MEDICAL UNIVERSITY OF SOUTH CAROLINA
CARDIOTHORACIC SURGERY EDUCATION PROGRAM

The Cardiothoracic Surgery Educational Program at the Medical University of South Carolina consists of two programs: 

1. The independent (traditional) program in which a resident matches at the PG-6 level every three years. (Five years of general surgery and three years of cardiothoracic surgery).
2. The six-year integrated program in which a resident is matched out of medical school at the PG-1 level.  Residents for the integrated program apply in their fourth year of medical school, similar to standard applications for other residency programs. Upon completion of an integrated residency, residents are eligible to sit for ABTS certification.  One position is matched each year.

The MUSC Cardiothoracic Surgical Residency Program started in the early 1960’s and it has been continuously accredited by the Thoracic Surgery Residency Review Committee since that time.  The traditional independent program changed from a two-year program to a three-year program in 1987. In 2007, the MUSC faculty developed a six-year integrated CT residency program matching directly out of medical school.  This was approved by the Thoracic Surgery Residency Review Committee in July 2008.  The first six-year program resident began training July 1, 2009.  Our program is proud to be one of the first three programs to be approved along with Stanford and the University of Pennsylvania.

The six-year integrated program is still in its infancy and many changes have occurred from its beginning in July 2009.  As the program continues to grow, it will most likely continue to change.  Any potential applicant should be aware of that possibility.

As of July 1, 2011, the current curriculum changed to consist of categorical surgical training in the first three years in order to meet the Thoracic Surgery RRC and American Board of Thoracic Surgery operative case log requirements. ATBS Certification Requirements

The first year cardiothoracic surgery rotations include one month each in General Thoracic, Adult Cardiac Surgery, Congenital Cardiac, and VA Cardiothoracic.  The surgical rotations include one month each in Trauma, Plastic Surgery, Transplant, Pediatric Surgery, GI Surgery, Vascular and Night Emergency Trauma.  A one-month rotation in Echocardiography and Imaging is also included in the first year.

Year two consists of two-month rotations on Pediatric Surgery, Vascular Surgery, Night Emergency Trauma, Trauma Surgery, Breast/Endo, and Cardiothoracic Surgery.

Year three consists of two-month rotations on GI Laparoscopic, Night Emergency Trauma, Transplant Surgery, VA General Surgery, GI Panc/Bili, and SICU.

The independent program residents and the PGY4-6 integrated program residents are assigned to specific block rotations at MUSC and the VA Hospital.  These include dedicated rotations on the general thoracic surgery service as well as on the congenital heart service.  Graded responsibility for patient care is provided as they progress through the residency.  During the final year of training, the resident is allowed considerable latitude in decision-making and operative responsibilities while on rotation at the VA Medical Center.

                                                CT SURGERY SIX-YEAR INTEGRATED PROGRAM
                                                  MEDICAL UNIVERSITY OF SOUTH CAROLINA

Throughout the entire residency including the VA rotation, the resident is always under the direct supervision of the responsible attending surgeon, and the lines of responsibility from the PG-1 general surgery and integrated program resident through the upper level thoracic surgery residents to the attending surgeons to the Chief of the Division are clear to all involved. In this program and particularly while on rotation at the VA, residents are able to review and evaluate the patient preoperatively with the responsible attending and perform the major components of the operation themselves, and then provide in-hospital as well as out-patient follow-up of the majority of patients upon whom they have operated. Those who cannot be followed directly by the residents include those who do not return directly to MUSC for postoperative care (such as congenital heart patients in outlying pediatric cardiology clinics, and some adult cardiac patients who are seen in an outlying clinic held approximately 75 miles away). All residents have easily been able to meet the minimal case load requirements in all areas as required by the RRC and the ABTS. The operative experience for the most recent four chief residents are listed here.

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 ) .  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 Ralph Johnson VA Hospital which houses a very important component of the CT residency program.  Both cardiac and general thoracic procedures are performed in that facility for veterans referred from throughout South Carolina.  The MUSC Children’s Hospital is one block away and houses the congenital heart surgery component of the residency.  Children with congenital heart disease in South Carolina are cared for through the South Carolina Children’s Heart Network, and any patients requiring surgery have it performed at MUSC Children’s Hospital.

Conferences

A variety of cardiothoracic surgery teaching conferences are regularly attended by residents and attending faculty. 

On Tuesday at 7:00 a.m. the CT Resident Teaching Conference is held and this conference utilizes the Thoracic Surgery Directors Association Weekly Curricula.  This conference is mandatory for CT residents and attending faculty.  These sessions are intended to be a question and answer session where assigned attending surgeons should be conducting a half-hour discussion with the residents by asking questions and soliciting answers in order to satisfy themselves that the residents have adequately reviewed and understand the material for that session.  It is not the responsibility of the assigned resident to read all the papers and deliver a didactic talk.  Rather, it is the responsibility of the assigned resident to review the assigned material to make sure that it is up to date.  Secondly, it is the responsibility of the assigned resident to meet with the two faculty members who are assigned for that week and confirm that the material is adequate for discussion and if further articles are required, to obtain those and distribute them to the residents and staff.  Furthermore, it is the assigned resident’s responsibility to locate any assigned chapters or other articles that are not immediately accessible and distribute these to the group.   

On Wednesday from 5:00 to approximately 6:30 p.m., the CT Service Conference is held.  At this conference, all patients operated upon or cared for non-operatively during the previous week are reviewed by the residents and the CT attendings.  Specific attention is paid to patients who have had complications or who have died.  Pertinent imaging data, cath data, echo data, and autopsy findings are presented when appropriate.  Attendance by CT attendings and residents is mandatory.

The South Carolina Cardiothoracic Journal Club is hosted by the Division of Cardiothoracic Surgery and is held off campus at a downtown restaurant on a monthly basis from 7:00 to 9:00 p.m. the third Thursday of each month.  Attendance by CT faculty and residents is mandatory but the opportunity for all cardiothoracic surgeons in the State of South Carolina to attend is available by invitation.  The most pertinent journal articles the The Annals of Thoracic Surgery and The Journal of Thoracic and Cardiovascular Surgery from the previous month are presented by CT residents and faculty and discussed in detail.  Articles are critiqued for their scientific and statistical validity.

A Thoracic Surgery Tumor Board is held on Wednesday at 12:00 p.m.  This is a multidisciplinary conference which includes the two general thoracic surgery attendings as well as oncologists, radiologists, and others.  Attendance by the resident assigned to the General Thoracic Service is mandatory.  At this conference, patients with thoracic cancer are discussed and plans of treatment are developed.

Pediatric Cardiology Conference is held on Mondays and Thursdays from 4:00 to 5:00 p.m.  Patients scheduled to undergo surgery during the following week are discussed in detail on Thursdays including physical findings, laboratory data, and echoes and catheterizations.  Attendance by the CT resident on the congenital heart rotation is mandatory and optional for the other CT residents.

Heart & Vascular Morbidity and Mortality Conference is held the third Thursday each month 4:30-5:30 p.m.  This conference is a combined morbidity and mortality conference for the Heart and Vascular Service Line and is attended by the faculty and residents from Cardiothoracic Surgery, Cardiology, Vascular Surgery and Interventional Radiology.  Attendance by CT residents is required unless patient care emergencies do not permit.

Duty Hours Requirements and Continuity of Care

In order to comply with 80-hour work week mandates, the chief residents at the VA and MUSC alternate weekend coverage so that on alternate weekends, each has two full days (or the entire weekend) off.  In-house coverage is provided by two PG-1 general surgery residents assigned to the service and a team of mid-level providers.  CTICU coverage is handled by CT residents from home.  Emergency situations in the ICU are covered by the surgical critical care team until the CT resident and CT attending can arrive.  Continuity of care has been maintained effectively, and there have been remarkably few incidents related to the absence of in-house CT residents.  Currently, a total of five nurse practitioners and three PAs are assigned to the service at MUSC and one physician assistant at the VA Hospital.  These individuals provide enormous help in patient workups, scheduling of diagnostic tests, retrieval of lab data, OR scheduling, and assistance in the operating room.  Perhaps most importantly, they provide continuity of care, especially for the general surgery residents rotating through the service on relatively short rotations.

Simulation

The cardiothoracic residency program has expanded to include a significant simulation effort.  The simulation effort includes installation of a small skills lab in the residents' office area for use of both the residents' own time and part of a structured technical assessment schedule by CT faculty.  In addition, the residents will participate in wet labs at least quarterly which are arranged through industry.  These labs consist of simulative operations done on porcine hearts using prostheses and other materials provided by the respective companies.  Thirdly, a significant simulation effort has been put together through the Division of General Surgery.  While on general surgical rotations, the residents will participate in the laparoscopic skills laboratory curriculum which for the Integrated Six-Year residents will result in significant experience to obtain Fundamentals of Laparoscopic Surgery certification.  Lastly, through a collaborative effort with the College of Health Professions and the School of Clinical Perfusion, the cardiothoracic residents will learn to deal with cardiopulmonary bypass crisis scenarios through interactions with a state-of-the-art cardiopulmonary bypass simulator housed within the College of Health Professions.

MUSC residents are recruited from all areas and parts of the United States. 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.

Eligibility

Only applicants with qualifications as required by the Accreditation Council for Graduate Medical Education and American Board of Thoracic Surgery are considered eligible for residency positions.

• Integrated Program:  Completion of an M.D. or D.O. degree from an institution accredited by the Liaison Committee of Medical Education (LCME).  Graduates of medical schools from countries other than the United States or Canada must present evidence of final certification by the Education Commission for Foreign Medical Graduates (ECFMG).
• Independent Program:  Successful completion of surgery residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or by the Royal College of Physicians and Surgeons of Canada.

How to Apply & Selection

The Division of Cardiothoracic Surgery at the Medical University of South Carolina is a participating member of the National Resident Matching Program and accepts applications only through the ERAS system.  All applicants are required to complete the universal application form available through the Electronic Residency Application Services of the Association of American Medical Colleges (AAMC) and submit this along with a curriculum vita, board scores (including ABSITE scores for the independent program applicants), three letters of reference, personal statement, a dean's letter, and medical school transcripts.  All applicants must have successfully passed USMLE Step 1 and Step 2 exams (or the equivalent COMLEX Step 3 Exam or MCCQE Parts I and II).  

Residents are selected on a fair and equal basis without regard to race, color, religion, sex, national origin or sexual orientation.  Selection of applicants for both programs is based upon qualities such as publications, test scores, letters of recommendation, personal statement and upon how an applicant will fit into the department based upon interview.  Of particular importance, especially for the integrated program, is dedication to and interest in cardiothoracic surgery. Interested medical students can optimize their chances of getting into the new integrated program by doing more than just their required clinical rotations by either spending time doing cardiothoracic-related research or more focused time in cardiothoracic surgery rotations. It is also strongly encouraged that applicants to the integrated program spend time in clinical rotations on Cardiothoracic Surgery at the Medical University of South Carolina.

• Cardiothoracic Division
• CT Surgery Residency Program Graduates
• Graduate Medical Education Office

For further information contact:  Rose Haselden, Program Coordinator by e-mail at:  haselder@musc.edu