PROGRAM GOALS AND OBJECTIVES FOR CARDIAC AND THORACIC SURGERY RESIDENT EDUCATION VANDERBILT UNIVERSITY MEDICAL CENTER NASHVILLE, TENNESSEE This residency education program encompasses the operative, perioperative, and critical care of patients with pathologic conditions within the chest. This includes the surgical care of coronary artery disease; cancers of the lung, esophagus, and chest wall; abnormalities of the great vessels and heart valves; congenital anomalies of the chest and heart; tumors of the mediastinum; diseases of the diaphragm; and management of chest injuries. PROGRAM PHILOSOPHY The philosophy of this residency program is to: Provide a robust, appropriately supervised setting in which advanced, highly skilled education in adult cardiac surgery, pediatric cardiac surgery, and thoracic surgery can take place. Seek opportunities for the resident to acquire an in-depth knowledge and advanced skill in cardiac and thoracic surgical techniques. Develop academically and professionally. Skills to be acquired include those of medical knowledge, patient care, practice-based learning and improvement, communication and interpersonal skills, professionalism, and systems based practice. Provide an excellent clinical education and graduated clinical advancement accomplished by directed expert clinical, academic, and social instruction promoting self-directed education, and fostering the refinement of the individual resident s clinical, professional, social, and academic pursuits. Combined resident mentoring with instruction by faculty including both didactic and Socratic education, hands-on experience, and self-directed learning. CORE COMPETENCIES GOALS AND OBJECTIVES Core competencies Goals are shown below for (1) Patient Care, (2) Medical Knowledge, (3) Communication and Interpersonal Skills, (4) Practice based learning and Improvement, (5) Professionalism, and (6) Systems-based practice. These objectives amplify the expectations of the ACGME General Competencies and apply to residents at all levels. The objectives characterize the general requirements for successful completion of our residency program. A continuum of achievement in accomplishing these goals throughout the residency education training will serve as one indicator of satisfactory progress. Residents are expected to build upon skills and techniques learned in previous years. These goals will be taught by self-directed reading, resident conferences, and demonstrations by the faculty. Opportunity for observation by the resident, and practice will be provided. These skills will be evaluated by the faculty. As often as daily, feedback will be provided. 1
PATIENT CARE AND MEDICAL KNOWLEDGE Developing a sound understanding of the pathophysiology of thoracic and cardiac diseases, including acquiring an in-depth knowledge of the management of critically ill and critically injured patients including the literature supporting various particle approaches. Mastering the use of various technologies for cardiopulmonary support, and monitoring in the cardiac and thoracic units. Confidently applying therapeutic interventions in a variety of settings including outpatient clinic, general and patient wards, intensive care unit, operating room, and in various perioperative areas. Developing the administrative skills necessary to direct patient care within a cardiac or thoracic intensive care unit. Acquiring sound clinical decision making and surgical judgment. Enhancing professional behavior, and communication and interpersonal skills inside and outside the operating room. PRACTICE BASED LEARNING Develop a personal program of self-study and professional growth with guidance from the teaching staff and faculty advisor. An understanding of the etiology, pathogenesis, pathophysiology, diagnosis and management of cardiac and thoracic surgical disorders is absolutely necessary. This will allow for sound surgical judgment which relies on knowledge, rational thinking and the surgical literature. Participate in teaching and organization of the educational conferences and activities of the Department of Thoracic Surgery and the Department of Cardiac Surgery and assume responsibility for teaching and supervision of subordinate surgical house staff, and medical students. PROFESSIONALISM Participate in compassionate patient care maintaining the highest moral and ethical values with a professional attitude. The resident should be sensitive to the needs and feelings of others, including the patient's family members, allied health care personnel (nurses, clerical staff, etc.), fellow residents, and medical students. Demonstrate respect, compassion and integrity in the care of patients on a daily basis. Show sensitivity to patients culture, age, gender and disabilities. INTERPERSONAL RELATIONSHIPS AND COMMUNICATION SKILLS Create and sustain a therapeutic and ethically sound relationship with patients to include both counseling and education of patients and families. 2
Work effectively with other members of the medical team including faculty, colleagues (coresidents) allied health care personnel (nurses, clerical staff, etc.), fellow residents, and medical students. Maintain professional interactions with other health care providers and hospital staff. SYSTEMS BASED PRACTICE Understand how the health care organization affects surgical practice. Demonstrate cost effective health care. Knows how to partner with health care managers and allied health personnel to improve health care. Follow established practices, procedures, and policies of the Department of Thoracic Surgery, and the Department of Cardiac Surgery and integrated and affiliated hospitals. Completion of medical records operative notes staff sheets and notes, patient database cards and other patient care related documentation in a timely, accurate and succinct manner. EDUCATION OVERVIEW The first year of residency education is directed toward developing clinical skills and medical knowledge by taking a medical history and performing physical examinations as well as learning about the special techniques and diagnostic tests used in the specialty. The second year expands upon the skills developed in the first year. Increased responsibilities are reflected and the residents involvement in patient consultation, teaching of medical students, and residents of other programs in the Vanderbilt system, continuation of experience in managing patients in the outpatient clinic, and refining diagnostic and treatment skills. Further surgical technical skills are learned. Operative judgment and Intraoperative management is emphasized. In the third year, the resident has senior-most responsibility in the management of patients. The resident develops refined knowledge and experience in the management of various complex medical and surgical procedures, accurate anatomic treatment of perioperative events or complications, rehabilitative techniques, and other complex procedures. Elective and emergency end-house consultations are performed by the resident. New skills are learned in the area of major emphasis. Common objectives for individual resident years are presented for Communication and Interpersonal Skills, Practice Based Learning and Improvement, Professionalism, and Systems-based Practice. A progressive graduated acquisition of skills for years 1, 2, and 3 are provided. Residents are expected to accomplish the following objectives in the time frame indicated: 3
YEAR 1. Patient care and Medical Knowledge will be met by the curriculum: Thoracic Surgery 1 st Year Resident Curriculum Goals and Objectives for the Cardiac Surgery Rotation Thoracic Surgery Rotation Objective: Perform above the 50th percentile (for year of residency education) on the TSDA-ITE primary examination YEAR 2. Patient care and Medical Knowledge will be met by the curriculum: Thoracic Surgery 2 st Year Resident Curriculum Goals and Objectives for the Cardiac Surgery Rotation Echocardiography and Diagnostic and Therapeutic Catheterization Pediatric Cardiac Surgery Rotation Thoracic Surgery Rotation Objective: Perform above the 50th percentile (for year of residency education) on the TSDA-ITE primary examination YEAR 3. Patient care and Medical Knowledge will be met by the curriculum: Thoracic Surgery 3 nd Year Resident Curriculum Goals and Objectives for the Cardiac Surgery Rotation Thoracic Surgery Rotation Objective: Perform above the 50th percentile (for year of residency education) on the TSDA-ITE primary examination. 4
CONCLUSION OF RESIDENCY EDUCATION PROGRAM At the conclusion of this residency education program in Cardiac and Thoracic Surgery, the successful resident will: Have a thorough understanding of all components of cardiac and thoracic diseases including diagnostic, therapeutic, and management options. Be able to develop a diagnostic and therapeutic plan for a wide spectrum of surgical diseases. Have the medical knowledge, operative skills, judgment, and leadership to perform common adult cardiac, pediatric cardiac, and thoracic surgical procedures without supervision. Be the operating surgeon on complex procedures assisted by the surgical attending Organize staff conferences as well as departmental conferences as assigned. Mentor to general surgery residents, thoracic surgery residents, and medical students. Critique personal practice outcomes and demonstrate recognition of the importance of lifelong learning in surgical practice. Communicate effectively with other health care professionals, counsel and educate patients and families, and effectively document practice activities. Maintain high standards of ethical behavior; demonstrate a commitment to continuity of patient care; and demonstrate sensitivity to age, gender and culture of patients and other health care professionals. Practice high quality, cost effective patient care; demonstrate knowledge of risk-benefit analysis, and demonstrate an understanding of the role of different specialists and other health care professionals in overall patient management). The program is designed to provide a sound didactic and clinical education which is carefully planned to optimize educational opportunities for the resident concurrently with balancing concerns for patient safety and resident well-being. Service obligations are minimized but not eliminated. Ancillary staff, including a cadre of nurse practitioners and physician assistants, assist with healthcare service. Didactic and clinical education has priority for residents time and energy. Faculty, residents, and staff collectively have responsibility for the safety and welfare of the patients. Faculty and residents are educated to recognize the signs of fatigue via web in-service tools and programs. Active departmental policies ensure duty hour compliance minimizes fatigue and optimizes educational energies. Moonlighting is not allowed. These goals are fostered in an environment of progressively graded clinical and operative experience and responsibility. Within the limits of variability found in a clinical practice, an equivalent experience will be afforded each resident, under the guidance and supervision of qualified teaching staff. With this process, each resident will develop mature surgical judgment and operative skills which will prepare him/her to provide independent surgical care to patients with a wide range of cardiac and thoracic disorders in a manner appropriate to a specialist in surgery and a candidate for a Diplomat of the American Board of Thoracic Surgery. The final assessment of whether these objectives are being achieved is made by the Program Director as recommended by the Resident Education Committee, and the faculty of the Department of Cardiac Surgery, and the Department of Thoracic Surgery. 5
CURRICULUM Our curriculum is designed to accomplish the goals and objectives of our program. The curriculum is multifaceted and includes didactic, supervised and semi-independent clinical care in addition to a robust perioperative and operative experience in adult cardiac, pediatric cardiac, and thoracic surgery. 1. Reading: Textbooks including: General Thoracic Surgery (Shields), Cardiac Surgery in the Adult (Cohn and Edmunds), Pediatric Cardiac Surgery (Mavroudis & Backer), Demanding Medical Excellence (Millenson), and Crossing the Quality Chasm (Institute of Medicine) 2. Evolving current information from the peer-reviewed surgical literature and information derived from presentations of national meetings. Articles will be used for Journal club, program management and improvement meetings, and other forums. 3. Basic science is addressed through various resident teaching conferences as described in the conference schedule. 4. Other conferences. Residents are encouraged to participate in rotation specific conferences to acquire skills leading toward integrated and multidisciplinary care of complex cardiac and thoracic surgery patients. 5. Research opportunities. Residents are encouraged to participate in research during residency. This typically has included clinical trials, retrospective chart reviews, evaluation of patient outcomes, etc. 6