The overall goals of the Thoracic Surgery Residency Program are: 1) to ensure that, upon completion of the full program, the resident will have the clinical educational experience needed to prepare for successful completion of the certification process with the American Board of Thoracic Surgery; and 2) to lay the foundation for a lifetime of self-education and improvement in a resident’s chosen field.
The residency program consists of three basic rotations: adult cardiac surgery, pediatric cardiothoracic surgery and general thoracic surgery. Although there are two identifiable tracks in the program – general thoracic and cardiac – all residents rotate through all subspecialties. The residents also rotate to Christian Hospital Northeast and occasionally St. Luke's Hospital for additional experience in cardiac surgery.
Two or three thoracic surgery residents rotate on the Adult Cardiac Service at Barnes-Jewish Hospital and one resident rotates at Christian Northeast Hospital with one of these (a second-year resident) acting in the capacity of administrative chief resident. For six months of the year, there is also one resident on the Cardiothoracic Service at St. Luke's Hospital. The residents are expected to achieve their educational goals by assuming graded levels of clinical responsibility under the close supervision of the faculty. This includes the areas of preoperative evaluation and preparation, intraoperative participation (up to and including assuming the role of primary surgeon) and provision of postoperative care. Close and frequent contact between the faculty and resident is maintained to ensure that patient care follows appropriate pathways and that the educational experience of the resident is maximized. Upon satisfactory completion of the two-year program, the resident should be able to manage both routine and complex adult cardiac surgical problems.
For most of the year, one resident rotates on the Pediatric Cardiothoracic Service. The resident assumes levels of responsibility commensurate to his or her ability as determined by the faculty. The trainee has the unique opportunity to spend one day per week in the cardiac catheterization laboratory to gain experience in the practical aspects of diagnostic and interventional cardiac catheterizations including the nature of how various hemodynamic variables are measured and calculated. On this service, night call is shared with the pediatric cardiology and critical care staff. At the completion of this rotation, the resident should be able to manage all but the most complex and uncommon forms of congenital cardiac disease and should be familiar with the management of even those complex problems.
Two residents rotate on the General Thoracic Service at any given time. The abundance of clinical activity at all levels of complexity on this rotation assures the residents of a meaningful educational experience, and the variety of activity allows for active participation in all phases of patient care. Faculty members are renowned for their innovative approaches to the evaluation and surgical management of thoracic diseases, and they take particular pride in the wealth of clinical experience available to residents on the service. Upon completion of this rotation, the resident should be able to manage the entire spectrum of thoracic disease including the most innovative forms of therapy.
In 2006, one combined general and thoracic surgical training “fast-track” position was approved at Washington University by the Residency Review Committees for General and Thoracic Surgery. This pilot program is one of only a handful of such programs in the country. The curriculum consists of four years of general surgery and three years of thoracic surgery, at the completion of which the trainee will have the opportunity to sit for exams with both the American Board of Surgery and American Board of Thoracic Surgery. The rotations of this resident do not impact those of the core residents.