Thoracic Surgery Residency Program

Program Overview

There are three training institutions, the University Medical Center (UMC), a 365-bed tertiary care center with two full time dedicated cardiothoracic operating rooms, an adult cardiothoracic intensive care unit and a pediatric intensive care unit; the Southern Arizona Veteran's Affairs Health Care System (SAVAHCS), which has approximately 200 beds, one dedicated cardiothoracic operating room and an eight bed surgical intensive care unit, and Tucson Medical Center (TMC), a 610-bed facility with three dedicated cardiothoracic operating rooms.

The two residents in the program rotate between these three hospitals. The Thoracic Surgery Resident is, therefore, the Chief Resident of either the UMC, VAMC, or TMC cardiothoracic service for the entire two years of his training. As such, he is responsible for preoperative evaluation and postoperative care of all cardiac, thoracic, and transplant patients. At the present time, the resident is aided by two general surgery resident at UMC and three nurse practitioners at UMC, SAVAHCS, and TMC. In addition to inpatient hospital care, residents at all institutions are expected to attend clinics and participate in outpatient care of a wide variety of cardiac and thoracic patients. Total patient visits per week at UMC at the outpatient clinic for cardiothoracic surgery number approximately 50, at the SAVAHCS approximately 15 patients are seen. In the outpatient setting, the cardiothoracic surgery resident sees patients independently and consults with the attending surgeon on their care.

The operative experience for cardiothoracic surgery residents at each institution consists of cardiac and thoracic cases. On a given day, a resident might participate in an open-heart procedure as well as a pulmonary resection. At the SAVAHCS and TMC, the operative experience consists of both cardiac and non-cardiac cases. At UMC, we see complex adult and congenital procedures, as well as cardiac and pulmonary transplants and a variety of "artificial hearts." Our goal is to train residents who are excellent surgeons and physicians. A review of residents who have gone through this program suggests strongly that this goal has been realized.

The daily schedule of a resident would typically start at 6:00 or 6:30 a.m. with patient rounds and include rounding on all patients of the service. At the University Medical Center the average census is approximately 30 patients per day. At the SAVAHCS, the number is smaller at approximately 5. Afternoon rounds at UMC begin after all major surgical procedures have been completed. These are supervised by the program director in most instances. The day, between morning and evening rounds, consists of operating (two cases per day), seeing patients who require care in the hospital, seeing new patients and attending clinics. The resident is also expected to attend the didactic sessions and to participate as presenter in the Morbidity/Mortality Conference once a month as well as a presenter occasionally at the conferences. He is also expected to attend the Transplant Conference and Artificial Heart Conference and present all inpatients. If possible, he is also invited to attend, and most often does attend, the Pediatric Catheterization Conference.

The cardiothoracic resident is never subordinate to any other resident or fellow in our program. The cardiothoracic resident participates in all cases except those in which two faculty members are scrubbed. This occurs in less than 10 percent of cases.

Our caseload is distributed roughly as follows: open-heart adult 500 (UMC), 150 (SAVAHCS), 200 (TMC), pediatric 85 (UMC); general thoracic 120 (UMC), 40 (SAVAHCS), 100 (TMC). The trend in numbers of cases has seen a slight increase in adult cases each year, both thoracic and cardiac. In congenital heart operations the number has been relatively constant.

Our training program is two years. We do not have an additional year. For any resident wishing to extend his training by one year either in research or clinical activity, we most often would be willing to make the appropriate arrangements.

Revised 10/2002