COMPETENCY-BASED PERFORMANCE OBJECTIVES FOR SECOND- AND THIRD-YEAR RESIDENTS IN CARDIOTHORACIC SURGERY
SECOND-YEAR RESIDENTS: THORACIC SURGERY
1. Evaluate thoracic pathophysiology, order and interpret appropriate tests such as chest x-rays, CAT scans, pulmonary function tests, and angiograms.
2. Diagnose and provide initial management of fractures of ribs, clavicle, sternum, scapula, and spine.
3. Evaluate patients for thoracic surgery with regard to risk factors such as criteria for lung resections, pulmonary function studies, and possible postoperative disability.
4. Manage general thoracic perioperative procedures.
5. Be familiar with the use of mechanical ventilators.
6. Observe and:
a. Insert chest tubes
b. Perform thoracenteses
c. Insert central venous access lines
d. Perform bronchoscopies
e. Perform tracheostomies
7. Be familiar with the criteria for sedation for endoscopic procedures.
8. Be familiar with and able to interpret diagnostic and therapeutic procedures to assess and plan treatment for thoracic pathology.
9. Insert Swan Ganz catheters and perform cardiovascular monitoring, and know the interpretations thereof.
10. Supervise ventilator regulations.
SECOND-YEAR RESIDENTS: CARDIAC SURGERY
1. Perform preoperative evaluation history and physical examination of cardiac surgery patients.
2. Obtain and interpret indicated diagnostic studies.
3. Discuss diagnostic and therapeutic approaches to specific acquired and congenital cardiac disease with the attending physicians.
4. Assist with selected cardiac cases such as pacemaker and defibrillator insertions, saphenous vein harvesting, and wound closure for coronary bypass operations, pericardial drainage operations, tracheostomies, and minor vascular repairs.
5. Provide postoperative cardiac surgery follow-up care
for the following cases: coronary surgery, valve surgery, thoracic
aortic surgery, and pacemaker and defibrillator placement.
THIRD-YEAR RESIDENTS: THORACIC SURGERY
1. Perform and supervise bronchoscopies.
2. Resect ribs, treat empyema cavities, and perform pleural and lung biopsies.
3. Initiate the management of thoracic trauma.
4. Initiate and be familiar with management concepts of thoracic aortic aneurysms and dissections.
5. Be familiar with ventilator-dependent management strategies.
6. Be able to perform significant parts of lung resections, rib resections, mediastinoscopies, and mediastinotomies.
7. Manage cardiac arrhythmias.
8. Be able to perform or supervise pacemaker and defibrillator insertions.
9. Manage all pharmacotherapeutics associated with thoracic surgery.
10. Treat medical conditions associated with thoracic
THIRD-YEAR RESIDENTS: CARDIAC SURGERY
1. Serve as first assistant on selected major
cardiothoracic cases, including:
a. Coronary artery bypass surgery
b. Valve replacement and repairs
c. Thoracic aortic surgery
d. Complex defibrillators
e. Emergency thoracotomies
2. Perform the following procedures under supervision, or
a significant part thereof:
a. Insert intra-aortic balloon pump
b. Insert pacemaker
c. Median sternotomy incision
d. Saphenous vein harvest
e. Perform proximal coronary anastomoses
f. Repair of vascular trauma
3. Coordinate the work-up of emergency cardiac surgery
a. Emergency Room and Trauma Team
b. Cardiac Cath Lab
c. Diagnostic Imaging Service
f. Operating Room
4. Assist with emergency cardiac surgery, including trauma cases.
5. Recognize and prescribe treatment for complications of
cardiac surgery, such as:
a. Gastrointestinal bleeding
b. Cerebrovascular accidents
c. Endocrine abnormalities
d. Pulmonary complications
e. Renal dysfunction
h. Low cardiac output
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