOPHAGUS
DIAPHRAGM

Summary Curriculum Goals:
The goal of the curriculum is to guide the program director, faculty, and residents in their pursuit of thoracic surgical education. The curriculum is a model for surgical learning and competency achievement.
The curriculum can serve to facilitate the development of: mature, skilled clinicians; thoughtful and learned physicians; curious scholars; successful managers; and productive citizens.
Specific Curriculum Goals:

Create an organizational structure of academic, clinical and technical criteria to facilitate the education of residents in thoracic surgery.
Maintain educational criteria that are congruent with the aims of the American Board of Thoracic Surgery and are in compliance with the established requirements of the Residency Review Committee for Thoracic Surgery.
Integrate principles of basic science with in-depth clinical experiences.
Promote a broader understanding of the role of thoracic surgery and its interaction with other disciplines such as Cardiology, Pulmonary Medicine, Gastroenterology, Diagnostic Radiology, Pediatrics.
Facilitate the self-directed study of residents via recommended readings and learning activities.
Suggest learning experiences based on measurable objectives for the education of thoracic surgeons.
Guide the mechanism for residents' progressive responsibility from initial patient care to complete patient management.
Guide thoracic surgical residents to skillfully use research techniques in conducting investigations.
Assist residents in achieving professional leadership and management skills.
Promote the understanding of the economic, legal, and social challenges of contemporary and future thoracic surgery.
Foster continuing education to promote lifelong individual initiative and creative scholarship.
12. Suggest broad and diverse teaching methodologies to transmit knowledge, skills, and attitudes from faculty to residents.

Core Competencies:
The objectives of each unit of the Thoracic Surgery Curriculum describe the learning activities that are to occur during the course of curriculum implementation. When these objectives have been met, the expected outcome is that core competencies, describing the abilities made possible by a professional education, can be performed. The competencies reflect the three domains of education, cognitive, psychomotor, and affective, and specify what the resident should know, be able to do, or have an attitude about at the completion of thoracic surgery training. Each of the competencies listed below should be prefaced by the following statement:
"At the completion of training, the resident can . . .":

Make sound ethical and legal judgment appropriate for a qualified thoracic surgeon (Professionalism).
Respect the cultural and religious needs of patients and their families, and provide thoracic surgical care in accordance with those needs (Professionalism).
Manage thoracic surgical disorders based on a thorough knowledge of basic and clinical science (Patient care; Medical knowledge).
Utilize appropriate skill in those surgical techniques required of a qualified thoracic surgeon (Patient care; Practice-based learning and improvement).
Use critical thinking when making decisions affecting the life of a patient and the patient=s family Patient care; Medical knowledge).
Collaborate effectively with colleagues and other health professionals (Practice-based learning and improvement; Interpersonal and communication skills).
Teach and share knowledge with colleagues, residents, students, and other health care providers (Interpersonal and communication skills).
Teach patients and their families about the patient=s health needs (Interpersonal and communication skills; Patient care).
Be committed to scholarly pursuits through the conduct and evaluation of research (Practice-based learning and improvement; Medical knowledge).
Provide cost-effective care to thoracic surgical patients and families (Systems-based practice).
Adapt and eventually direct complex programs and organizations (Systems-based practice).
Value lifelong learning as a necessary prerequisite to maintaining thoracic surgical knowledge and skill (Practice-based learning and improvement; Medical knowledge)

Clinical Competence
Clinical competence in thoracic surgery requires factual knowledge and technical skills in the preoperative evaluation, operative management, and postoperative care of patients with pathologic conditions involving thoracic structures. Precise definition of the scope of thoracic surgery as well as the current methods used to assess clinical competence have been developed to ensure that our residents have met certain standards and qualifications.
The scope of thoracic surgery encompasses a knowledge of normal and pathologic conditions of both cardiovascular and general thoracic structures. This includes congenital and acquired lesions (including infections, trauma, tumors, and metabolic disorders) of both the heart and blood vessels in the thorax, as well as diseases involving the lungs, pleura, chest wall, mediastinum, esophagus, and diaphragm. In addition, the ability to establish a precise diagnosis, an essential step toward proper therapy, requires familiarity with diagnostic procedures such as cardiac catheterization, angiography, electrocardiography, imaging techniques, endoscopy, tissue biopsy, and biologic and biochemical tests appropriate to thoracic diseases. It is essential that the thoracic surgeon be knowledgeable and experienced in evolving techniques such as laser therapy, thoracoscopy and thoracoscopic surgery.
The highest educational standards are best achieved in residency programs in which close supervision and instruction as well as progressive individual responsibility for operative and postoperative care are possible. The program is designed to provide a sound didactic and clinical education which is carefully planned to optimize educational opportunities for the resident concurrently with balancing concerns for patient safety and resident well-being. Service obligations are minimized but not eliminated. Ancillary staff including a cadre of nurse practitioners and physician assistants assist with healthcare service. Didactic and clinical education has priority for residents' time and energy. Faculty, residents, and staff collectively have responsibility for the safety and welfare of patients. Faculty and residents are educated to recognize the signs of fatigue via institutional-sponsored conferences as well as professional programs. Active departmental policies to ensure duty hour compliance minimizes fatigue and optimizes educational energies.