Specific Educational Goals and Education
Service: Cardiac Surgery
Supervision: PGY-1 → Attending
All management decisions will be discussed with the senior resident and faculty.
- Serve as PGY-1 on the cardiac service
- Appropriate, professional supervision of student teaching in light of educational goals
- Attend clinic as assigned
- Manage OR patients with supervision
- Assist with consultations to the cardiothoracic service as assigned by the Attending
- Round on post-surgical patients as instructed.
- Attend educational conferences
- Complete surgical case logs
- Participate in transplantation (procurement/implantation).
- Performance feedback will be given to the resident as appropriate for educational events and mid-term progress will be discussed.
- Global evaluation will be performed by the cardiothoracic attending physicians at the completion of each rotation. Surgical case logs will be evaluated for the appropriate number and breadth of procedures and will be present in the resident's portfolio to be reviewed at the Program Evaluation meeting held twice yearly.
- At the completion of this rotation, the resident is required to complete a rotation evaluation form assessing the quality of the rotation. The resident should also address the teaching undertaken by the attending physicians on the rotation at the conclusion of this rotation.
Before the Rotation: Contact Dr Merritt (firstname.lastname@example.org) and Wally Bussey, PA (email@example.com) one week prior to starting the rotation. They will provide you with contact information and attending assignments. You will rotate with each cardiac surgeon for one week at a time, following the surgeon for all cases and clinics during that week. You will operative, see consults and write postoperative notes on patients. As our service does not have consistent junior resident rotators, we feel this “apprenticeship model” will improve relationships between attending and resident, and allow a more fruitful OR and rotational experience. There are no overnight call duties; however if the surgeon to which you’re assigned is operating late or seeing a critical patient, we will expected you to do the same. You will round two weekends during the month, and should easily meet duty hour requirements as listed below.
Dr Siddique: Monday morning
Dr Moulton: Tuesday morning
Dr Um: Wednesday morning
Dr Merritt: Thursday morning
Monday 7am: Cardiac Valve Conference- Hunt Radiology Conference Room SB 1500
Monday 8am: Cardiac Surgery patient Checkout- Clarkson CVICU Room 3810
Tuesday 4pm: Cardiac Cath Conference Grissom Conference Hall UT5412
Wednesday 7am: Cardiac Surgery Grand Rounds Grissom Conference Hall UT5412
Friday 7am: Cardiac Transplantation Listing Meeting Clackson Tower B850
Residents will expected to round on and discuss any postoperative patients with which they have been involved. Specifically on Thursday mornings at 7am, didactic rounds will occur starting in the CVICU. These rounds will include resident presentation to faculty surgeon with knowledge of patient history, anatomical considerations, and operative approach, as well as postoperative complications and plans, and a period of educational discussion to follow.
Hours are to be logged into New Innovations on a weekly basis and will be reviewed weekly by the Program Director for ACGME violations and reviewed weekly for delinquencies by the Program Coordinator. Over a four week period; you will not average more than 80 hours a work week, you will have one day in seven free of clinical duty, in-house call will be no more frequent than one in three nights, you should receive 10 hours free between all duty periods and after in-house call and you will not be on duty for more than 30 consecutive hours. If you are assigned more hours than mentioned heretofore or have patient care duties that are extending you beyond these limits, it is your responsibility to notify your supervising resident or faculty so arrangements can be made to relieve you.
- Recommended Reading
- TSRA Review of Cardiothoracic Surgery, 2nd Ed (LaPar)
- Cohn- Cardiac Surgery in the Adult, 4th Ed (Cohn)
- Manual of Perioperative Care of the Adult Cardiac Surgery Patient, 5th Ed (Bojar)
- SCORE curriculum modules
- Conferences : See above
Competency Based Performance Objectives:
Goal: The resident will be able to use acquired skills and knowledge of cardiothoracic principles in the management of surgical patients with pathologic conditions of the heart and great vessels.
Objective: The resident will be able to:
- Perform pre-operative evaluation, history, and physical examination of cardiac surgery patients.
- Obtain and interpret indicated diagnostic studies.
- Discuss diagnostic and therapeutic approaches to specific acquired and congenital cardiac diseases with the attending physicians.
- Assist with selected cardiac and general surgery cases, such as:
- Saphenous vein harvest and wound closure for coronary bypass operations
- Sternotomy or thoracotomy and closure
- Proximal vein graft anastomosis (if applicable)
- Valve and coronary operations, including TAVR
- Transplant organ procurement
- Pericardial drainage operations
- Provide post-operative cardiac surgery follow-up care in the ICU and Intermediate Care Units.
- Perform insertion and removal of chest tubes, central lines, intra-aortic balloon pumps arterial, and pulmonary artery catheters with supervision.
Competency Based Knowledge Objectives:
Goal: Demonstrate knowledge of the anatomy, physiology, and pathophysiologic conditions of the heart and great vessels which are amenable to surgical correction.
Objectives: The resident will be able to:
Describe and demonstrate a working knowledge of the heart and great vessels, including:
- Cardiac valves (mitral, aortic, tricuspid, pulmonic)
- Cardiac chambers
- Coronary arteries
- Intrinsic and extrinsic conduction system
- Great vessels
Describe and demonstrate working knowledge of cardiac physiology, including:
- Determinants of myocardial oxygen consumption
- Determinants of cardiac output
- Interactions of preload, afterload, contractility, PVR
- Normal pressures, waveforms, and oxygen saturation in cardiac chambers
Consider the following for risk assessment and perioperative management:
- Patient age
- Patient age
- Risk factors for cardiovascular disease (FHx, BMI, HLP, HTN, DM)
- Symptoms/signs associated with CAD, ventricular dysfunction, and valvular dysfunction
- Pulmonary dysfunction (pulmonary hypertension, COPD)
- Neurologic abnormalities
- Renal dysfunction
- Hematologic abnormalities
- Hepatic dysfunction
- Cerebrovascular, peripheral vascular, or aneurysmal disease
- Gastrointestinal considerations
- Metabolic, nutritional, genetic, immune, and oncologic abnormalities
- Psychiatric conditions, psychological and social interactions
- Re-operative chest surgery
- Miscellaneous considerations (prior operations including vascular or valvular prostheses, substance abuse, dental status, interactions of medications)
Discuss the use and interpretation of cardiovascular diagnostic tests in identification of cardiovascular pathology, including:
- Echocardiography (transthoracic and transesophageal)
- Traditional roentgenography
- Cardiac catheterization
- Vascular ultrasonography
- Computer and magnetic resonance imaging
- Radionuclide scintigraphy (stress tests)
Understand temporary percutaneous and intra-cardiac pacing wires
Discuss techniques, mechanisms of action, and potential complications for mechanical and pharmacologic support of the circulation, including:
- Pre- /after- load agents (Nipride, nitroglycerine, Neo-synephrine)
- Inotropic agents (dopamine, dobutamine, epinephrine, norepinephrine, etc)
- Intra-aortic balloon pump
- Ventricular assist devices
- Cardiac pacing
Describe and assess the operative indications, risk, and expected outcomes associated with several cardiac surgical procedures, including:
- Coronary artery bypass surgery
- Valvular replacement/repair (aortic, mitral, tricuspid)
- Surgery for arrhythmia
- Cardiac and Pulmonary Transplantation
- Operations of the ascending aorta, aortic arch and descending thoracic aorta
- Pericardial drainage procedure
Discuss the complications of cardiac surgery and methods used to reduce their incidence.
- Death, myocardial infarction, stroke, bleeding, arrhythmias, low cardiac output syndrome, cardiac tamponade, pneumothorax, sternal and extremity wound infections, respiratory and renal failure
Review the management of post-operative cardiac surgery patients in the intensive care unit.
Summarize the management of the following post-cardiac surgery variances, including the monitoring, prevention, and the therapeutic intervention of:
- Arrhythmias (ventricular and atrial)
- Bleeding (correction of coagulopathy, indications for re-exploration)
- Infection (methods of prophylaxis, empiric and culture-specific therapy)
- Low cardiac output and hypotension
- Post-operative hypertension
Demonstrate working knowledge and use of the following post-operative support systems:
- Mediastinal and pleural drainage
- Cardiac medications (afterload reduction, anti-platelet, beta-blockers, diuretics)
- Mechanical ventilation, airway management systems
- Temporary and permanent pacemakers
- Intra-aortic balloon pumps and other ventricular assist devices
- Dialysis and ultrafiltration
- Cardiopulmonary bypass and extracorporeal membrane oxygenation
Discuss the evaluation and therapeutic options available for surgical management of cardiac trauma such as:
- Blunt and penetrating cardiac and great vessel injury
- Traumatic transection of the aorta and other great vessels
Evaluation and surgical management of advanced heart failure
Interpersonal and Communication Skills:
Goal: Counsel patients and obtain informed consent for cardiothoracic procedures
Objectives: The resident will demonstrate the ability to obtain informed consent, outlining the risks and benefits
Goal: Communicate effectively to discharge patients after surgery.
Objectives: The resident will demonstrate the ability to instruct patients regarding monitoring for cardiothoracic complications:
Goal: Communicate effectively as a member of the healthcare team.
Objectives: The resident will demonstrate the ability to communicate effectively by:
- Providing appropriate check out when handing patients to another team member
- Requesting consults from other services with appropriate information
- Dictating operative reports in a timely fashion
Goal: Maintain patient confidentiality
Objectives: The resident will demonstrate
- The ability to protect health-related patient information per HIPAA compliance
- List and be aware of sites in the hospital and clinic where loss of privacy for the patient may occur
Goal: Maintain appropriate professional relationships
Objectives: The resident will demonstrate professional interactions with:
- Medical students
- Nursing and support staff
- Supervising faculty
- Consulting residents
- Physician peers
- Patients and their families
Practice-Based Learning and Improvement
Goal: Identify personal and practice improvement strategies
Objective: The resident will demonstrate:
- Receptiveness to faculty instruction and feedback
- Ability to use medical information with the ability to access information through traditional and online sources to support their educational experience
Goal: Use medical evidence to evaluate cardiothoracic practices
Objective: The resident will demonstrate the ability to:
- Discuss studies regarding cardiothoracic surgery
Goal: Provide safe patient care
Objective: The resident will:
- Attend Crew Resource Management courses as required by the hospital
- Follow recommended protocols in the OR for patient safety
- Demonstrate compliance with Medical Center policy for surgical site identification
- Demonstrate compliance with Medical Center policy for patient identification