General-surgery residents have cardiac and thoracic surgery rotations for blocks of approximately two months in the first, second and fourth years.

Jefferson supports a fully accredited, three-year cardiothoracic residency. The program accepts one CT resident per year and provides rotations on:

• the adult cardiothoracic surgical service at Jefferson (18 months)

• the general thoracic surgical service at the Medical Center of Delaware (6 months)

• the congenital cardiac surgical service at the Children's Hospital of Philadelphia (6 months)

The CT resident also spends time in laboratory research. With the volume and diversity of cases, these separate aspects make for thorough and complete training.

Cardiac
The staff includes three full-time and two part-time cardiothoracic surgeons, as well as three cardiothoracic fellows. Sixty to seventy percent of patients undergoing cardiac surgery at Jefferson receive coronary artery bypass grafts. Twenty-five to thirty percent of patients undergo valve repair or replacement. Other procedures performed on the cardiac service include closure of cardiac septal defects, repair of acute and chronic diseases of the aorta, Patent Ductus Arteriosis ligations, cardiac pacemaker insertions and surgery for cardiovascular trauma. As special features of the program, the staff uses ventricular-assist devices and takes advantage of an air-transport system that includes Jefferson's roof-top helipad for emergency cardiac arrivals.

The cardiothoracic fellow directs all residents on this rotation. The PGY 1 resident assumes general patient-care duties in the cardiopulmonary service. The PGY 2 resident oversees the open-heart surgery patients in the SCCU and is responsible for critical care. Patient care and coordination of the ICCU/ step-down area, plus sternotomy and cannulation procedures, are responsibilities assigned to the PGY 4 resident.

At the end of three rotations, residents are thoroughly knowledgeable in the principles of preoperative cardiac-patient evaluation, from interpreting coronary angiograms to identifying candidates for coronary-artery and valve surgery. The residents also master essential skills in caring for open-heart surgery patients postoperatively, with extensive experience in managing ventilators, interpreting ECGs, supporting circulation mechanically and pharmacologically and in controlling dysrhythmias.

Six seminars and conferences per week supplement clinical training on the service. Current research in the division's lab involves studying the use of skeletal muscle to enhance left ventricular function.

Thoracic
Residents on the thoracic surgical service develop skills in diagnosing and managing a spectrum of benign and malignant problems of the lung, mediastinum, pleural cavity, chest wall and esophagus. Clinical training focuses on preoperative evaluation, postoperative management and surgical techniques related to care of the thoracic patient. Six senior thoracic surgeons and three cardiothoracic residents make up the service.

Residents have the opportunity to become proficient in a variety of procedures, including thoracoscopy, bronchoscopy, tube thoracostomy, pulmonary resection, mediastinal-tumor removal, pacemaker insertion, multimodality approaches to esophageal cancer and thoracic trauma management. Thoracic surgery at the Wilmington Veterans Administration Hospital further enhances residents’ training.

Residents dedicate two months of their fourth year to thoracic surgery. Fourth-year residents are responsible for patients’ preoperative evaluations and postoperative management. Under an attending’s or fellow’s supervision, these residents also perform all thoracic surgery. This intensive rotation provides the resident with an in-depth experience in all aspects of thoracic surgery.

To supplement the clinical work, Jefferson offers three weekly interdisciplinary conferences, where the staff discusses lung cancer and medical-surgical pulmonary topics. At each conference, attendees review difficult diagnostic problems and therapeutic-management issues from the various specialty viewpoints – surgical, medical, radiologic and oncologic.