Cardiac Surgery Residency Program

The resident is intricately involved in all aspects of patient care. As a group they work with the staff to provide quality care for the patients. Teaching revolves around clinical and surgical experience as well as seminars, conferences and research projects designed to encourage the advancement of knowledge.

The initial two years of the program - the core years -will involve surgical rotations that will introduce the resident to the principles of surgery. The resident will be exposed to assessing and examining patients preoperatively and managing them postoperatively. Operating room experience will introduce the resident to issues in anaesthesia, coagulation as well as to surgical techniques, procedures and instruments. In Core I, the resident will learn to harvest the saphenous vein and radial artery, insert radial artery lines, central venous catheters, Swan Ganz catheters and dialysis catheters, as well as insert intra-aortic balloons. During Core II, the resident will also perform median sternotomy incisions and insertion of intravenous pacemakers. During the Intensive Care Unit rotation the resident will deal with patients requiring hemodynamic monitoring, inotropic support and mechanical ventilation. Cardiology rotations will include patients requiring coronary care, hospital ward care, out-patient visits and rehabilitation. The resident will be exposed to various cardiac investigations including stress testing and various imaging modalities: nuclear studies, PET scanning, echocardiography and cardiac catheterization.

The third year of the residency program will have a greater focus on operative skills in cardiovascular and thoracic surgery. Each rotation will include preoperative patient assessment, postoperative management and follow-up in an outpatient setting as well as a role for hospital and emergency consultations.

The junior cardiac surgery rotation will expect the resident to learn cannulation of the patient for cardiopulmonary bypass, begin to harvest the left internal mammary artery and perform proximal aorto-coronary bypass grafts. The resident will assume a gradually increasing role in performing parts of coronary artery bypass procedures.

The vascular surgery rotation will provide additional opportunity for the resident to perform arterial anastomoses. In addition, the resident will be exposed to management of conditions involving venous disorders and acute ischemia.

During the thoracic surgery rotation the resident will learn to perform thoracotomy incisions and have the opportunity to perform bronchoscopy, mediastinoscopy, thoracoscopy and tracheostomy. He/she will assist in pulmonary resections and transplantations.

During the pediatric cardiac surgical rotation, the resident will be introduced to congenital conditions, their embryologic origin, the methods of investigation and imaging and the indications and outcomes of surgical interventions. He/she will take part in a large number of different procedures, and have the opportunity to examine patients preoperatively and will be supervised in their postoperative management.

The senior year in cardiac surgery will provide the resident with a large volume of cardiac surgery. Upon its completion the resident will be capable of independently performing coronary artery bypass surgery and valve replacement, including internal mammary artery anastomosis to the left anterior descending artery and distal anastomoses of aorto-coronary saphenous bypass grafts. He/she will also have gained experience in "reop" surgery. Arrangements will be made to ensure maximal resident exposure to procedures that are performed less frequently, such as those involving aortic root enlargement, aortic arch surgery, pericardial resection, emergency cases such as aortic dissections, and specialized cases such as mitral valve repair and pulmonary thromboendarterectomy. The resident will attend weekly cardiac surgery rounds, participate in academic half day sessions and the journal club. In preparation for the final fellowship examination, arrangements will be made for regularly scheduled sessions with staff to assist in thoroughly covering the necessary material.