Best Chest

[dr.evil]

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I'm sure most people are sick of the "which program is best?" questions but I need a little outside input.

I'm leaning towards cardiothoracic surgery as my specialty of choice. I don't need to hear how it's a dying specialty, how cardiologists are taking over the world, and how I'll be a hobo in 10 years.

I need to know what programs people think are excellent training programs, which ones are well known, and which ones are geared toward academics vs. private practice. It would be great if could get input from everyone as everyone here has varying experiences at different programs.

Thanks a lot guys. I think the only place I would not go is somewhere in New York (my apologies to the New Yorkers).

BTW, what's the word on the fast track CT programs (4+3 or 3+3)? anyone know?

 

[droliver]

The big boys on the east IMO are probably Michigan, Duke, Baylor, Columbia, and the Cleveland Clinic. Duke & Michigan have more of an academic prepatory reputation then those others if thats your interest. There are a number of other very good programs in the East including Washington University, Penn, Florida, UAB, Emory, Hopkins, & Harvard/MGH that I might put just below that first group. Different programs will have different strengths depending upon their thoracic surgery exposure (some programs are very heavily weighted on the cardiac side), transplant volume, & the amount of vascular surgery that is incorporated. Everyone gets plenty of CABG experience, but most of these places listed are active in clinical trials for many of the latest techniques & technologies (robotics, ventricular remodeling, ABIOCOR, etc..) Carolina's Medical Center has an interesting 3 year program where you get double boarded in vascular & CTVS.

As to the fast track programs... the door is wide open for adopting them as of last winter (2001) when the prerequisite for ABS certification was dropped. The only early adopter that I've heard about so far is Washington University which plans on implementing it for this years incoming PGY-1's for their trauma, transplant, peds-surg, CTVS, and vascular fellowships @ Wash. U
Many influential surgical chairs (ours included) and educators are violently opposed to the trend & I suspect it will still be awhile before it becomes widespread. There are still some huge issues to be sorted out here, especially as to how this will be disruptive to manpower issues in general surgery programs & whether or not these new models work at all progams (there's been some mixed results with similar programs in the past)

 

[scutking]

I agree with droliver regarding the best CVTS programs. As for the 4+3 fast track question... It's meeting a lot of resistance around the country, mainly because of its impact on general surgery training and staffing. We had a recent grand rounds lecture on this topic by our Chairman of Vascular Surgery, who is on the ACS committee deciding this issue. He was of the opinion that the only programs what would be allowed to do the fast tracking, at least initially, were those programs which currently have all 3 fast track fellowships available: pediatric surgery, CVTS, and vascular. Perhaps this is for logistical reasons, I'm not sure. I'd be curious if anybody has heard anything else about this subject.

 

[dr.evil]

thanks droliver and scutking.

Of these programs, do you have experience with fellows from there or fellow residents who went to these programs. Reputation is great but I'm a bit more comfortable with stories from those who have been on the front line.

Who are stronger in LVAD's, Transplant, and most importantly (to me), thoracic surgery (esophagus, lung, etc)?

My question about the 4+3 stemmed from a fellow resident who interviewed for CT and UCLA. The program director there told him he felt that by 2006 that the majority of programs would have a fast track option. I found this a bit hard to believe.

BTW, one of my chief residents has been hearing rumors that all fellowships would likely have a fast track option in the future. For this to happen, I think a global change in general surgery residency would happen including making it 4 years. Then if you wanted to "just" do general surgery, you would do one more year of general surgery and if not then you would do your fellowship. I thought this sounded like a good idea with our super-specialization of surgical fields.

Anyone have any thoughts

 

[droliver]

I've had two friends recently finish CTVS @ Florida and Baylor University. Both of these guys were all-stars, just absolutely brilliant doctors with incredible CV's who could have gone anywhere. Florida has a reputation for an outstanding pediatric cardiac experience, enough that many of its CTVS graduates have not had to do peds. fellowships in order to get positions & privledges @ some of the top programs in the country. I think they also have an unusually rich experience with thoracoabdominal aneurysms which is what interested my friend (he's now on staff there). Baylor has historically been one of the leaders in cardiac surgery for 40 years & its reputation kind of speaks for itself.


I know Michigan has one of the strongest & most influential thoracic groups, as does the Cleveland Clinic (whose chief of thoracic surgery, Dr. Decamp, is a great guy and former Louisville med school grad.). The University of Wisconsin is a place I think that's know for its thoracic surgery as well. As you'd expect the Harvard/MGH program & John's Hopkins are outstanding too

The timetable for these abbreviated programs is up in the air. Again only the earliest trials are starting now & I bet most people will sit on the sidelines at first to see some others experiences. There will be some considerable resistance @ some programs to changing to this model & I think 2006 is prob. way to early to get to the point where its widespread. I don't know what the division chiefs are telling current CTVS applicants about all this.