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Resident Education Program in Thoracic Surgery

Third Year Curriculum

GENERAL THORACIC SURGERY ROTATION YEAR 3

Provided below are the specific educational goals for the residents as it pertains to their acquisition of knowledge in Thoracic Surgery.  Each listing represents a section of the Comprehensive Requisite Thoracic Surgery Curriculum.  The resident is to complete the designated topic prior to the specific Thoracic, Adult Cardiac or Pediatric Cardiac Conference. 

 

I. 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 completion of this unit the resident:

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 completion of this unit, the resident:

Knows the complications of lung resection and their management.

 

C. Neoplastic Lung Disease

Learner Objectives: Upon completion of this unit the resident:

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 completion of this unit the resident:

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 completion of this unit the resident:

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.

 

C. Neoplasms

Learner Objectives: Upon completion of this unit the resident:

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 completion of this unit the resident:

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 completion of this unit the resident:

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 completion of this unit the resident:

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 completion of this unit the resident:

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;

G. Miscellaneous Anomalies

Learner Objectives: Upon completion of the unit the resident:

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 completion of the unit the resident:

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 completion of the unit the resident:

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 completion of the unit the resident:

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 completion of the unit the resident:

Knows the techniques of single and double lung transplantation;

 

C. Heart-Lung Transplantation

Learner Objectives: Upon completion of the unit the resident:

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.

  

XI.  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 completion of the unit the resident:

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 completion of this unit the resident:

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-reviewedjournal 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 completion of this unit the resident:

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;

Copyright © 2004, Vanderbilt University Medical Center, Department of Thoracic Surgery

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