Residency Curriculum

Overview

The mission of our program is to develop outstanding clinicians, educators, researchers, and potential leaders in the field of Cardiothoracic Surgery. The UCSF Thoracic Surgery Residency Program consists of two training pathways:

1. Traditional three-year residency following completion of an ACGME-accredited general surgery residency
2. Fast-track 4/3 pathway integrated with general surgery training

Both pathways provide a comprehensive experience in all aspects of acquired heart disease, thoracic oncology, congenital heart disease, diseases of the great vessels, and thoracic transplantation. Upon completion of training, the resident will be capable of independent practice. Many will have fulfilled UNOS criteria for thoracic transplantation.

Traditional Three-Year Thoracic Surgery Residency

The traditional three-year residency program consists of rotations through four core rotations and one or more elective rotations (see description of rotations below). The total time on these rotations depends on the selected training pathway (Cardiac or Thoracic). Each site and rotation exposes the resident to different cardiovascular and thoracic pathologies, treatment technologies, and patient population, all of which contribute to a broad and diverse experience. The training background, clinical expertise, and research focus of the teaching faculty on each rotation complement the education and training.

Fast-Track 4/3 Pathway

The Fast-Track 4/3 Pathway allows for early integration of the thoracic residency curriculum during the fourth and fifth years of general surgery residency. Residents complete a total of eight months of cardiothoracic surgery rotations during their fourth and fifth clinical years of general surgery residency. Fast-track 4/3 residents are eligible for board certification by both the American Board of Surgery (at the completion of their general surgery residency) as well as the American Board of Thoracic Surgery (at the completion of their thoracic surgery residency). Only current UCSF categorical general surgery residents in good standing are eligible to apply. Both cardiac-track as well as thoracic-track residents are encouraged to apply. Interested residents should contact our program coordinator approximately two years before they start their fourth clinical year. Typically, this is during the first half of their first research year.

Clinical Rotations

Description of Rotations

Core Rotations

UCSF Adult Cardiac Rotation (Parnassus Campus)

This rotation is designed to provide a broad exposure to the comprehensive management of simple and complex acquired heart disease. UCSF Moffitt/Long is the parent hospital for the UCSF School of Medicine and serves as a local, regional, and international referral center for cardiac care. As such, in addition to a broad range of common disorders and fundamental surgical cases, the cardiac surgery service also evaluates patients with advanced or unusual cardiovascular disease and patients at extremes of age often providing the foundation for unique case discussions and presentations. The resident participates in outpatient clinics (weekly) inpatient ward and ICU rounds (daily), operating theater (4 days/week), and clinical teaching conferences (weekly Cardiothoracic Conference, Catheterization Conference, Transplant Listing Conference), all on site.

Under direct supervision, the resident is expected to formulate pre- and post-operative diagnostic and treatment plans for patients with acquired cardiac diseases. The resident is expected to participate as primary surgeon in approximately 50% of the surgical cases. Reconstructive valvular procedures, cardiac arrhythmia surgery, re-operative cardiac surgery and thoracic transplantation are emphasized. Experience in mitral reparative surgery is particularly robust, with significant expertise in surgery and echocardiography. The resident also gains exposure to the diagnosis and management of cardiac trauma.

In addition, the resident is expected to attend all Cardiothoracic Division weekly Teaching Conferences (Thursdays) and Morbidity and Mortality Conferences (Wednesdays). The third year chief resident organizes and directs these conferences and with faculty assistance, selects guest speakers with local, national and international expertise in cardiothoracic surgery. A UCSF faculty member supervises preparation for presentations at these conferences and the Thoracic Surgery Directors Association/Self Education Self Assessment in Thoracic Surgery learning resources are provided.

UCSF Thoracic Surgery Rotation (Parnassus Campus)

This rotation is designed to provide a broad exposure to the comprehensive management of simple and complex thoracic diseases. Patient referrals come from local, regional and national sources. The resident participates in outpatient clinics (twice-weekly) and clinical teaching conferences (weekly Thoracic Tumor Board) at UCSF/Mt. Zion. Inpatient ward and ICU rounds (daily) and operating theater (3 days/week) are on site. The Thoracic Tumor Board Meeting exposes the resident to discussions of multi-modality therapies and clinical trials for advanced thoracic malignancies. Under direct supervision, the resident is expected to focus on and formulate diagnostic and treatment plans for patients with pulmonary or esophageal malignancies and pleural space infections in both the outpatient and inpatient settings.

The resident is expected to function as primary surgeon in approximately 50% of the surgical cases, focusing on the fundamentals of thoracic incisions, pulmonary and esophageal resection and video-assisted surgical methodology. The resident also participates in supervised organ procurement for lung transplantation and gains exposure to common thoracic trauma in the Emergency Room, ICU and operating room settings. In addition, the resident is expected to attend all Cardiothoracic Division weekly Teaching Conferences (Thursdays) and Morbidity and Mortality Conferences (Wednesdays).

UCSF Benign Thoracic Rotation (Parnassus Campus)

This rotation is designed to provide a broad exposure to benign esophageal pathology as well as interventional pulmonology procedures. Patient referrals come from local, regional and national sources. The resident participates in two half-day outpatient clinics (Wednesday AM with Interventional Pulmonology and Wednesday PM with Upper Foregut) at UCSF/Mt. Zion. Inpatient ward and ICU rounds (daily) and operating theater (Mondays/Tuesdays with Interventional Pulmonology and Thursdays/Fridays with Upper Foregut) are on site. Residents are expected to participate in all aspects of pre-operative work-up and planning, intra-operative techniques, and post-operative care of benign thoracic disease including upper foregut pathologies as well as the evaluation of pulmonary and mediastinal nodules.

The resident is expected to function as primary surgeon in approximately 50% of the surgical cases, focusing on the fundamentals of upper foregut abdominal incisions, upper foregut anatomy and mobilization techniques, esophageal stenting, as well as a wide variety of interventional pulmonology skills such as interventional bronchoscopy, EBUS, EMN-guided bronchoscopy, rigid bronchoscopy, and airway stenting. The resident also participates in inpatient consultations and gains exposure to airway procedures in the Emergency Room, ICU and operating room settings. During this rotation, the resident is expected to attend all Cardiothoracic Division weekly Teaching Conferences (Thursdays) and Morbidity and Mortality Conferences (Wednesdays).

UCSF Congenital Heart Surgery Rotation (Mission Bay Campus)

This rotation is designed to provide dedicated exposure of the resident to the diagnosis and management of congenital heart disease. UCSF has been internationally recognized for its expertise in this area where many notable advances in congenital heart surgery have been developed. In addition to routine cases, complex neonatal surgery and fetal surgery offer a rich experience in understanding cardiac embryology, anatomy, and physiology. The resident participates in pediatric outpatient clinics (weekly), inpatient ward and ICU rounds (daily), operating theater (4 days/week), and clinical teaching conferences (weekly Catheterization Conference, Case Management Conference), all on site. Under direct supervision, the resident is expected to formulate diagnostic and treatment plans for patients with common congenital heart diseases. The resident is expected to participate in 20-30 surgical cases during the rotation and serves as primary surgeon in approximately 50% of these. The challenges of surgical technique in neonates and children serve to refine the surgical skills of the resident. Surgical management for conditions that increase or decrease pulmonary blood flow as well as anomalies of the great vessels, aorta, and pulmonary veins are emphasized. In addition, for select conditions, the resident is exposed to hybrid management schemes involving operating room and catheterization lab techniques. Percutaneous valve replacements are included.

Kaiser San Francisco Cardiothoracic Rotation (Kaiser San Francisco Campus)

This rotation is designed to provide an exposure to high volume adult cardiothoracic surgery in a community practice setting. As such, in addition to a broad range of common disorders and fundamental surgical cases, the Thoracic resident also has extensive exposure to thoracic aortic disease and percutaneous cardiovascular procedures (TEVAR, TAVR) as well as general thoracic oncology.

The primary site will be the Kaiser San Francisco campus, where exposure to surgery for acquired heart disease is emphasized. High volumes of coronary bypass surgery, valve replacement (surgical and TAVR) and surgery of the thoracic aorta are available. The resident will also participate in basic thoracic procedures during the rotation. The resident participates in outpatient clinics (weekly), inpatient ward and ICU rounds (daily), operating theater (daily), and clinical teaching conferences (Wednesday cath/pulmonary conference from 4-5pm and Thursdays from 7-9am.), all on site. The resident will be on call (from home) 1-2 days per week and 1-2 weekends per month. Under direct supervision, the resident is expected to formulate pre- and post-operative diagnostic and treatment plans for patients with acquired cardiac diseases. The resident is expected to participate as primary surgeon in approximately 50-75% of the surgical cases.

Elective Rotations

UCSF Thoracic Transplant Rotation (Parnassus Campus)

This rotation is designed to provide a dedicated exposure to thoracic transplantation and artificial circulatory support in patients with advanced heart and/or lung failure. UCSF currently has one of the largest lung transplantation services nationally and has a unique experience in the use of extracorporeal life support (ECLS) as a bridge to lung transplant. The service oversees the complete management of the transplant patient, from recipient/donor selection to postoperative immunosuppression, providing an in-depth exposure to critical care surgery and recovery.

The potential complexities of mechanical ventilation and artificial circulation provide a rich, multi-disciplinary education in these areas. The resident participates in outpatient clinics (weekly), inpatient ward, and ICU rounds (daily), operating theater (4 days/week), and clinical teaching conferences (weekly CT service, Catheterization Conference, Transplant Listing Conference), all on site. The resident is expected to participate in transplant cases and Ventricular Assist Devices/ECLS cases and organ procurements during the rotation and to serve as primary surgeon in approximately 50% of these. It is expected that the resident becomes eligible for United Network for Organ Sharing (ONAS) certification in Lung Transplantation. During the rotation, the resident continues to attend outpatient clinics, teaching conference and will lead Journal Club discussions on related topics.

UCSF Advanced Thoracic Surgery Rotation (Parnassus Campus)

The primary objective of this elective is to prepare the resident for a subspecialization in General Thoracic Surgery. Pre-operatively, the resident focuses on application of risk stratification methodologies in patient selection and management as well as evidence-based standards for medical versus surgical treatment options. Operative experience involves greater exposure to advanced pleural disease (e.g., extra-pleural pneumonectomy for mesothelioma), tracheal surgery, complex mediastinal tumors, surgery for esophageal cancer, thoracoscopic pulmonary resection and endobronchial procedures for benign and malignant diseases. The resident has an opportunity to participate in recipient lung transplantation.

The resident is expected to participate as primary surgeon in approximately 90% of the surgical cases. Importantly, residents undertaking the General Thoracic elective are expected to achieve an even greater fluency and competence with state of the art multimodality approaches to Thoracic Oncology. This familiarity includes not only the most recent evidence available from large and small-scale clinical trials, but also with salient elements from the translational science literature. Furthermore, as future academic leaders, residents gain a familiarity with the principles and responsibilities of human clinical trial design and execution. During the rotation, the resident continues to attend outpatient clinics, teaching conference, and leads Journal Club discussions on related topics.

UCSF Heart Failure Rotation (Parnassus Campus)

This rotation is designed to provide cardiac pathway trainees with additional exposure to more heart failure surgery, procedures and new technologies. The resident will be expected to master evidence-based guidelines for the management of valvular heart disease and he/she will participate in the Multidisciplinary Heart Valve Clinic which is charged with the selection of patients for Transcatheter Aortic Valve Replacement (TAVR). In addition, it is expected that the resident will become facile with the institution and conduct of cardiopulmonary bypass, including hypothermic circulatory arrest, and extra-corporeal life support systems and perform re-operative cardiac procedures. During the rotation, the resident will continue to attend outpatient clinics, teaching conferences, and will lead Journal Club discussions on related topics.

UCSF Advanced Congenital Surgery Rotation (Mission Bay Campus)

This rotation is designed for trainees interested in pursuing a career in congenital heart surgery. The rotation emphasizes cases referred for tertiary care of diseases such as arterial transposition of the great vessels, single ventricle, anomalous pulmonary venous drainage, and aortic atresia. Preoperative care and preparation for surgical intervention is emphasized and the resident is expected to have a detailed understanding of surgical options for these diseases. The resident has the opportunity to refine fine motor skills required for the conduct of surgical procedures on these patients and is exposed to the application of extra-corporeal life support and/or ventricular assist devices which may be required in the care of pediatric patients. During the rotation, the resident attends outpatient clinics and teaching conferences.

Non-Surgical Assignments (Various)

During the second year of training, the resident encounters a 2 to 4 week experience in a non-surgical assignment (cardiac catheterization lab, echocardiography lab, pulmonary function lab, esophageal manometry lab) based on the resident’s chosen training pathway. During the non-surgical assignments, the resident is excused from his/her surgical rotation responsibilities, including inpatient, outpatient and on-call duties. The resident is encouraged to maintain attendance at the Thoracic Teaching conference and Journal Club, especially when conference topics coincide with the non-surgical assignment.

Clinical Pathway for Robotic Surgery Training

All UCSF Thoracic Residents who wish to develop the knowledge and skills to perform robotic thoracic surgery [link: https://top.ucsf.edu/conditions--procedures/robotic-thoracic-surgery.aspx] have the opportunity to complete the Clinical Pathway for Robotic Surgery Training on the latest, state-of-the-art robotic surgical systems. Residents will complete a four-phase curriculum building on skills acquired in the previous phase, ultimately achieving competency performing complex robotic thoracic procedures independently as the Console Surgeon. Upon successful completion of the Clinical Pathway, a Certificate of da Vinci System Training as Console Surgeon will be issued by the Robotic Program Director.

• Phase I: Introduction to da Vinci® Surgery
• Phase II: Simulation Training
• Phase III: Off-site Dry Lab and KindHeart Simulation Training
• Phase IV: Post-System Training