Just for background purposes I recently matched into an I6 CT program and am starting in two weeks. Below is my advice for anyone looking to know a bit more about the programs and what my thoughts are on how to secure a spot. Keep in mind there are many ways to get into these programs and also there are many ways to become a CT surgeon (not just the I6 programs). Also the more input you get from more people the better so that you can conclude whats best for you.
Should you apply for an I6 program? I only recommend applying if you are absolutely, 100% sure that you want to do CT surgery and are willing to make the sacrifices to do it. If you are even wavering a bit, I would suggest that you do either a 4+3 year program or a regular general surgery program followed by a fellowship. These programs allow you the opportunity to still pursue CT surgery while having the flexibility to change if you decide to do so. The last thing you want to do is regret going into a field you may not fully be committed to. In addition (and there are many schools of thought on the following comment), I am skeptical about going into an I6 program if you are primarily focused on wanting to do thoracic as a career instead of cardiac. My personal belief is you need more experience in the abdomen to become a thoracic surgeon and thus either need to go to an I6 program that is thoracic heavy (U of Washington) or do a 4+3 or gensurg training program. My experience on the interview trail was that most (not all) programs were looking for applicants who wanted to do cardiac over thoracic, however, I suspect this will definitely change with time.
So I6 is a definite how do I prepare? Again, there are many ways to become a competitive applicant but there are some consistently important things that will give you the best chance of procuring a spot.
- Board scores: numbers are tossed around all the time but as long as you have a very competitive score (most likely above a 240 you should make the cut), I was never once asked about my step II scores during the interview but I did have them available and they were competitive as well.
- Grades: you will need to be one of the top students in your class to be competitive, there is no standardized grading system for schools but as long as you excel at your school you should be competitive, its important to not only excel in surgery and cardiology but also all the subjects and rotations you don't have as much of an interest in, remember every little bit counts.
- Research: most of the I6 programs are looking for someone with a dedicated interest in research or who has done some significant amount with publications. I took a year off before medical school and did bench research that had nothing to do with CT surgery and then came and did mostly clinical research in my four years at medical school (mostly CT or ICU related). Productivity and the ability to complete a project from beginning to end are impressive qualities to these programs and they would prefer applicants who are going to have the same academic drive during residency. Lots of people take a year off if they feel like they lack research so this is always an option.
- Interest in CT Surgery: I can't recommend this enough. Start early in medical school by getting involved with the CT department at your school. Scrub in, attend grand rounds, transplant runs, do research with attendings, make friends with fellows, really anything you can to become known to the department. I started getting involved with the CT department as a first year medical student and consistently showed up to be noticed throughout my four years. This will help with the small world network that CT surgery is that others had alluded to in earlier posts. Remember even if your medical school doesn't have an I6 program, most likely the CT surgeons know chiefs, chairs or surgeons at programs that do and will not only put in a good word but write you your letters if you prove yourself.
- Subis: Some programs only like offering interviews to candidates they saw in person. Penn seemed to be the most geared towards this as they only interviewed 9 people and I was one of only a couple that hadn't done a subi there. To be competitive I would recommend doing a rotation in CT surgery at your own institution (regardless of if they have an I6 program), a couple CT surgery subis at outside institutions with I6 programs in addition to one general surgery subi (at your own institution). Depending on how hard you want your fourth year to be this can be a lot but its definitely worth it as you get to know the programs first hand and that experience is incredibly valuable. Stanford, Penn, and Mount Sinai really get you involved on your subis and exposed you nicely to the field (all three allow you to do donor runs for transplants in addition to your normal surgical schedule). The rest of the institutions I can't speak to as I didn't do aways there. Columbia has a reputation to sticking with their own medical students as I6 candidates so be cautious about doing a month there if they already have slotted in their own. However, this may change with time
- Letters: Need to be from the most important CT surgeons at your institution and therefore you need to get to know them well so that they can write outstanding ones for you.
- Extracurriculars: Being involved with teaching and other things to boost your resume is always important but in my interview experience seemed to be the least important out of all of the above.
What are the programs like? I repeatedly said throughout the interview process that if I didn't get a top notch I6 spot that I would rather do a 4+3 year program or a gensurg at a great institution like MGH, Hopkins, UCSF, Duke, etc. In my opinion, there is a clear level of top I6 programs and another level of I6 programs that are not as good. The top level ones include Stanford, Penn, Columbia, and Mount Sinai. Maryland is right below that in my opinion but has an absolutely fantastic program as well under their chief. I think Northwestern has a chance to join the top level once they become more established and the same goes for Mayo, UVA, and Rochester but this will require more time. I thought U of Washington was too geared towards thoracic and was geographically undesirable for me so I didn't apply there. Some of the other programs are still solid programs but lack the same pedigree. I ended up canceling interviews at these other I6 programs after learning more about what I wanted while on the interview trail.
Important aspects at an I6 program to know of?
- Big names at the institution (chief, chairman, etc...) as it will be their phone calls and involvement in cutting edge changes that will allow you to flourish/secure a position after the program is over.
- Would you fit in there? If you are going to be miserable at an institution then I would recommend you going someplace else.
- Willingness for the program to change to make your education as great as possible. Besides Stanford most of these programs are still test piloting their training so if something doesn't work they have to be willing to change and change quickly for you (Sinai, Maryland, and Stanford seemed great with this but I don't have as good of an insight into the other programs).
- Operative volume and range of operations. Columbia and Penn have two of the busiest programs. Sinai is behind them but not too far. Unfortunately this is one of the few downsides to Stanford as their volume has suffered recently.
- Opportunity to operate and not just be a first assist. CT surgery is a hands on sport so unless you get to do it yourself you won't progress. They throw you in early and get you involved greatly at Columbia, Stanford, Maryland, Sinai, and Penn.
- Research opportunities. Penn, Columbia, and Stanford are involved with trials, clinical research, and have amazing lab opportunities. Sinai is involved with new trials, clinical research, and offers interesting opportunities to get a PhD in a shortened time period (also has a large animal lab). Maryland has fantastic lab experience and is involved with a lot of the STS database work.
- Surgical skills lab and wet labs that allow you to become competent in your surgical skills out of the OR before doing the real thing. Stanford has the best lab set up for this. The surgical simulation program at UNC is supposed to be amazing as well.
- Exposure during residency to cardiology, critical care, endovascular techniques, radiology, cardiac anesthesia and perfusion, etc. CT surgery is not just about being an open surgeon. Stanford is great at this and pioneered it all the way back during the teachings of Shumway. Penn and Sinai have followed in their footsteps. Collaborative institutions are definitely gearing up for the future as the days of CT surgery being in its own world have ended.
For my rank, I ended up listing my top four picks to be I6 programs followed by one general surgery program, and then another I6 program, followed by other general surgery/4+3 year programs. You can probably tell from the email above which programs were in my top four.
