The University of Michigan Thoracic Surgery Residency Program is regarded as one of the finest in the nation. The goal of the Program is to produce residents who are competent and safe for the independent practice of cardiothoracic surgery. Since its inception, the University of Michigan Thoracic Surgery Residency has emphasized balance in exposure to all aspects of this specialty - adult and pediatric cardiac surgery and general thoracic surgery. This has been achieved through four months block rotations in which the residents are able to immerse themselves and focus their attention upon individual subspecialties.
Effective July 2006, the University of Michigan "tracked" one of its 3 entering thoracic surgery residents into a general thoracic surgery slot; the remaining 2 residents will receive the traditional "cardiothoracic" training. This tracking was seen as a test for the new ABTS pathways in General Thoracic and Cardiothoracic Surgery, which will come into effect July 2007. This plan allowed us to pilot the new rotation schedule for one year, and to insure that the residents would be able to meet the new case requirements. In addition to simply meeting the case numbers, we strove to place the 2nd year emphasis on General Thoracic or Cardiothoracic Surgery as appropriate. Thus far this year, the rotations have succeeded and will allow the General Thoracic resident to complete his cardiac case requirements in the first 16 months of his residency, allowing the final 8 months to be spent on General Thoracic. Similarly, the 2 Cardiothoracic residents will finish the final 8 months of their residency dedicated to Cardiothoracic rotations.
The past two years have been a period of challenges and exciting changes in Thoracic Surgery training with the implementation of the new case number requirements and the two pathway system. These increased numbers of required cases are seen against a backdrop of decreasing numbers of cases, particularly CABG. Fortunately, as we have never been a "coronary mill," we have been relatively immune to this trend, and actually have slightly increased adult cardiac case volume over the past few years. Of course simple case numbers, whether ABTS requirements or hospital volume are only part of the story, and other challenges include exposing the resident to new technologies, such as endovascular therapy, and observing the 80-hour work week restriction.
It has always been the goal of the Thoracic Surgery Residency Program at the University of Michigan to produce the very finest, well rounded, academically-inclined thoracic surgeons in the world. As such, we made the difficult decision to change from a program of 3 residents to 2 residents, one General Thoracic and one Cardiothoracic. This decision was made after countless hours of discussion and deliberation, reviewing the pros and cons of changing the residency, which are far beyond the scope of this introduction. However, the final decision to decrease the size of the residency was made entirely on the basis of what was felt to be optimal for resident education. Amongst the primary reasons for the decrease was that it will allow us to focus our resources on fewer residents, leading to a more concentrated experience.
Below is the resulting rotation schedule.
A unique feature of the University of Michigan Thoracic Surgery Residency is an optional one-year fellowship experience after completion of the two-year residency. The experience provides an opportunity for the fellow to gain additional focus and clinical experience in either Pediatric Cardiac, General Thoracic, Adult Cardiac, or Thoracic Transplantation surgery while functioning at a junior faculty level. The fellowship is intended to facilitate the transition to an academic thoracic surgery faculty position. However, it is emphasized that this third year of fellowship (as opposed to residency) training is optional, the University of Michigan Thoracic Surgery Residency being an ACGME-approved 2-year program.
In addition to the operative experience, during the first year of residency, three weeks are committed to the "Core Curriculum". During their Core Curriculum rotations, the residents are freed from clinical responsibilities on their thoracic surgery rotations and spend several days with faculty from other departments and division gaining exposure to the ancillary fields which impact so greatly upon the specialty of cardiothoracic surgery:
Thoracic Surgery Core Curriculum
(Offered During First Year of Training)