Thoracic Surgery 6-Year Integrated Training Program - Rationale

Cardiothoracic surgery has evolved significantly over the last few decades with truly amazing technological advancements having been developed. While traditional open surgery remains an integral part of the cardiothoracic surgeon’s armamentarium, technology and innovation have led to a myriad of treatment options for the patient with cardiothoracic disease. Minimally invasive techniques using the robot or endoscopic instruments and percutaneous techniques such as endovascular devices or radiofrequency ablation have emerged as viable and sometimes preferred treatment options. While many of these technologies have been developed by physicians in other specialties, each of them needs to be taught to cardiothoracic surgery trainees and the next generation of cardiothoracic surgeon needs to be facile in both traditional open surgery as well as these new approaches.

In the traditional training pathway consisting of a five or six year general surgery training program followed by a two or three year cardiothoracic surgery training program, it has become increasingly difficult to fully train residents in all these areas over a two or three year time period. Many residents find the need to pursue even more training following completion of the cardiothoracic fellowship in order to be facile in these techniques. It is not uncommon, then, that after completion of the traditional training pathway, many residents will have trained for 10 or more years prior to entering the workplace with half of this training being done in general surgery.

Acknowledging this, the American Board of Thoracic Surgery approved alternative pathways leading to board certification including the completion of a six-year integrated program. We at the Medical College of Wisconsin feel that a six-year integrated cardiothoracic residency will allow for a more focused, streamlined training in cardiothoracic surgery. This unique curriculum is designed to provide a broad based surgical and medical education with a continuous focus on cardiothoracic surgery. There will also be significant exposure to emerging technologies including rotations in cardiac catheterization, interventional radiology, and vascular/endovascular surgery. This curriculum, since it is more tightly focused on and relevant to cardiothoracic surgery, can be completed in less time than the traditional pathway. We feel that dedicating six years of training to areas which apply to the specialty which the trainees will be practicing for their entire careers will produce better trained surgeons and allow a greater sense of satisfaction.