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MEDICAL UNIVERSITY OF SOUTH CAROLINA The MUSC Cardiothoracic Surgical Residency Program started in the early 1960’s and has been continuously accredited by the Thoracic Surgery Residency Review Committee since that time. At the time of the last two site visits (2001 and 2007), NO citations of any kind were listed, and the program was commended for its overall excellence. For many years the program was a traditional two-year program with two residents each year (2-2). As the spectrum of cardiothoracic surgery expanded rapidly in the 1980’s, the faculty felt that two years were not enough time to educate a modern cardiothoracic surgeon. Accordingly, in 1987 the program requested a change to a three-year program with one resident in each year (1-1-1), and this was approved by the Thoracic Surgery RRC. In 1997 the RRC requested that we accept an additional resident into our program from a program that had lost accreditation. The addition of this resident improved the overall quality of the educational program. A similar request was made to accept another resident from yet another program that lost accreditation in 1999. Because of these two experiences, it became apparent that the MUSC program functioned much better with a total compliment of four residents than with three. Accordingly, the program requested a permanent change be made to a 2-1-1 program, and this was approved by the Thoracic Surgery RRC in 2001. (This is one of the very few programs to be allowed to expand its compliment of residents by the Residency Review Committee in recent history.) In the current program, two residents are accepted every third year and work their way through the program (Year 1: 2-1-1; Year 2: 1-2-1; Year 3: 1-1-2) so that there are always four residents in the program. These changes have progressively improved the quality of the cardiothoracic educational experience, have not decreased the overall operative experience (link to resident operative experience), and were helpful in adjusting to the 80-hour-work-week limitations. Despite these changes, Dr. Crawford has long advocated a change in cardiothoracic surgery education in order to increase the exposure to cardiothoracic surgery and related specialties and to decrease the time allocated to general surgery. Ideally such a program would both improve cardiothoracic education while decreasing the length of the program. Very recently, changes by the American Board of Thoracic Surgery and the Thoracic Surgery Residency Review Committee have permitted alternative pathways to ABTS certification. In 2007, the MUSC faculty developed a six-year integrated CT residency program matching directly out of medical school. This was submitted to the Thoracic Surgery Residency Review Committee and approved in July 2008, and the program will match its first resident in the spring 2009 match. Only three such programs have been approved at this time (MUSC, Stanford, and the University of Pennsylvania), and this division is proud to be one of these programs which could completely change cardiothoracic surgery education. Institution of this program will require a transition period of three years during which time residents will be matched to both the traditional program and the new integrated program. This is necessary in order that there be no “gaps” in the program as the new curriculum is phased in. In other words, if the traditional program were to be abandoned completely as the six-year program is started, after three years the existing senior residents in the program would have all finished and yet there would only be three residents left (one each at the PG-1, 2 and 3 level). One unique aspect of the new six-year program is that every third year an additional resident will match at the PG-4 level. Thus, the “senior” years would continue to have the present compliment of residents and rotations (2-1-1; 1-2-1; 1-1-2). This is being done because we believe there will continue to be some who may decide late (perhaps after several years of general surgery) that they want to be a cardiothoracic surgeon, and this plan would allow such individuals access to the program. The rotation for each year of the new six-year program are outlined in the rotation schedule table. As will be apparent, some traditional general surgery rotations (link) will be maintained because of their educational value to a cardiothoracic surgeon. New rotations in related specialties (cardiology, heart failure, imaging, echo, cath lab, etc.) will provide in depth exposure to these disciplines which relate closely to cardiothoracic surgery. Significantly increased exposure to cardiothoracic surgery itself will occur in each of the first three years. Rotations in the final three years are only slightly changed from the current experience. The overall CT residency program includes rotation at the new Ashley River Tower facility, MUSC Children’s Hospital, and the Ralph Johnson VA Hospital. Residents are based at Ashley River Tower where they have office space within the overall office space of the Division of Cardiothoracic Surgery. This office space is contiguous to that of the Division of Adult Cardiology which also includes office space for cardiology fellows and for both cardiothoracic surgery and cardiology physician extenders. This office space includes two conference rooms and a small cardiothoracic library. Ashley River Tower has facilities for the complete care of the adult cardiothoracic and vascular patient including chest pain center, out-patient clinics, wards, ICUs, operating rooms, etc. This facility opened in February 2008 and is absolute state-of-the-art in every respect, but especially in the four cardiothoracic surgery operating rooms click here for virtual tour The MUSC CT Surgery Residency Program has been fully compliant with the 80-hour-work-week since it was begun in July, 2003. In order to do this, residents and faculty are assisted by a large compliment of experienced physician extenders. These individuals alternate with general surgery PG-1 residents for in-house night call on an every-fourth-night basis. (CT residents do not take in-house call.) Physician extenders also provide continuity of care for the wards and clinics, assist in the operating rooms, do admission workups, and thus relieve the residents from the majority of “nonessential” routine tasks. General surgery residents rotate at the PG-1 level where they alternate night call with physician extenders and assist in the wards in the operating room. At the PG-2 level the general surgery resident assists in the CTICU and the operating room and rotate second call from home with the CT residents every third night. Operative experience for CT residents always far exceeds ABTS requirements. The operative experience for the most recent four chief residents are listed here. The residency program includes two major teaching conferences. The first is a Tuesday morning didactic session which follows closely the curriculum recommended by the Thoracic Surgery Directors Association. Conferences are given by CT attendings, CT residents, and invited guest speakers. Attendance is required for all faculty and CT Surgery residents. The second major conference is the Wednesday afternoon Service Conference at which all patients operated upon in the previous week are reviewed for deaths, complications, and interesting teaching points. A Cardiothoracic Journal Club is held monthly off campus at a local restaurant. Other teaching conferences are listed here. Cardiothoracic residents are funded by the Division to attend one major CT meeting (link) each year in addition to one educational conference sponsored by industry. In addition expenses are funded for any resident who has a paper accepted for presentation at a major meeting. MUSC residents are recruited from all areas and parts of the United States (link map). After completion of the residency, residents have entered both academic and private practice depending upon their interests. Residents since 1980 and their current location are listed here. All MUSC residents since 1980 have successfully completed part I and II of the American Board of Thoracic Surgery examination and are ABTS certified. The family of Horace Smithy, a pioneer cardiac surgeon at MUSC in the 1940’s, has funded both an endowed chair and lectureship in his memory. Dr. Crawford was the first recipient of the Horace Smithy Chair in Surgery in 1997 and has held it since that time. Each fall, a prominent leader in cardiothoracic surgery is invited to spend two days at MUSC interacting with the residents and presenting the annual Horace Smithy Lecture in Cardiothoracic Surgery. Previous Horace Smithy visiting professors are linked. |
) . A hybrid operating room with state-of-the-art imaging equipment for endovascular and other procedures is also available. Immediately next door to the Ashley River Tower is the 
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