• Complete Comprehensive Cardiothoracic Curriculum (*pdf)

All Cardiothoracic Surgery related activities are overseen by the Program Director and attending surgeons in the Cardiothoracic Surgery Division.

Clinical and Research Components

The resident will participate in all of the clinical activities of the Cardiothoracic Surgery Service. During the week, the residents will share call and alternate weekend call for the service. A member of the faculty will always be on for call for the service.

The resident will see consults and new patients with the faculty. Prior to an operation, the fellow will review the patient and the workup. The workup and pertinent diagnostics studies of patients will be discussed with the faculty. The resident will go to the operating rooms with the patients and will have a progressive increase in responsibility for the conduct of the operation, as appropriate. The resident will actively participate in the postoperative care of patients in the cardiac surgery intensive care unit and in the step down telemetry unit. The resident will participate in the post-discharge follow up of cardiac surgical patients including following patients admitted for surgical complications.

The resident will be expected to perform a research project during the residency. In most cases, this will be a clinical research paper. The faculty will discuss possible research projects with the resident and will oversee this project. The project should culminate in a manuscript submitted for publication. The Division of Cardiothoracic Surgery is active in both clinical and basic research. The basic research program of the Division of Cardiothoracic Surgery is centered on research into cardiomyopathies and related disorders of the heart, and treatment modalities including heart transplants, bioprosthetic values and cardiac stem-cell therapy. Preclinical studies using animal models are ongoing, including studies of the molecular effectors of native and bioprosthetic aortic valve degeneration. In addition we are establishing a Cardiothoracic and Vascular Tissue Repository at Cedars-Sinai to improve access to healthy and diseased heart and related human tissues for research study.

Procedure Requirements

The resident will acquire expertise in various surgical procedures from the simple to the complex. These include harvesting of the saphenous veins and radial arteries (including minimally invasive techniques); opening of the chest; dissection of the internal thoracic arteries for coronary artery bypass grafting and cannulation and decanulation for cardiopulmonary bypass. The resident will then perform distal and proximal coronary anastomosis; assist with valve replacement and repair, and perform valve replacement and simple valve repairs. The resident will participate in heart and lung transplantation including donor organ harvest and recipient operation. In addition, the resident will assist on complex operations such as ventricular assist device placement and congenital heart surgery operations and perform simple congenital heart surgery operations.

Didactic Component

Participation in the following educational activities will be required for the residents:

• Weekly rounds which combine case conference, morbidity and mortality and journal club
• Monthly core curriculum lectures in cardiothoracic surgery (please refer to the Core Curriculum PDF file above)
• Weekly cath conference for adult cardiology and pediatric cardiology

The first six months the resident will work on the General Thoracic Surgery service. Their responsibilities will be equal to the Thoracic Surgery residents on the service. The second half of the year the fellow will be on the Cardiothoracic Surgery service and continue to enhance skills acquired during the first year. The thoracic surgery curriculum is as follows:

Clinical and Research Components

The resident will participate in all of the clinical activities of the General Thoracic Surgery Service. During the week, the resident and the general surgery resident on the service will share call for the service. On weekends, the resident and the General Surgery resident on the service will alternate weekend call for the service. A member of the faculty will always be on for call for the service.

The resident will see consults and new patients with the faculty. Prior to an operation, the resident will review the patient and the workup. The workup and radiological evaluation of patients with thoracic disease will be discussed with the faculty. The resident will go to the operating rooms with the patients. The resident will have a progressive increase in responsibility for the conduct of the operation, as appropriate. The resident will actively participate in the postoperative care of patients on the service. The resident will spend time in the esophageal lab to learn about the workup for esophageal reflux.

The resident will be expected to perform a research project during the fellowship. In most cases, this will be a clinical research paper. The faculty will discuss possible research projects with the fellow and will oversee this project. The project should culminate in a manuscript submitted for publication. The Cedars-Sinai Medical Center Thoracic Surgery program has a very active thoracic research component. Our thoracic surgeons actively collaborate with medical oncologists, radiation therapists, radiologists, nuclear medicine experts and pathologists. A complete menu of clinical and basic research protocols for all stages and clinical settings of lung cancer are made accessible to patients.

The resident will be under the supervision of the General Thoracic Surgery Faculty (Robert J. McKenna, Jr., MD and Clark B. Fuller, MD). The faculty will assess the activities of the fellow and will discuss the evaluations with the resident.

Procedural Requirements

As part of the training, the resident is required to assist the faculty in the operating suites on various thoracic surgical procedures, including video-assisted thoracoscopic surgery (VATS), lobectomy, thoracotomy, wedge resection, pneumonectomy, thoracoscopy, decortication, chest wall resection, thoracentesis, mediastinoscopy, bronchoscopy, tracheotomy, esophagoscopy, esophagostomy, esophagectomy, trachoplasty, and bronchoplasty. The resident will also assist the faculty in other invasive procedures including chest tube placement, arterial linen placement, NG tube placement, and endotracheal intubation. The fellow is expected to participate in the pre-operative screening and the post-operative care of thoracic patients.

Didactic Components

Participation in the following educational activities will be required for the resident:

• Weekly Thoracic Oncology/Pulmonary Medicine Tumor Board meeting which inclues three to four lectures a year by guest speakers, visiting scientists, or visiting professors from outside Cedars-Sinai Medical Center and its affiliated universities
• Esophageal disease conference
• Teaching conferences and didactic courses (nine to 12 per year) which includes clinical research, basic science,ancillary, multidisciplinary and journal club
• Monthly core curriculum lectures in general thoracic surgery
• Monthly thoracic oncology research meetiing
• Quarterly LVRS team meeting
• Weekly morbidity/mortality meeting