We appreciate your inquiry about the Residency Program in Cardiothoracic Surgery at the Hofstra North Shore-LIJ School of Medicine. We feel the best way to train cardiothoracic surgeons is through an integrated hands on approach with increasing levels of responsibility. We have a fully accredited ACGME thoracic surgery residency which has been in existence as a free standing residency for many years. The North Shore Long Island Jewish Health System is the nation's third largest, non-profit, secular healthcare system and the nation's 14th largest integrated healthcare network and largest in the Northeast. The Health System services and area of 5.2 million people in Long Island, Queens and Staten Island. Residents will have the opportunity to train at three of our campuses; North Shore University Hospital in Manhasset, Long Island Jewish Medical Center in New Hyde Park, and Southside Hospital in Bay Shore. These three centers serve as advanced diagnostic and treatment centers for cardiovascular and thoracic diseases, and are part of the Hofstra North Shore-LIJ School of Medicine.
The Cardiothoracic Surgical Residency training program at Hofstra North Shore-LIJ School of Medicine is a 24-month integrated experience in clinical cardiothoracic surgery, including pediatric cardiothoracic surgery, general thoracic surgery and adult cardiac surgery. Clinical decision-making in preoperative and postoperative care is increased during the two-year training period. During the first 12 months of training, ten months are allocated to general thoracic surgery and two months are designated to pediatric cardiac surgery. The second (senior) year is designated as adult cardiac surgical training. The educational program is designed to achieve the following goals for each block of training.
- Mastery of the core curriculum as developed by the Thoracic Surgery Directors Association
- Successful Preparation for standardized testing in thoracic surgery (Board examination and In-service training examinations)
- Appropriate preparation for the preoperative evaluation and postoperative management of patients undergoing adult and pediatric cardiothoracic surgical procedures
- An appropriate level of achievement in the technical performance of operative procedures included in the realm of cardiothoracic surgery and attainment of sufficient operative experience as surgeon to allow entry to the Thoracic Surgery Board examinations at the conclusion of the training period.
- Development of the Core Competencies as described by the ACGME
- Develop the clinical, analytical and technical skills required to perform cardiothoracic surgery independently
During the first twelve months of clinical rotations, the (junior) cardiothoracic resident is expected to concentrate his efforts on the development of core knowledge in general thoracic and cardiothoracic surgery. He/she will serve in the role of first assistant and primary surgeon in cardiothoracic surgical operative procedures under the supervision of an attending surgeon at all times. During the first ten months of training, the general thoracic rotation includes training in pacemaker and implantable cardioverter defibrillator therapy, thoracic oncology, pulmonary diagnostic evaluations and in GI endoscopy. During the second six months the junior resident should expect increased exposure to adult cardiac procedures. Two months are designated to training in congenital heart surgery.
Responsibility for operative procedures is assigned by the responsible attending surgeon and is graduated according to ability. The junior resident is administratively subordinate to the senior resident on the service and is expected to help in the preparation of M&M's, Tuesday and Thursday morning lectures, journal club, morning ward rounds, assistance in the instruction of general surgical residents, medical students and physician assistants rotating on the service, as well as take an equal share in coverage of the clinical service with the senior cardiothoracic resident.
The second calendar year of the residency is focused on adult cardiac surgery. During the first six months of the second year, the resident is exposed to cardiac catheterization and perfusion services and during the final six months is exposed to echocardiography. The senior resident is responsible for the presentation of mortality and morbidity conferences with his co-resident. The physician assistants help with gathering data for presentations. The senior resident in cardiothoracic surgery is administratively responsible for the assignment each day of personnel (surgical residents and physician's assistants) to the operating rooms. He/she is instructed to maximize his own educational experience to be certain that he/she has fulfilled the Board eligibility requirements as a trainee in terms of operative experience by the completion of his 24-month training. It is understood that the senior resident on the service may at any time choose to be present (either as assistant or operating surgeon) on any procedure, which will optimize his educational experience. The program director monitors the cases to insure that the residents receive a balanced and similar education.
The rotation schedule is adjusted to allow a greater exposure to general thoracic surgery for residents who wish to pursue the thoracic tract.
Residents at both the junior and senior level are involved preoperatively in preparation of both inpatients and outpatients. They are required to be present during office hours (clinic) at least once per week and participate in the evaluation of preoperative data, patient evaluation and planning. They are required to log this activity. Similarly, inpatient work ups are organized and directed by the cardiothoracic surgery resident. They are involved in the preoperative education of the patient and family and generate a formal consultation under the supervision of the attending surgeon. A formal plan of surgical intervention is discussed with the attending surgeon prior to the operative procedure. Decision making based on evidenced-based medicine and compassion are stressed at all levels. It is the duty of the cardiothoracic surgery resident to have an understanding of the patient's pathology and the plan of treatment. This includes collation and evaluation of all preoperative testing (with the assistance of the physician's assistant staff and general surgical house staff). It is understood that the attending surgeon is available to review the plan of therapy with the resident at any time.
The program requires each resident to maintain a concurrent log of operative and clinic activities. The web-based database is used for operative logging and each resident is asked to submit a case list at the completion of each quarter of training. Cases lists are reviewed with the program director quarterly and the resident is made aware of any deficiencies in operative experience so that they may be corrected in a timely fashion. Additionally, the cardiothoracic surgery office employs a full time data collection nurse whose job it is to maintain records for New York State and for hospital-wide Quality Assurance. These databases provide a backup source of information for residents since each case is logged with surgeon and assistant as well as patient identification, operative procedure, outcome and perioperative morbidity.
The volume of cardiothoracic procedures has increased over the last several years particularly in the area of general thoracic surgery. This has intensified the trainees' exposure to thoracoscopic pulmonary and mediastinal procedures, tracheal procedures, chest wall procedures, airway and upper GI endoscopy and multimodality thoracic oncologic approaches. Catheter based interventions are increasing relative to surgical referrals for ischemic cardiac disease such as thoracic endografting for aortic pathology (TEVAR) and percutaneous valve placement which are currently being performed at our facilities. This has resulted in an increase in the number of referrals for patients with cardiac disease.
The Hofsta North Shore-LIJ School of Medicine conforms rigorously to the working hour and resident supervision requirements of New York State. This means that there is adherence to both the Bell Commission Regulations and ACGME requirements, including a maximum average 80-hour work week and provision for adequate rest after extended hours. The average workday begins at 6:00 am and concludes at 6-7pm. Weekends days are abbreviated since operative procedures are not booked electively on weekends. They are scheduled for one day of rest for each seven-day period. Cardiothoracic surgery residents are allowed to take calls from home and return to the hospital only for emergencies and for operative procedures. They are required to leave the hospital the next day if the work hour limits are exceeded. Formal attending-level intensive care (intensivist) coverage was initiated in 1999 and covers 24 hours per day, seven days per week as of July 2001. This administrative change will further reduce the nighttime call responsibilities of the cardiothoracic surgery resident.
Each faculty member on a formalized evaluation document evaluates each resident quarterly. The resident is required to evaluate each faculty with whom he/she has had exposure and to separately evaluate the quality of his training experience on each rotation. During the quarterly meeting with the program director, the resident is allowed to review his evaluations and comments. He/she is advised of any deficiencies and encouraged in areas of strength at that time. A formal memorandum of the meeting is entered into his file by the program director. Residents are encouraged to be forth right in their evaluations of faculty and rotations. There is a formal policy for redress if the resident feels his comments have resulted in prejudicial treatment by the faculty.