Policies

Goals and Objectives of Specific Rotations (Two-Year Traditional Program)

The goals described below are adjusted for individual residents according to their specific talents and skills; the goals should be regarded, therefore, as only approximations of the progression of training for a particular resident. These goals, listed, are structured to conform with the six competency requirements set forth by the ACGME and TSDA. At all levels of training, residents are expected to participate in teaching younger house officers and medical students, consistent with their own knowledge and experience. Throughout the training of all cardiothoracic residents, an attending surgeon is scrubbed or immediately available for all operations.

YEAR 1

ECHI – Adult Cardiac Surgery (6 months)

Goals and Objectives

  1. Patient Care

    • Perform the standard preoperative work-up prior to surgery.
    • Discuss the preoperative conditions that might adversely impact successful performance of surgery or uncomplicated recovery.
    • Describe preoperative methods for lessening the impact of such co-morbidities.
    • Discuss the causes of perioperative infections and techniques for prevention of perioperative infections. Interpret data presented in a cardiac catheterization report.
    • Describe and interpret the images obtained at a cardiac catheterization. Read and interpret an electrocardiogram.
    • Describe the methods, interpret the reports, and discuss the perioperative uses of pulmonary function testing.
    • Describe the indications, methods, and interpretation of reports, and discuss the preoperative significance of noninvasive vascular testing.
    • Discuss the common complications of cardiac surgery, and their diagnosis and treatment.
    • Describe the available treatments for congestive heart failure and their rationale.
    • Describe the incisions available for the exposure of thoracic organs, as well as their indications and associated complications.
    • Perform a median sternotomy and appropriate closure.
    • Dissect and prepare a pedicled internal mammary artery bypass conduit in ≤30 minutes.
    • Harvest a saphenous vein conduit expeditiously.
    • Recognize and respond appropriately to unexpected urgent patient needs in a timely manner.
    • Describe anticoagulation of cardiac valve patients and the use of Coumadin.
    • Demonstrate familiarity with mechanical assist devices.
  2. Medical Knowledge

    • Describe the difference between on-pump and off-pump coronary artery bypass grafts.
    • Discuss the causes of coronary artery disease and possible medical treatment plans for prevention or stabilization.
    • Describe the indications for surgery for coronary artery disease.
    • Explain normal clotting function.
    • Describe acquired abnormalities of clotting function, their causes and treatment of heparin-induced thromobocytopenia and thrombosis.
    • Describe the structure, function, and operation of the cardiopulmonary bypass machine.
    • Discuss the various methods, advantages, and potential complications of harvesting coronary artery bypass conduits, and their durability.
    • Demonstrate understanding of the pathological conditions requiring cardiac pacing and the various pacing modes and indications for their use.
    • Describe electrical parameters and programmable options of cardiac pacing.
    • Demonstrate the ability to program both temporary and permanent pacemakers.
    • Document regular participation in CT Residents’ Seminars.
  3. Practice-Based Learning and Improvement

    • Demonstrate ability to practice lifelong learning by reading and discussing current issues of
    • Annals of Thoracic Surgery and Journal of Thoracic and Cardiovascular Surgery.
    • Use information technology to do focused clinical research on cardiac surgery issues.
    • Study, prepare for, and perform satisfactorily on in-training written and oral exams.
    • Critically evaluate the advantages and disadvantages of preferred surgical techniques of different attending surgeons.
  4. Interpersonal and Communication Skills

    • Demonstrate the ability to hand off and receive patients for coverage while ensuring complete and knowledgeable care during cross coverage.
    • Deal competently and effectively with referring cardiologists and other members of the patient care team.
  5. Professionalism

    • Demonstrate a working knowledge of the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
    • Communicate effectively and compassionately with patients and their families.
    • Demonstrate punctuality for service activities, including conferences and patient care responsibilities.
    • Respond to pages and requests for assistance consistently in a timely manner.
    • Demonstrate patience, sensitivity, and tact in dealing with the moral, legal, and ethical issues associated with the care of CT patients.
    • Exhibit appropriate attire at all times.
    • Demonstrate integrity and respect for all members of the patient care team.
    • Dictate timely, clear, and concise CT surgery operative reports.
    • Document regular attendance at CT Residents’ Seminars on ethics and professionalism.
  6. Systems-Based Practice

    • Perform efficient, timely, and cost effective practice patterns.
    • Demonstrate understanding of clinical practice management and human resource issues and participate in evaluating CT team members, through attendance at CT Faculty Departmental meetings.
    • Discuss the appropriate use of generic drugs.

ECHI – General Thoracic Surgery (5-6 months)

Goals and Objectives

  1. Patient Care
    • Communicate effectively and compassionately with patients and their families regarding the diagnoses of lung and esophageal cancer.
    • Develop and carry out plans for management of patients with lung and esophageal cancer through interactions with attendings and through participation in Thoracic Tumor Board Rounds.
    • Demonstrate operative skills in general thoracic procedures, such as endoscopy, mediastinoscopy, video-assisted thoracoscopic surgery, pulmonary and esophageal resections.
    • Recognize and respond appropriately to unexpected urgent patient needs in a timely manner.
      Read accurately and interpret chest x-rays, CT scans, pulmonary function studies, endoscopic ultrasound results, and PET scans.
    • Describe the importance of smoking cessation, and learn how to counsel patients to stop.
    • Supervise general surgery residents in consultations for pulmonary and esophageal diseases.
  2. Medical Knowledge
    • Describe the staging of lung and esophageal cancer, and stage appropriate therapy.
    • Discuss recent trends in multi-modality therapy for lung and esophageal cancer.
    • Accurately interpret studies for the diagnosis and staging of lung and esophageal cancer.
    • Evaluate and interpret test results for benign esophageal disease (manometry, pH probe).
    • Describe pulmonary physiology and ventilatory support at an advanced level.
    • Document regular participation in CT Residents’ Seminars.
    • Practice-Based Learning and Improvement
    • Demonstrate ability to practice lifelong learning by reading current issues of Annals of
    • Thoracic Surgery and Journal of Thoracic and Cardiovascular Surgery focusing on developments in lung and esophageal cancer care.
    • Use information technology to perform focused clinical research on general thoracic surgery issues.
    • Document regular participation in multi-disciplinary conference and clinic.
    • Assume graded responsibility for post-operative care.
    • Educate junior residents and medical students in the operating room and on the units about basic thoracic surgery problems.
    • Study, prepare for, and perform satisfactorily on in-training written and oral exams.
    • Critically evaluate the advantages and disadvantages of preferred surgical techniques of different attending surgeons.
  3. Interpersonal and Communication Skills
    • Create and sustain sound relationships with patients and families through effective communication and empathy.
    • Accept constructive criticism enthusiastically and use it for self-improvement.
    • Integrate smoothly and relate well to the operating room team.
    • Deal competently and effectively with referring physicians and other members of the patient care team.
    • Interact collegially with pulmonary, oncology, GI, and radiation therapy physicians in multidisciplinary clinic and conference.
    • Manage the surgical team effectively, ensuring that pre-operative studies are known by the member assigned to the case, OR cases are covered, and postoperative care is efficient.
  4. Professionalism
    • Demonstrate punctuality for service activities, including conferences and patient care responsibilities.
    • Respond to pages and requests for assistance in a consistently timely manner.
    • Display patience, sensitivity, and tact in dealing with the moral, legal, and ethical issues associated with the care of lung and esophageal surgery patients.
    • Exhibit appropriate attire at all times.
    • Demonstrate integrity and respect for all members of the patient care team.
    • Dictate timely, clear, and concise CT surgery operative reports.
    • Document regular participation in CT Residents’ Seminars on ethics and professionalism.
    • Demonstrate knowledge of the ethics of clinical trials and patient confidentiality.
  5. Systems-Based Practice
    • Describe the impact of lung and esophageal cancer on society, particularly in North Carolina.
    • Perform efficient, timely, and cost effective practice patterns.
    • Demonstrate understanding of clinical practice management and human resource issues and participate in evaluating CT team members, through attendance at CT Faculty Departmental meetings.
    • Discuss cost-benefit analyses of studies such as screening chest CT, PET scan & endoscopic ultrasound
    • Describe appropriate use of routine post-operative tests.

ECHI – Pediatric Cardiac Surgery (0-1 month)

Goals and Objectives

  1. Patient Care
    • Interpret and evaluate appropriately preoperative echocardiograms and cardiac catheterizations.
    • Demonstrate technical ability in closed operations, including patent ductus ligation and vascular rings, as well as open operations including secundum and sinus venosus atrial septal defects.
    • Assist competently in neonatal repairs.
    • Execute appropriate postoperative management in children who have undergone congenital cardiac surgery, including appropriate ventilator management.
    • Recognize and respond appropriately to unexpected urgent patient needs in a timely manner.
  2. Medical Knowledge
    • Discuss the history of cardiopulmonary bypass and early operations for congenital heart disease.
    • Describe the function, construction, and operation of the cardiopulmonary bypass machine.
    • Describe the physiology, presentation and evaluation of common congenital heart defects.
    • Discuss current surgical management of 1- and 2-ventricle congenital heart repairs.
    • Document regular participation in conferences related to congenital heart disease.
    • Expand knowledge base of current surgical issues and develop peer relationships through attendance at a national CT surgery conference and an industry-sponsored course.
    • Document regular participation in CT Residents’ Seminars.
  3. Practice-Based Learning and Improvement
    • Demonstrate ability to practice lifelong learning by reading current issues of Annals of
    • Thoracic Surgery and Journal of Thoracic and Cardiovascular Surgery focusing on congenital heart disease.
    • Use information technology to perform focused clinical research.
    • Assume graded responsibility for post-operative care.
    • Perform satisfactorily on in-training written and oral exams.
  4. Interpersonal and Communication Skills
    • Demonstrate skill in the communication of patient care issues with the congenital heart team and use of sensitivity and tact during discussions with patients’ families.
    • Deal competently and effectively with pediatric cardiologists and other members of the patient care team.
  5. Professionalism
    • Communicate effectively and compassionately with patients and their families.
    • Demonstrate punctuality for service activities, including conferences and patient care responsibilities.
    • Respond to pages and requests for assistance consistently in a timely manner.
    • Demonstrate patience, sensitivity, and tact in dealing with the moral, legal, and ethical issues associated with the care of pediatric cardiac surgery patients.
    • Exhibit appropriate attire at all times.
    • Demonstrate integrity and respect for all members of the patient care team.
    • Dictate timely, clear, and concise CT surgery operative reports.
    • Exhibit ethical behavior and describe the process of surrogate decision making.
    • Document regular attendance at CT Residents’ Seminars on ethics and professionalism.
  6. Systems-Based Practice
    • Discuss prenatal diagnosis in the care of patients with congenital heart defects.
    • Perform efficient, timely, and cost effective practice patterns.
    • Demonstrate understanding of clinical practice management and human resource issues and participate in evaluating CT team members, through attendance at CT Faculty Division meetings.
    • Discuss risk-benefit analysis involved in:ligation of a patent ductus arteriosus in an 800gm premature baby in the NICU,
    • palliation versus repair of symptomatic 3 kg infant with tetralogy of Fallot.

ECHI/CVICU – Intensive Care Unit (2 weeks)

Goals and Objectives

  1. Patient Care
    • Perform standard routine immediate postoperative care of cardiac and thoracic intensive care unit patients.
    • Discuss common postoperative complications and assessment and treatment of these.
    • Describe the use of invasive monitoring devices, such as Swan-Ganz catheters, arterial lines, etc
    • Describe the indications, physiology and use of mechanical assist devices, including LVAD, Impella, Tandem Heart.
    • Describe the use of standard intensive care unit hemodynamic medications and discuss each medication, indications, and mechanism of action
    • Describe indications and use of ECMO circuits; understand the physiology and parameters behind the ECMO system
    • Understand cardiac arrhythmias, pacemakers, and various pacing modes and indications for use.
    • Describe the evaluation of postoperative bleeding, use of blood products and coagulation studies, and discuss when return to operating room is necessary
    • Perform emergency resuscitation protocols, open chest cases, and emergency re-opening at bedside when necessary, with appropriate supervision.
    • Perform the standard preoperative workup of cardiac and thoracic intensive care unit patients.
    • Discuss the preoperative conditions that might adversely impact successful performance of surgery or uncomplicated recovery.
    • Describe preoperative methods for lessening the impact of such co-morbidities.
    • Describe and interpret the images obtained at a cardiac catheterization. Read and interpret an electrocardiogram.
    • Describe the indications, methods, and interpretation of reports, and discuss the preoperative significance of noninvasive vascular testing.
    • Describe the available treatments for congestive heart failure and their rationale.
    • Demonstrate familiarity with mechanical assist devices.
  2. Medical Knowledge
    • Describe the use of hemodynamic parameters for evaluation of patient status and need for intervention
    • Describe the use of, indications for, and mechanism of action of standard intensive care unit medications
    • Discuss postoperative heart failure and methods of treatment
    • Discuss common postoperative complications and methods of treatment
      Explain normal clotting function.
    • Describe acquired abnormalities of clotting function, their causes and treatment of heparin-induced thromobocytopenia and thrombosis.
    • Describe the structure, function, and operation of the cardiopulmonary bypass machine, various mechanical assist devices, and ECMO circuits.
    • Demonstrate understanding of the pathological conditions requiring cardiac pacing and the various pacing modes and indications for their use.
    • Describe electrical parameters and programmable options of cardiac pacing.
    • Demonstrate the ability to program both temporary and permanent pacemakers.
    • Document regular participation in CT Residents’ Seminars.
  3. Practice-Based Learning and Improvement
    • Demonstrate ability to practice lifelong learning by reading and discussing current issues of Annals of Thoracic Surgery and Journal of Thoracic and Cardiovascular Surgery.
    • Use information technology to do focused clinical research on ICU issues.
      Study, prepare for, and perform satisfactorily on in-training written and oral exams.
    • Critically evaluate the advantages and disadvantages of preferred patient management techniques of different attending surgeons.
  4. Interpersonal and Communication Skills
    • Demonstrate the ability to hand off and receive patients for coverage while ensuring complete and knowledgeable care during cross coverage.
    • Deal competently and effectively with referring cardiologists, consultants, and other members of the patient care team.
    • Create and sustain sound relationships with patients and families through effective communication and empathy in an intensive care environment with critically ill patients.
    • Accept constructive criticism enthusiastically and use it for self-improvement.
  5. Professionalism
    • Demonstrate a working knowledge of the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
    • Communicate effectively and compassionately with patients and their families.
    • Demonstrate punctuality for service activities, including conferences and patient care responsibilities.
    • Respond to pages and requests for assistance consistently in a timely manner.
    • Demonstrate patience, sensitivity, and tact in dealing with the moral, legal, and ethical issues associated with the care of CT patients.
    • Exhibit appropriate attire at all times.
    • Demonstrate integrity and respect for all members of the patient care team.
    • Dictate timely, clear, and concise CT surgery operative reports.
    • Document regular attendance at CT Residents’ Seminars on ethics and professionalism.
  6. Systems-Based Practice
    • Perform efficient, timely, and cost effective practice patterns.
    • Demonstrate understanding of clinical practice management and human resource issues and participate in evaluating CT team members, through attendance at CT Faculty Departmental meetings.
    • Discuss the appropriate use of generic drugs.

YEAR 2

ECHI Adult Cardiac Surgery (6-12 months)

Goals and Objectives

  1. Patient Care
    • Independently cannulate and place a patient on cardiopulmonary bypass.
    • Demonstrate understanding of and ability to perform various techniques for implantation of an artificial cardiac valve.
    • Demonstrate facile technique for coronary artery anastomosis. Implant a pacemaker using transvenous or epicardial leads.
    • Perform straightforward cardiac transplant operations.
    • Describe ventricular assist device (VAD) technology and first assist on VAD implantations.
    • Describe and competently perform the appropriate cardiac incisions for exposure of cardiac valves.
    • Describe surgical steps and competently perform mitral and tricuspid valve repair.
    • Demonstrate ability to use stabilization devices performing off-pump coronary artery bypass surgery.
    • Demonstrate sound strategy and proficient technical performance of complex thoracic aortic surgical procedures.
    • Proficiently conduct complex cardiac surgical procedures, such as multiple valve repair/replacement or combined valve/coronary bypass.
    • Exhibit the capacities of a mature cardiac surgeon, capable of dealing with all but the most complex intraoperative and postoperative situations.
    • Perform all types of cardiac transplants under the supervision of attending transplant surgeon.
    • Demonstrate proficiency in donor organ procurement.
  2. Medical Knowledge
    • Describe the causes of valvular heart disease and the indications for valve replacement or repair.
    • Discuss the causes and management of cardiomyopathy and congestive heart failure.
    • Describe the use of different anticoagulation strategies during cardiopulmonary bypass.
    • Demonstrate understanding of the types, construction, complications, long-term results, and rationale for the choice of artificial cardiac valves.
    • Discuss the pathologic conditions requiring cardiac pacing.
    • Describe the various pacing modes and their indications.
    • Discuss cardiac transplant related issues as presented in the Journal of Thoracic
    • Cardiovascular Surgery, Annals of Thoracic Surgery, and Journal of Heart and Lung Transplantation.
    • Describe the techniques & interpretation of imaging & diagnostic modalities used in cardiothoracic surgery.
    • Discuss and evaluate current therapeutic issues.
    • Develop peer relationships through attendance at a national CT surgery conference and an industry- sponsored course.Describe the types and etiologies of thoracic aortic disease and options for therapy, including use profound hypothermic circulatory arrest.
    • Discuss the medical, interventional, and surgical treatment options for atrial fibrillation.
    • Demonstrate understanding of all aspects of candidate selection, pre-transplant management, immunosuppressive protocols, intraoperative management, postoperative management, and the diagnosis and treatment of post-transplant complications
  3. Practice-Based Learning and Improvement
    • Demonstrate familiarity with and ability to use the STS database.
    • Demonstrate ability to practice lifelong learning by reading and discussing current issues of
    • Annals of Thoracic Surgery and Journal of Thoracic and Cardiovascular Surgery.
    • Use information technology to perform focused clinical research on cardiac surgery issues.
    • Perform satisfactorily on in-training written and oral exams.
    • Critically evaluate the advantages & disadvantages of preferred surgical techniques of different attending surgeons.
    • Demonstrate independent, critical evaluation of clinical, interpersonal, and technical performance and demonstrate adaptive ability to correct deficiencies.
    • Demonstrate independent functioning, incorporating not only current practice but also developing technologies in cardiothoracic surgery, cardiac transplantation and mechanical assistance.
    • Demonstrate ability to practice lifelong learning by reading current issues of Annals of
    • Thoracic Surgery and Journal of Thoracic and Cardiovascular Surgery focusing on congenital heart disease
    • Use information technology to perform focused clinical research.
    • Educate junior residents and medical students
  4. Interpersonal and Communication Skills
    • Effectively request and utilize consultation from supportive medical services.
    • Provide complete and adequate information regarding patient status to the patient and family while remaining supportive.
    • Demonstrate the ability to hand off and receive patients for coverage while ensuring complete and knowledgeable care during cross coverage.
    • Deal competently and effectively with referring cardiologists and other members of the patient care team.
  5. Professionalism
    • Project a demeanor suggesting knowledge, competence, and compassion.
    • Serve as a well-recognized resource for CT residents and for other services regarding complex surgical problems.
    • Communicate effectively and compassionately with patients and their families.
    • Demonstrate punctuality for service activities, including conferences and patient care responsibilities.
    • Respond to pages and requests for assistance in a consistently timely manner.
    • Demonstrate patience, sensitivity, and tact in dealing with the moral, legal, and ethical issues associated with the care of CT patients.
    • Exhibit appropriate attire at all times.
    • Demonstrate integrity and respect for all members of the patient care team.
    • Dictate timely, clear, and concise CT surgery operative reports.
    • Document regular attendance at CT Residents’ Seminars on ethics and professionalism.
  6. Systems-Based Practice
    • Perform efficient, timely, and cost effective practice patterns.
    • Demonstrate understanding of clinical practice management and human resource issues and participate in evaluating CT team members, through attendance at CT Faculty Departmental meetings.
    • Demonstrate the ability to balance the needs of multiple patients in planning service activities and operating schedules.

ECHI – General Thoracic Surgery (0-6 months)

Goals and Objectives

  1. Patient Care
    • Communicate effectively and compassionately with patients and their families regarding the diagnoses of lung and esophageal cancer.
    • Develop and carry out plans for management of patients with lung and esophageal cancer through interactions with attendings and through participation in Thoracic Tumor Board.
    • Perform complex thoracic cases competently (e.g., Pancoast tumors, colon interpositions, complex video-assisted surgery).
    • Describe the importance of smoking cessation, and learn how to counsel patients about its importance.
  2. Medical Knowledge
    • Describe the staging of lung and esophageal cancer, and stage appropriate therapy.
    • Discuss recent trends in multi-modality therapy for lung and esophageal cancer.
    • Describe physiology and anatomy of lung transplantation, and details of procedure.
    • Describe new biological treatment of lung cancer.
      Accurately interpret studies for the diagnosis and staging of lung and esophageal cancer.
    • Read accurately and interpret chest x-rays, CT scans, pulmonary function studies, endoscopic ultrasound results, and PET scans.
    • Evaluate and interpret test results for benign esophageal disease (manometry, pH probe).
    • Describe pulmonary physiology and ventilatory support at an advanced level.
    • Document regular participation in CT Residents’ Seminars.
    • Manage preoperative evaluation and postoperative follow-up of general thoracic patients in clinic
  3. Practice-Based Learning and Improvement
    • Demonstrate ability to practice lifelong learning by reading current issues of Annals of Thoracic
    • Surgery and Journal of Thoracic and Cardiovascular Surgery focusing on developments in lung and esophageal cancer care.
    • Use information technology to perform focused clinical research on general thoracic surgery issues.
    • Document regular participation in multi-disciplinary conference and clinic.
    • Perform satisfactorily on in-training written and oral exams.
    • Critically evaluate the advantages and disadvantages of preferred surgical techniques of different attending surgeons.
  4. Interpersonal and Communication Skills
    • Create and sustain sound relationships with patients and families through effective communication and empathy.
    • Accept constructive criticism enthusiastically and use it for self-improvement.
    • Integrate smoothly and relate well to the operating room team.
    • Deal competently and effectively with referring physicians and other members of the patient care team.
    • Interact collegially with pulmonary, oncology, GI, and radiation therapy physicians in multidisciplinary clinic and conference.
    • Manage the surgical team effectively, ensuring that pre-operative studies are known by the member assigned to the case, OR cases are covered, and postoperative care is efficient.
  5. Professionalism
    • Communicate effectively and compassionately with patients and their families.
    • Demonstrate punctuality for service activities, including conferences and patient care responsibilities.
    • Respond to pages and requests for assistance in a consistently timely manner.
    • Demonstrate patience, sensitivity, and tact in dealing with the moral, legal, and ethical issues associated with the care of lung and esophageal surgery patients.
    • Exhibit appropriate attire at all times.
    • Demonstrate integrity and respect for all members of the patient care team.
    • Dictate timely, clear, and concise CT surgery operative reports.
    • Document regular participation in CT Residents’ Seminars on ethics and professionalism.
    • Demonstrate knowledge of the ethics of clinical trials and patient confidentiality.
    • Systems-Based Practice
    • Describe the impact of lung and esophageal cancer on society, particularly in North Carolina.
    • Perform efficient, timely, and cost effective practice patterns.
    • Demonstrate understanding of clinical practice management and human resource issues and participate in evaluating CT team members, through attendance at CT Faculty Division meetings.
    • Discuss cost-benefit analyses of studies such as screening chest CT, PET scan and endoscopic ultrasound.
    • Describe appropriate use of routine post-operative tests.