integrated CT surgery interview thread

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raosen

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have not seen anyone post about this, perhaps because there are only a few of us. was wondering if any of you were out there. maybe we can start a discussion. difficult times, since we are the banner year for the growing pains of this transition.

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I am a third year who, at the moment at least, is interested in applying next fall so I hope you get some kind of response. If you have an interview or any insight into the process I'd appreciate a PM regarding anything you don't want to post here.
 
I'm in the integrated residency applicant pool with you.

The novelty of these programs is part of what I like though -- they are newly planned and likely not set in stone. I think this gives us the opportunity to make these malleable programs better based on our input. Could be fun...

-BTD
 
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For the two of you who are applying, did you do away rotations at any of the program sites? I was considering contacting them after the interview season is over to set something up. Also, the charting outcomes document does not really contain any statistics except number of applicants last year. Do you have any idea what average USMLE scores are or whether they put heavy emphasis on AOA or publications?
 
I'm in the integrated residency applicant pool with you.

The novelty of these programs is part of what I like though -- they are newly planned and likely not set in stone. I think this gives us the opportunity to make these malleable programs better based on our input. Could be fun...

-BTD

i guess it depends how much of a say you think you might have as the junior on the totem pole. the malleability is likely going to come from top down, which changes a fun, controllable situation into a potentially risky, unpredictable one, from a trainee perspective.
 
For the two of you who are applying, did you do away rotations at any of the program sites? I was considering contacting them after the interview season is over to set something up. Also, the charting outcomes document does not really contain any statistics except number of applicants last year. Do you have any idea what average USMLE scores are or whether they put heavy emphasis on AOA or publications?

TGAmed or whoever is interested, send me a PM with a list of explicit questions, and I will try to respond at some point, likely after the match so I can give you more context. Very quickly though, I would recommend to all interested, yourself and those just viewing this thread, to make contact with programs early on and establish relationships. These programs are all very nimble and tight knit. Candidate evaluation is more intimate, and you become part of a much smaller team for a longer period of time than you would if you were to interview for a larger general surgery program.
 
Question to anyone with an answer:

Do these integrated thoracic programs offer a cardiac/cardiovascular track? or do they all intensify their training towards thoracic surgery?
 
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Question to anyone with an answer:

Do these integrated thoracic programs offer a cardiac/cardio-vascular track? or do they all intensify their training towards thoracic surgery?

most of these integrated programs are actually unofficially cardiovascular track, as opposed to thoracic track. there is plenty of contention about whether or not this training paradigm is appropriate for cardiovascular surgery as is, and even more controversy that they are appropriate for those interested in general thoracic surgery. the thinking being that general surgery is more directly applicable to thoracic surgery, given the increasing MIS component of general surgery and its direct relation to several of the thorascopic procedures in general thoracic.
 
most of these integrated programs are actually unofficially cardiovascular track, as opposed to thoracic track. there is plenty of contention about whether or not this training paradigm is appropriate for cardiovascular surgery as is, and even more controversy that they are appropriate for those interested in general thoracic surgery. the thinking being that general surgery is more directly applicable to thoracic surgery, given the increasing MIS component of general surgery and its direct relation to several of the thorascopic procedures in general thoracic.

Thanks Raosen.
 
On another note, there seems to be an element of risk associated with these integrated programs: These programs do not enable one to sit for the general surgery board examination. Given the progression of non-invasive procedures which have and continue to plague the field, and taking into account the ever so familiar stories about newly certified cardiac surgeons being offered $80,000 in Florida after 15 years of training; it seems to me that being board certified in both general surgery and thoracic surgery would ensure that one has a job when every specialty in existence decides to take some food from the dinner table of non-invasive heart procedures. The possibility of development of safer non-invasive procedures with better outcomes in the future seems pretty high, and such advents may indeed further eradicate a great chunk of the bread and butter invasive cardiovascular procedures; and thus further diminish the strictly cardiothoracic surgeon (non-general surgeon) job market. If my thinking is erroneous or misinformed please feel free to correct me.
 
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be very very cautious about these integrated programs.

Most trainees want to get a job doing mostly cardiac, however the reality is that almost nobody gets such a dream job right away. (unless you take a crappy academic job with poor working conditions and low pay)

with most decent jobs in private practice avail today, you can expect to do all the crap thoracic cases and you better be able to do peripheral vascular.
Hell, I even know of jobs that require trauma/general surgery call. But the good thing is you get to stop doing those cases and move up the totem pole as time goes on.

doing an integrated program will really put you at a disadvantage in the job market trying to compete with a traditional general-CV surgery candidate who can "do it all" and there are plenty of unemployed and underemployed candidates out there
 
be very very cautious about these integrated programs.

Most trainees want to get a job doing mostly cardiac, however the reality is that almost nobody gets such a dream job right away. (unless you take a crappy academic job with poor working conditions and low pay)

with most decent jobs in private practice avail today, you can expect to do all the crap thoracic cases and you better be able to do peripheral vascular.
Hell, I even know of jobs that require trauma/general surgery call. But the good thing is you get to stop doing those cases and move up the totem pole as time goes on.

doing an integrated program will really put you at a disadvantage in the job market trying to compete with a traditional general-CV surgery candidate who can "do it all" and there are plenty of unemployed and underemployed candidates out there

It looks like ESU_MD fully agrees with me.
 
I think all the considerations raised, is why ABTS has "mandated" transition to ALL integrated trained for board eligibility at some point in future. It is a transition period. Eventually all will be integrated, few likely double boarded (i.e. ABS & ABTS). Current practitioners double boarded are actually allowing ABS certification to "lapse" and just maintaining ABTS certification. The field is changing and there will be dips and valleys during the transition....
 
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Current practitioners double boarded are actually allowing ABS certification to "lapse" and just maintaining ABTS certification.

Although I admit my experience is limited and as ESU_MD stated, the cardiac surgeons I've met who fall in this category are academic physicians doing CABGs and valve repairs day in, day out. I'd be surprised if this was the case for a number non-academic surgeons; As I know a couple ex-academic, private practice thoracic guys who do general surgery cases on a regular basis.
 
Although I admit my experience is limited and as ESU_MD stated, the cardiac surgeons I've met who fall in this category are academic physicians doing CABGs and valve repairs day in, day out. I'd be surprised if this was the case for a number non-academic surgeons; As I know a couple ex-academic, private practice thoracic guys who do general surgery cases on a regular basis.
I think I read somewhere that the population of CT surgeons is currently predominantly over age 65.... Again, a significant shortfall of available Cardiac or Thor surgeons is easily anticipated. The marked drop in applicant numbers, those that apply and quit, and the rev up integrated system (which takes 6 years to graduate someone) all will have an impact. There will be a transition... But, community folks are more and more moving to formally trained subspecialists including vascular surgeons, etc... The leapfrog and other such measures pushing for minimum numbers in procedures, average GSurge residents "doing" less then 3 lobectomies during training, limited ABS GSurge requirements for GenThor/Card experience, liability issues, etc.... ALL will change the landscape and scopes of practice over the next decade, IMHO.

Oh, and lapse of ABS cert is more and more common.... most have no intention to perform GSurge, especially when they do GenThor grudgingly....
 
Average age of CT surgeons is somewhere in late 50's (57 to be exact, if i am not mistaken), not 65. So the shortage is coming, but not as soon as one would hope. As far as shortages are concerned, the purported shortage of general surgeons, that everyone talks about, was apparently there ten-twelve years ago as well, according to some of our attendings, who were hearing the same thing back then.
I think, in general, the situation with jobs in CTS is somewhat better now then 3-4 years ago, but you are still not likely to be picking the job - rather the job would pick you, for few years.
 
Average age of CT surgeons is somewhere in late 50's (57 to be exact, if i am not mistaken), not 65. So the shortage is coming, but not as soon as one would hope. As far as shortages are concerned, the purported shortage of general surgeons, that everyone talks about, was apparently there ten-twelve years ago as well, according to some of our attendings, who were hearing the same thing back then.
I think, in general, the situation with jobs in CTS is somewhat better now then 3-4 years ago, but you are still not likely to be picking the job - rather the job would pick you, for few years.
Ok, so here is what I found:

http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.108.776278v1
http://www.theheart.org/article/988839.do

So, i guess around 1/2 of active cardiothoracic surgeons are older then 55yrs of age.
I presume a GSurgery shortage exists by your reply and:
http://www.medpagetoday.com/Surgery/GeneralSurgery/9201
http://www.usatoday.com/news/health/2008-02-26-doctor-shortage_N.htm

So, as the integrated programs rev-up and become the mandatory route to ABTS, the CT surgeons are not a component for GSurgery supply. This adds to the GSurgery shortage. Again, this paradigm shift of greater specialty seperation will have a degree of transitioning time. But, it is a reality. Current CT surgeons are more often then not, loath to do GenThor. They do GenThor to pay the bills for lack of pump cases. They surely are not looking to do GSurgery. So, I do not see (ABTS) preserving the GSurgery back-up as a consideration in future plans...

JAD
 
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General thoracic surgery nowadays pays better, and has a better lifestyle for the most part. as far as people doing chest cases to pay bills - i don't think you can speak so categorically. Some do, i am sure, but there are others who do, because, that's what they are trained at, and some simply enjoy it.
When i am done with my training, i want to do hearts, chest and maybe some carotids and aortas (abdominal).
As far as shortages in general surgery, few of our attendings said, that 1-15 years back, when they were training, there was also a buzz about how in 10-15 years there is going to be a huge shortage. This time is here and job situation is the same. Plenty of nice paying jobs in periphery, where you cover three hospitals, always on call, and not much in terms of great offers in big cities.
 
Went to a talk by the thoracic RRC chief a few months ago and was able to chat a little with him afterwards about this topic of integrated programs.
the general gist- its not really being well received overall- probably for a variety of reasons. CV surgeons are reluctant to change (ironic) is one of the biggest reason. Plus he stated that they have tried these integrated programs in the past and they have failed.

Of course for it to work it probably has to be 100%, or at least gain enough steam to get a critical mass of these "hybrid" trainees out and about. as it stands now- nobody really knows what to do with these guys.

who will show these guys the basics-? the GS guys will blackball them for sure. maybe the PA's can train them by sewing up the legs, etc.. but its gonna be an uphill battle. CV staff has a hard enough time letting a PGY-8+ lay down a distal, few would have patience to get essentially a junior resident up to speed.

the biggest problems are actually getting programs to "sign on." from what I heard, the mandate to integrate is not a true rule, but rather a suggestion. I bet theres just not enough true thoracic surgery educators who are willing to really lobby this issue on the grassroots level. from what I've seen, I just cant see any programs willingly changing to this format, nor can I see the ABTS or anyone else forcing the issue.

these new programs are probably good in theory, and I'm sure the places that sponsor them have PD's who are already on the vanguard of educating thoracic surgeons. They will make sure their trainees succeed- no matter what the format is. I work with plenty of European trainees who have integrated training and they are pretty good, so the system CAN work. Sometimes I think they should just eliminate some of the malignant abusive programs and maybe just have fewer programs with dedicated teachers.

However- nobody in their right mind wants to be the guinea pig in a new training paradigm.

it wont be the first time that the unwillingness to change or embrace something new was detrimental to the field of thoracic surgery
 
I believe MUSC, UNC Chapel Hill, Stanford, and others are already on-board. The situation is the decreasing numbers of interested in the "traditional" 5+2 or 3.... This has resulted in traditional programs hoping for at least 8-12 qualified applicants while, upwards of 80 applicants to EACH of the integrated programs.... The med-students are pushing this as are the "negative" drive in GSurgery residents...
 
the issue here is - how many of people here at the beginning of their med school knew exactly what they wanted to do? As a stud - you never know what surgery is like, forget CT surgery. At least, if you for gen surg there are multiple opportunities, once you done. If you spent six years as a CT surgeon, only to decide thats not what you want...
that being said, this is how the rest of the world trains their CT surgeons.
 
the issue here is - how many of people here at the beginning of their med school knew exactly what they wanted to do?...If you spent six years as a CT surgeon, only to decide thats not what you want...
that being said, this is how the rest of the world trains their CT surgeons.
This is always an interesting, though IMHO, hollow perspective.... What if at the end of GSurgery you decide you don't like it after 5 yrs, how about OB/Gyn, NeuroSurge, Ortho, ENT... integrated plastics, etc.... 7yrs Neurosurgery, 6yrs CT, 5yrs GSurge, 4yrs OB/Gyn, 4yrs Uro, etc.... That's life.... I guess really unfair for neuro...

I guess basically, this argument is if it comes to CT, you really shouldn't have to make a grown up choice and choose a specialty.... rather, you should spend five years in GSurgery gauntlet....
 
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This is always an interesting, though IMHO, hollow perspective.... What if at the end of GSurgery you decide you don't like it after 5 yrs, how about OB/Gyn, NeuroSurge, Ortho, ENT... integrated plastics, etc.... 7yrs Neurosurgery, 6yrs CT, 5yrs GSurge, 4yrs OB/Gyn, 4yrs Uro, etc.... That's life.... I guess really unfair for neuro...

The real issue though is attrition. Most of these integrated programs have what, 1 resident per year? What happens if 4 years down the line your senior CT resident decides it's not for him/her? Then you have a big hole to fill in your residency...
 
The real issue though is attrition. Most of these integrated programs have what, 1 resident per year? What happens if 4 years down the line your senior CT resident decides it's not for him/her? Then you have a big hole to fill in your residency...
Ok, but you can have that in Neurosurgery. You can have that in traditional 5+2 paths.... I just don't see that as a rational to mandate 5 years GSurgery. As noted numerous other countries run it integrated. Obviously, we aren't numerous other countries, we are USA. But, there seems some magic fear in the CT world that seems there is less attrition and better program by beeting someone for 5yrs in GSurgery... to finally reach the heart. Every program has attrition. There are plenty of "traditional" programs that have a "1st yr" fellow with no "senior/2ndyr" because of attrition.....
 
this thread is getting more interesting daily. i agree that there is a great deal of uncertainty with being a guinea pig in this new training paradigm, and if push came to shove, the risk averse side of me wishes i was either 10 years older or younger at this point in my "career", so that i could be in either proven track. the truth of the matter is that no US residency program has yet had a graduate of an integrated program, and that is somewhat scary and perhaps exciting at the same time. in the same vein, the real "powerhouse" cardiac programs seem to, for the most part, be heading in the integrated direction (if not with 0+6, then at least 4+3), although i am sure there will be some disagreement as to which centers belong in this category, and perhaps, for how long they will stay committed.

so the difficult decision, in my mind, is to ask yourself whether you are willing to shoulder the risk of being an experiment at the chance to train at a top notch facility, in a more progressive model that may or may not enable better, more focused, more efficient knowledge of the actual skillset needed to be a good cardiac surgeon (and mind you, there is plenty of debate, usually along the lines of "better pt manager and confidence gained as primary operator and service runner as a general surgery chief v. more thorough and earlier cardiovascular knowledge (ie echo interpretation, wire skills, endovasc techniques, higher volume of cases starting in junior years, etc.)").

the reciprocal risk for staying at a traditional general surgery program (and doing 2 years of research to stay academically focused) may result in many fewer options for fellowship training down the road. as an example, stanford has had its last year of traditional fellows, and will no longer train cardiac surgeons unless they are committed straight from medical school. if several of the "powerhouse" programs do this, then your chance at being a competitive academic cardiac surgeon are likely hurt more than helped by staying in the traditional track.

in regards to competitiveness, several of the interviewees thinking about taking the integrated plunge are, IMHO, absolutely stellar general surgery candidates. i have no official numbers to gauge, but the people that i have met on the trail are the same individuals that are interviewing at arguably the most elite general surgery programs. i think that these integrated programs will generate good residents regardless, if for no other reason than the fact that the underlying protoplasm will hopefully prove capable.

and if it isnt obvious, i am personally committed to academic cardiac surgery, regardless of pay, training duration, etc. none of these comments will likely resonate as well if your interests are in private practice or general thoracic, as again, i think most of the PDs i have met do not even think this is necessarily the right model for training a general thoracic surgeon.

most of us that are thinking about taking the plunge are resolved to CTS, and most are cardiac, and i think that it is neither a good or bad quality to have. i have spoken to several fellows who knew from early on that they were putting their paces in GS to do CT, and several others that decided during their GS residencies. if you are in the latter category, you are obviously best served by the traditional track, and should not even consider the integrated curriculum. And JAD makes a great point in that several of the surgical subspecialties require commitment straight from medical school, so CT should not necessarily be any different.
 
^^ Great post raosen.

When i am done with my training, i want to do hearts, chest and maybe some carotids and aortas (abdominal).

I don't imagne many CT surgeons end up doing both. The guys at my institution generally stick to one or the other. Which makes sense since we're talking about mostly vascular surgery on one hand and mostly oncology on the other.

General thoracic surgery nowadays pays better, and has a better lifestyle for the most part. as far as people doing chest cases to pay bills - i don't think you can speak so categorically. Some do, i am sure, but there are others who do, because, that's what they are trained at, and some simply enjoy it.

I definitely agree with with this.
 
Great discussion. I have listened for several years about the mythical integrated CT residency and I guess it's finally here. To me, it makes sense to shorten the training pathway simply because one can. If a competent, safe, CT surgeon can be produced in 6 years, then why not? Shave some years off the training. Lord knows there's quite a bit of general surgery which could be shaved off. I actually think general surgery could be a 4 year residency.

I think that the real issue lies with the training programs themselves. Are these CT attendings who are used to having fully trained general surgeons, who are independent, already skilled, and already have a huge amount of ICU experience, going to be willing to train residents from the ground up? I believe that it definitely is possible, but that is going to be a painful transition for those CT attendings. I have a really hard time imagining the CT guys I know having the patience to go through extremely basic concepts with a trainee that lacks the general surgery background. Even though general surgery residency contains some less useful experiences, it still provides a significant cardiac surgery experience, and a huge amount of ICU critical care, and that's not even mentioning all of the operative experience. One of the above posters mentioned "wire skills"... I can tell you that general surgeons in most programs have pretty good "wire skills", and endovascular skills. At my program, the vascular guys did all the EVARS, and TEVARS, and the CT guys would double scrub just to learn how to do them. Who is going to teach the integrated folks this stuff?

Best of luck to you guys. Really. Godspeed. I don't envy you guys, but I sincerely hope for the best for you all. I'm interested in hearing how things pan out in the coming years.
 
...general surgery residency...still provides a significant cardiac surgery experience...
My GSurgery training program provided almost NO cardiac surgery experience.... Those classes after my year actually had no cardiac rotation, just GenThor rotations... I have heard from others that this lack of cardiac surgery in GSurgery training was a growing trend.
...I think that the real issue lies with the training programs themselves. Are these CT attendings who are used to having fully trained general surgeons...going to be willing to train residents from the ground up? ...is going to be a painful transition for those CT attendings...
Agreed. The fall of interest in CT has been an issue resulting from CT attendings being unwilling to actually train their GSurgery fully trained fellows. The reality is, some retirements are in order, new, young attendings will have to take a large role in the training process.

The senior guys/gals have hindered the training of CT fellows to this point AND senior CV attendings lack a great deal of experience in new, minimally invasive techniques both card and GenThor. Further, many "senior"/"full professor" attendings have zero interest in new techniques.

Spending 6 yrs integrated to arrive at year 5/6 to now start learning the basics of CV & Gen Thor (i.e. now, year 5/6, "I may let you do part of a distal anastamosis") is counterproductive and will set the field of graduating CT residents back 2 decades.

It needs to be integrated and directed in such a way that the last 2 years you are now mastering the basics of CV/GenThor (i.e. you have already been DOING open anastamosis and thoracic resections) and now aquiring the the basics of ADVANCED techniques.... NOT aquiring the basics of the basics and then doing "fellowships" in port access valves/coronaries and/or VATS..... after completing 6yrs "integrated.
 
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My GSurgery training program provided almost NO cardiac surgery experience.... Those classes after my year actually had no cardiac rotation, just GenThor rotations... I have heard from others that this lack of cardiac surgery in GSurgery training was a growing trend.

Interesting. I actually think that a cardiac experience is useful if only for the valuable CT-ICU experience that it provides. One can learn a lot about physiology in the non-trauma, non-septic, cardiac ICU patient.

Most of my friends who did general surgery had cardiac experiences. They may not have done much in the OR, but they had to learn about the surgeries, and were responsible for caring for the patients post-op.

I don't know what the trend is for cardiac exposure in general surgery residency. It may very well be decreasing since the numbers of CABGs has declined over the years. At most academic medical centers though, there will still be a cardiac exposure.
 
...I actually think that a cardiac experience is useful if only for the valuable ct-icu experience that it provides...

Sorry you didn't get much cardiac exposure in your residency. I think it is valuable and would rather be doing that than more months of trauma.
agreed.
 
Dear Friends,

I have been watching closely every report, thread, discussion about the integrated CT surgery. What I think is that it has its own prons and cons, the same apply for traditional 5+2/3 or fast trak 4+3 programs.

As far Integrtaed programs, I feel it is good cause you don't have to practicee something you won't do it anymore in the future. Regarding cases, surgical techniques, you won't be asked to do hernias or lab cholys and you are cardiac surgery resident. Plus, the stitching materials used for coronaries different from bowel anastmosis. So, regarding the case types, and surgical techniques it won't help you if you get general surgery before CT surgery or not. In other words, integraded program would assure you protected time for what is relavent that you have to excel.

Second, time wise, I think it is easy to get ABTS certification by 6 years intead of 7 or 8 years, even it is one year, I don't like to wait it in something that I won't do it later on. Even you would think it is not enough, I mean 6 years, you can apply for CT surgery fellowship for 2 to 3 years after residency which auggments your skills and make you feel confident. I mean look at neurological surgery, they operate it at 7 years and they don't have to take general surgery, though graduates are really compaptative and fit in ORs.

Third, Regarding the currriculum, I heard some people saying that curriculum for integrated progams is not modified according to what the program director feels it is more benefitial. I mean even it is the case, I think it is a great oppoutunity to interact with your stuff telling them you feel week in that particular area, and you need to get exposed to more cases.

Forth, practicing general surgery before CT surgery doesn't gaurantee that you will be super spectacular in cardiac surgery. and that's what really irretates me when you see PDs pooling from the 2nd year general surgery to fast track CT surgery and they recommend them. I mean that doesn't make any sense to recommend someone did something in certain field and you wanna me accept him/her, though s/he won't be doing these cases again! I feel the recommendation should be based on a really good experience either in CT surgery rotations or basic research in CT surgery.

Fifth, and you won't belive it, I was attending a CT surgery by a CT resident who had the 5+3 and was doing fellowship, he took down the mamary in an hour, where in my home country they take it down in 6 mins max. Plus, he couldn't extract the the cath after periphral cannulation and the fem.v was torn. that didn't happen one but twice, and they called for a vascular surgery resident to fix it. I mean that is rediculous, instead of just spending 5 years of your life doing gs, I would excel areas I will face the most, cardiac, vascular, thoracic and some GI things for diapgramatic problems (included in thoracic anyhow).

Bottom line, I feel it is better to take integrated, and would still could have fellowships to increase your experience. But again, I could be wrong, still my point of view, and evry one should plan his own goals.

Thanks
MElsorady
 
My I have heard from others that this lack of cardiac surgery in GSurgery training was a growing trend.

I think this is true. In most places- cardiac service is pretty segregated. their own OR's, instruments, nurses, etc.. add in a 4th yr general surgery resident to the mix: as a 4, you start to feel pretty comfortable with doing OR stuff, then you go to CT where you dont understand any anatomy at first, and you can even have attendings telling you to step aside so their PA can assist them while you 2nd, or even 3rd assist!! It is a setup for disaster, and sure to make all but the most determined complain to their PD about the bad experience on the cardiac service. alas- no more cardiac rotations.

probably the best spot for a 4th yr experience is with a dedicated thoracic service- if your place has one. Not necessarily with the junior cardiac garbage man stuck with doing the lungs (doesnt make for a good teaching experience)

Another thing is I wish I was able to spend time as a pgy-2 taking care of cardiac postops. you havent seen a sick patient until you have have sat bedside with an unstable postop heart.
 
I think this is true. In most places- cardiac service is pretty segregated. their own OR's, instruments, nurses, etc.. add in a 4th yr general surgery resident to the mix: as a 4, you start to feel pretty comfortable with doing OR stuff, then you go to CT where you dont understand any anatomy at first, and you can even have attendings telling you to step aside so their PA can assist them while you 2nd, or even 3rd assist!! It is a setup for disaster, and sure to make all but the most determined complain to their PD about the bad experience on the cardiac service. alas- no more cardiac rotations.

probably the best spot for a 4th yr experience is with a dedicated thoracic service- if your place has one. Not necessarily with the junior cardiac garbage man stuck with doing the lungs (doesnt make for a good teaching experience)

Another thing is I wish I was able to spend time as a pgy-2 taking care of cardiac postops. you havent seen a sick patient until you have have sat bedside with an unstable postop heart.

I spent 8 weeks as an R2 taking care of sick (SICK) post cardiac/post lung transplant patients with zero OR experience. I take that back -- I helped the fellow close a chest on the third heart transplant of a Christmas weekend because everyone else was home with their families. I also spent 8 weeks as a 4 on the county thoracic service doing sweet cases and a hell of a lot of decorts (which are fun in their own way). The sum total of that education for me? After learning ton of great ICU care as an R2 I left the rotation assuming I'd NEVER want to do CT surgery. As a 4, my thoracic experience made me think that I would consider it...if it weren't too late, and I had no interest in cardiac. So my experience was valuable on a personal level but not so valuable in turning me into a future CT surgeon.

I think in some ways integrating CT surgery is an attempt to attract candidates who haven't had to face the reality of what it means to be a CT surgeon. If you are making the decision to do CT surgery before you've spent time in the CT ICU coding patients, supporting patients as they try to die in as many ways as possible, then you can't possibly know what you're getting into.
 
...I think in some ways integrating CT surgery is an attempt to attract candidates who haven't had to face the reality of what it means to be a CT surgeon...
IMHO...

I think that may be true of some of the "old guard", "senior professors". However, those are the individuals that also refuse to allow current "fellows" (fully trained GSurgery grads) to actually DO skin to skin cases, grudgingly hold back the distal anastamosis, spend hours of demonstrating the magic IMA to LAD anastamosis, spend 2-3 years proving to you why it MUST, in their eyes take another 5-10 years practice in the real world after completing their great observership to become competent; thus driving grads to spend an extra year observing in a "superfellowship"...

I think integrated is NOT designed/geared/intended for those individuals, those so called "professors"... It is designed to cut through that crap. It is designed to get you DOING CT cases by the time you are a PGY4 integrated resident. Thus, preparing you to move forward on modern technologies during PGY5 & 6.

It will have to be something similar to modernization of GSurgery.... The senior professors (in GSurgery) holding onto the superiority of open gall bladders and open colon resections and open Nissens, and open etc..... They held on because of the surgical mantra, "we do it the same way everytime...". It is a mantra that protects the archaic and fails to allow for advancement.... which is why Universities are more and more often followers and NOT leaders. They are bastians of tenureship that protects those that can not and/or will not learn the new....

Now, Those that wanted nothing to do with "chopsticks surgery" have retired or closed their mouths.... So to is the era of CT surgery. It will have to adapt and move forwrd or it will at best subject patients to decades of what is currently the decades old models of care. At worst, it will watch as CT procedures become more and more the domain of other fields.... Lap Nissens to GSurgeons, ?VATS lobes to surge-onc or GSurge, achalasia to MIS GSurgeons, cardiac disease and endovascular care to cardiologists, endoscopic esophageal procedures to GI, endotracheal procedures to pulmonology, etc, etc....
 
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I think this is true. In most places- cardiac service is pretty segregated. their own OR's, instruments, nurses, etc.. add in a 4th yr general surgery resident to the mix: as a 4, you start to feel pretty comfortable with doing OR stuff, then you go to CT where you dont understand any anatomy at first, and you can even have attendings telling you to step aside so their PA can assist them while you 2nd, or even 3rd assist!! It is a setup for disaster, and sure to make all but the most determined complain to their PD about the bad experience on the cardiac service. alas- no more cardiac rotations.

probably the best spot for a 4th yr experience is with a dedicated thoracic service- if your place has one. Not necessarily with the junior cardiac garbage man stuck with doing the lungs (doesnt make for a good teaching experience)

Another thing is I wish I was able to spend time as a pgy-2 taking care of cardiac postops. you havent seen a sick patient until you have have sat bedside with an unstable postop heart.

Our cardiac experience was slightly different. As PGY1 we did a CT floor rotation that had PA/NP coverage as well, and we could go to OR to watch and help with closure, etc. As PGY-2 it was mostly CTICU management, where you really learned how to put a line into anything with veins and sometimes without it. What you describe as PGY-4, we did as PGY-3, where we were taking a fellow call (our program has CT fellowship), and since we usually had 2-3 rooms going, you would be in one oof them. Since i had an interest in CT, i got to do quite a bit, including cannulating and distals. Most thoracic cases were also yours as PGY-3. Unfortunately, after my third year, things changed and now three's don't have to go through CT. Interns don't do the floor rotation. In my mind, it is too bad, because besides not having exposure to cardiac surgery, which would possibly turm someone off and someone on to the field, taking care of crashing cardiac patient is very educational and really grows hair on someone's chest like nothing else
 
before i get accused of making up stuff - "proximals, not distals". Was thinking of something else
 
Anyone want to give us 3rd-years an update on their experience thus far? There's not much out there with respect to the Integrated CT spots. Anything would be much appreciated.
 
Having just submitted ROL, I have a little more free time to respond. PMs sent to those who have messaged. Would love to be a resource for you if you need guidance, realize that this is a very nebulous process thus far, given that these programs/training paradigm are so new. So fire away.
 
Any word on the match? Anyone rank these programs or hear of anyone matching into them? Godspeed.
 
ND, thank you for the PM.

I matched to Stanford's program. Again, I will try to respond to inquiries as they come in, but cannot make any definite guarantees if that message volume starts to pick up.
 
woot woot, raosen! Excellent! A first for us, but no surprise for you. :)
 
Yeah. I saw the report on unfilled spots and obviously the integrated CT spots (10) all went filled. I'd like to know how many people actually applied AND ranked these programs.
 
Now that the madness is over, could any of you (matched or not) please share some insight on how to approach this process? Pros and cons of programs you looked at would be nice of course, but perhaps a public forum is less than ideal for that sort of thing.
The main thing I'm looking for is a sense of what it actually takes in practice to match one of these spots?
I will be trying for a 2012 match and I still have enough time to pick up appropriate away rotations which I gather are a must. To schedule wisely though, I want to get a sense of of whether or not I'm being realistic.
I only have so many sub-I's to fit into my 4th year and making a fool of myself for 4-8 weeks at a place where I should not even dream of getting in would be a waste of everyone's time.

I am not a prodigy med student by any stretch, but my heart is really in this and has been for a very long time. Any advice from you pioneers would be greatly appreciated.

Please PM if you prefer to do this by e-mail or private messages.
 
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