MS4 applying CT surgery

[harrdworrk]

Hello. I am a current MS4 at a US medical school currently applying to the I-6 integrated cardiothoracic surgery programs as well as general surgery. I have a strong interest in adult cardiac surgery based on my research experiences and rotations and I'm set and this is something I want to do with my career.

I have received conflicting advice regarding different training pathways. As you can imagine, more senior CT surgeons have told me that general surgery is the way to go, considering that that's what they trained in, as well as the fact that there is the impression that you might have more technical skills, ICU experience, and leadership experience with the chief year. However, I also hear that the I-6 is better because you might get a more immersive experience with cardiothoracic surgery, certain subspecialties that are important for CT surgery, such as echo, interventional cardiology, structural heart, cardiac anesthesia, etc.

To be honest, I'm not sure which training path is better for me, and my goal ultimately is to be a CT surgeon at the end of training. I would be happy to train or a strong academic general surgery program, an I-6 program, or even a 4+3 program. I'm just wondering if anyone here has some insight into which training paths are better and the pros and cons?

Additionally, I have heard that it's difficult to explain to general surgery program directors that you are not any less dedicated to general surgery by dual applying to I-6 programs. Does anyone have any thoughts about this as well? Thank you so much.

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[ThoracicGuy]

If I knew I wanted to go into CT Surgery from the start, the I6 programs are a nice option to have. There aren't many spots, though, so there is that.

For dual applying, I would make sure you have two different PS and two different sets of personal statements. You don't want your GS personal statements to mention anything about applying to I6 and vice versa. You can certainly spin a GS app as being interested in CT, but wanting to keep your options open after you have a chance to experience other subspecialties.

In the end, you'll come out with the training you need to do what you want to do. Apply to both and see how it shakes out in the interview offers.

 

[dienekes88]

Don't tell general surgery programs you are dual applying. Consider not applying to both kinds of programs at the same institution.

It's probably true that older forms of general surgery were good preparation for cardiac surgery. But modern general surgery has such a large laparoscopic component that it doesn't seem to help as much.

Separately, as cardiac patients get more complex and sicker, the experience in the SICU is not as big a benefit as just spending more time in a cardiac icu.

Having said that. The question isn't really i6 or trad route. Because not every i6 program is made equal. There are plenty of 4+3 programs I would have preferred over i6 programs.

Finally, you pointed it out yourself, but cardiac surgery has become incredibly complex. As these techniques and operations get more complex, having extensive experience in the cath lab, echo, CCU, CTICU, etc. Is going to put the integrated residents at a bit of an advantage.

Thoracic on the other hand may be better approached via general surgery.

 

[Circ Arrest]

I'm partial to the traditional route, mainly because I felt like my chief resident year helped me mature a lot as a doctor. That said, I have worked at places that have an I6 residency and I have many I6 residency trained partners who are all good. There are definite advantages to I6 training. If I knew I wanted to do cardiac when I was coming out of medical school, I would've likely tried to go route, but I thought I was going to do trauma or colorectal.

Remember, training in cardiac surgery doesn't end when you get your diploma. The first few years of being a new cardiac surgery attending can be very difficult and the learning curve can be very steep especially when it comes to cases that are not text book or situations (ie. complications) that require a lot of judgement. I think that its imperative that you are trained well in the OR. A lot of things can be forgiven if you can operate. Personally, I'd go to a good traditional program with a strong track record of placing graduates into successful practice than a new I6 residency where they're still trying to "figure it out". Also, remember, cardiac surgery patients have a lot of non-cardiac surgery related issues. When my post op CABG has ischemic colitis, I'm usually the first person to realize it, because I saw that consult a hundred times as a general surgery resident. And if I want to have a discussion with the consultant about it, I can do so in a way that I'm taken seriously.

 

[residentyear9]

I agree with the comments made above. As a general surgery senior resident going into CT, the longer training is less ideal, but the exposure and time spent taking care of patients count and are invaluable. At larger academic training programs, I think the variety of complex, open cases still exist despite the larger availability of minimally invasive techniques. I also sit on my program's interview committee, and I agree w/ the comment above about two separate applications - i6 and general surgery PS, interests, etc. I interview a lot of cardiac focused applicants or 4+3 interested folks. We all know that you will rank i6 cardiac program first on your list, unless you specifically say why our 4+3 is more interesting to you or indicate general surgery in another manner (i.e. thoracic specific). I do see plenty of applicants who blindly use one essay and activities summary which will clearly paint general surgery as a #2 preference.

 

[harrdworrk]

Hello all. Update: matched into an amazing academic (7-yr) general surgery program. I was super stoked to receive that news. Some reflections:

As Dienekes88 said, all I-6's are not made the same. In hindsight I realize that I would much rather train at a strong academic general surgery program with a track record of matching people into CTS than going into a newer or smaller I-6 program, much as "Circ Arrest" wisely commented above. Thus, my rank list reflected these thoughts.

Although I LOVED my CTS rotations as a medical student and they couldn't pull me out of the ORs, I do recognize that my insight into what the various careers within surgery look like is extremely limited. I just haven't had the exposure to be 10000% sure. I hope that as a resident I will be able to either solidify my interest in CTS or find a specialty that grabs me equally. As this year's application cycle went on, I quickly realized that a huge advantage of general surgery is it delays that decision and gives me the years (3 clinical+2 of research) to mature before applying as a clinical 4th yr.

My goal at this point will be to absorb as much as I can from my institution in terms of surgical knowledge, technical skills, and research mentorship. I will try to be the best GENERAL surgeon first and then try my luck at CTS again as a PGY-4. Thank you all for the insightful comments.

 

[droliver]

Hello all. Update: matched into an amazing academic (7-yr) general surgery program.

Does your HS program have a pathway to transition to CT (4+2/3) at the same place?

 

[harrdworrk]

Does your HS program have a pathway to transition to CT (4+2/3) at the same place?

Nope. But we do have a decently strong CTS department with a fellowship and an integrated (6yr) track.

 

[droliver]

Nope. But we do have a decently strong CTS department with a fellowship and an integrated (6yr) track.

You might test the waters on whether that's even something they would potentially consider. I think traditional programs still have the ability to early specialization "fast track" you into CTVS residency after your PGY4 general surgery year at the same institution. That was a thing a few years ago that a lot of heavy hitter academic programs like Wash U, UAB, Wisconsin, etc.. were offering within their Surgery departments. It's still mentioned as a pathway along with the traditional and integrated routes.

CT Surgery Training Pathways | TSDA

 

[harrdworrk]

You might test the waters on whether that's even something they would potentially consider. I think traditional programs still have the ability to early specialization "fast track" you into CTVS residency after your PGY4 general surgery year at the same institution. That was a thing a few years ago that a lot of heavy hitter academic programs like Wash U, UAB, Wisconsin, etc.. were offering within their Surgery departments. It's still mentioned as a pathway along with the traditional and integrated routes.

CT Surgery Training Pathways | TSDA

Thanks Dr. Oliver. I'll ask them what their thoughts are. A part of me does think about trying my hand at applying to some of the bigger academic CTS departments when I end up applying in about 6 year's time. There may be value in multiple institutional perspectives when I finally go out and practice.

 

[ThoracicGuy]

You might test the waters on whether that's even something they would potentially consider. I think traditional programs still have the ability to early specialization "fast track" you into CTVS residency after your PGY4 general surgery year at the same institution. That was a thing a few years ago that a lot of heavy hitter academic programs like Wash U, UAB, Wisconsin, etc.. were offering within their Surgery departments. It's still mentioned as a pathway along with the traditional and integrated routes.

CT Surgery Training Pathways | TSDA

If a place isn't set up to do a 4/3, I don't think they can just create the program like that.

 

[droliver]

If a place isn't set up to do a 4/3, I don't think they can just create the program like that.

My understanding is that it’s not that difficult but does require RRC application as the “4” part isn’t a special curriculum like the integrated programs are. I think a lot of programs that initially had them have mothballed them in lieu of integrated programs tho