Which med school to pick for cardiothoracic surgery?

Discussion in 'Surgery and Surgical Subspecialties' started by Dr. Chiquita, Apr 27, 2004.

  1. Dr. Chiquita

    Dr. Chiquita Senior Member
    7+ Year Member

    Dec 10, 2003
    Likes Received:
    I have a friend who got into Tulane and UT-Houston. He is determined to go into surgery, more specifically cardiothoracic surgery. He wants to go to a school which will help him get this competitive residency. IMHO, I think both schools are equally excellent, but he really wants to know if one will give him even a slightest advantage over the other. I would really appreciate any advice. 'Cause I have really no experience in this to tell him which one is better. Thanks!

    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  2. Winged Scapula

    Winged Scapula Cougariffic!
    Staff Member Administrator Physician Faculty Lifetime Donor Verified Expert Verified Account 15+ Year Member

    Apr 9, 2000
    Likes Received:
    Attending Physician
    CT Surgery is currently a fellowship following a General Surgery residency. Your friend's medical school will not significantly affect fellowship matching years from now. More important will be his General Surgery residency and his performance therein.

    Either school will prepare him for a General Surgery residency - if one has a stronger Gen Surg department which has a better match success, then he might give consideration to that program for medical school, the caveat being that the program at which he will be happiest will likely be the one he does best in.

    BTW, tell your friend that CT Surgery is no longer considered very competitive (in comparison to other specialties).
  3. aboo-ali-sina

    aboo-ali-sina Member
    7+ Year Member

    Mar 3, 2004
    Likes Received:
    although the ABTS (american board of thoracic surgery) and the ABS (american board of surgery) are working on a 3 + 3 or a 4 + 2 integrated cirriculum for cardiothoracic (much like in plastics) where you start in gen surg and you end in CT but you are only board certified in CT.

    Therefore in a long winded way to answer your question, if he is interested in one of these programs (should they come to fruition) it would be to his advantage to go somewhere where they are more likely to have one of these programs in the initial years (this will likely be places like Hopkins and Duke that had such programs before they were truly allowed) or to go someplace with influential CT surgeons who can talk to there buddies and get him into one of these pilot programs that are slated to start in the next 2-4 years.

    Of course, he can always go the traditional route (then see above)

    good luck
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  4. Dr. Chiquita

    Dr. Chiquita Senior Member
    7+ Year Member

    Dec 10, 2003
    Likes Received:
    Thanks for the input! Another question: Which one has a better reputation for general surgery?
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  5. droliver

    Moderator Emeritus 10+ Year Member

    May 1, 2001
    Likes Received:
    Attending Physician
    Two points:
    1. The 4+2 model described would still leave you board eligible in General Surgery as well. This is also the proposal for Pediatric Surgery, Trauma/CC, and Transplant. The pilot programs for CTVS are expected to start people into the fellowship tract this summer according the ACS Bulletin I read yesterday. The 3/3 model for CTVS is more contraversial & much less close to becoming reality. Vascular Surgery is in limbo as the Amer. Board of Surgery & the Vascular Surgery societies are fighting over whether Vascular Surgery should become its own board in the American Board of Medical Specialties or remain a specialty board of the ABS (they've petitioned previously & been denied but have appealed that.....stay tuned). The ABS would include Vascular with the 4/2 models while the Vascular Board would prefer to do an integrated 3/3 model

    2. The Duke/Hopkins "integrated" CTVS programs really weren't the same animal as what we're talking about. They were essentially non-binding promises that you'd eventually become a fellow. There was no special or abbreviated clinical curriculum as I understand, but they all included various stents in the lab for several years. Routinely those people were a resident for up to a decade with the lab time.

    I cut and pasted the relavent info. from the ACS bulletin below.


    Initiation of early specialization program
    After 12 months of preparation and comment,
    the ABS, in January 2003, adopted the early specialization
    program for vascular and pediatric surgery.
    The program will allow residents in an institution
    with residencies in either of these specialties
    plus general surgery to have an integrated program
    in which they will enter specialty training
    after the PGY-4 year. The chief year of general surgery
    will be completed in the PGY-4 year, and the
    PGY-5 year, which will be the first year of specialty
    training, will also count as a fifth year of general
    surgery. The program will allow residents to complete
    training in six years and be eligible for both
    the general surgery and specialty certificates.
    Initially the program will only be implemented
    in a single institution although, as experience is
    gained, it is envisioned that residents will be able
    to move between institutions for general surgery
    and specialty training. The program will be operating
    on a pilot basis initially, with outcome measures
    being maintenance of the number and diversity
    of total cases, as well as those in the defined
    categories of the residency review committee
    for surgery (RRC-S). Impact on those individuals
    entering the program, as well as other residents
    in the program, will be assessed and the
    ability of participants to maintain first-time pass
    rates on the qualifying and certifying examinations
    will also be monitored.
    The program was reviewed by the RRC-S in February
    2003 and approved. An oversight committee
    of representatives from the ABS and the RRCS
    has been appointed under the chairmanship of
    J. David Richardson, MD, FACS, and is currently
    in the process of developing specific guidelines and
    implementing the program. It is envisioned that
    applications will be received by the RRC-S this fall,
    based examinations for recertification, beginning
    in October 2003, with the specialty areas
    of vascular surgery, pediatric surgery, and surgical
    critical care.

    The American Board of Vascular Surgery
    (ABVS) applied for independent board status
    with the ABMS last year, and the application was
    heard by the Liaison Committee for Specialty
    Boards (LCSB) in December 2002. The LCSB
    denied the application, and the ABVS has decided
    to appeal the decision. A new committee
    will re-review the application and render a new
    judgment, but the timetable for that process has
    not yet been set.The ABS continues to oppose the designationof the ABVS as an independent board, and believes the VSB-ABS has done an outstanding job
    of representing vascular surgery. It is the belief
    of the board that vascular surgery represents an
    essential content area of general surgery and
    that the teaching of vascular surgery to general
    surgery residents remains crucial to their training,
    whether they choose to enter vascular surgery
    as a specialty area or not. Virtually all areas
    of general surgery and its specialties require
    a basic knowledge of vascular surgery, and the
    separation of this discipline from general surgery
    training would be a crucial error.

    New pathways/requirements certification
    On October 20, 2001, the ABTS approved the following
    resolutions regarding thoracic surgery certification.
    The exact timing of implementation for
    some of the resolutions has yet to be determined.
    1. Certification by the American Board of Surgery
    (ABS) is optional rather than mandatory for
    residents who begin their thoracic surgery training
    in July 2003 and after.
    2. One pathway to ABTS certification will consist
    of successful completion of a full general surgery
    residency approved by the Accreditation
    Council on Graduate Medical Education (five
    years) or the Royal College of Physicians and Surgeons
    of Canada, with or without ABS certification,
    followed by successful completion of a twoor
    three-year ACGME-approved thoracic surgery
    residency. Individuals entering thoracic surgery
    residencies in July 2003 or after will be eligible
    under this pathway.
    3. A second pathway to ABTS certification will
    be a categorical-integrated six-year thoracic surgery
    residency, to be developed by the Thoracic
    Surgery Directors Association (TSDA). Residents in these programs will be under the direction of
    the thoracic surgery program directors. Before
    this pathway is implemented, the residency review
    committee for thoracic surgery (RRC-TS)
    must first approve the standards and requirements
    for such programs. Individuals will match
    for such programs directly from medical school
    or at some later time. It is estimated that the
    first such programs would begin to accept residents
    in 2004 at the earliest.
    4. A third pathway to ABTS certification will
    be through successful completion of an ACGMEapproved
    three-year thoracic surgery residency
    after a minimum of three years in an ACGMEapproved
    general surgery residency, so long as
    certain prerequisite criteria are met during the
    general surgery training. These prerequisites include:
    General surgery: 12 months
    (including six months abdominal
    surgery and six months pediatric,
    oncology, and head and neck surgery)
    Critical care: 2 months
    Transplantation and immunology: 2 months
    Trauma: 2 months
    Cardiothoracic surgery: 3 months
    Vascular surgery: 3 months
    Total: 24 months
    It is estimated that such programs would begin
    to accept residents in 2005 at the earliest.
    5. Any individual currently in the ABTS certification
    process (that is, in a thoracic surgery
    residency or has already finished a thoracic
    surgery residency) will be guided by the requirements
    in force at the time of his or her residency.
    6. The ABTS supports the following recommendations
    of the Joint Council for Thoracic
    Surgery Education (JCTSE):
    a. The JCTSE strongly encourages the RRCTS
    as part of the special requirements for thoracic
    surgery residencies to require documentation
    of faculty participation in medical school
    b. The JCTSE strongly encourages the ABS
    and Association of Program Directors in Surgery
    (APDS) to develop a shorter curriculum in ?surgery?
    ?to include ABS certification that, if and
    when approved, would permit an alternate pathway
    to ABTS certification.
    c. The JCTSE strongly encourages the ABS
    and APDS to participate in the development of
    a surgical preparatory core curriculum as a standard
    entry to ACGME boarded surgical specialties.
    Interested parties should take particular note
    that the categorical-integrated program and the
    3/3 program mentioned above have yet to be fully
    developed and will require approval action by
    the RRC-TS before they become available. The
    ABTS is committed to working closely with the
    ABS and other organizations in general surgery
    toward the development of combined 4/3 programs
    leading to the possibility of certification
    by both the ABS and the ABTS.
  6. Good to hear. I've been worried about this. :)
  7. aboo-ali-sina

    aboo-ali-sina Member
    7+ Year Member

    Mar 3, 2004
    Likes Received:
    this is true the Hopkins program was 9 years:
    4 years clinical g-surg 2 years lab and 3 years CT but it was garunteed, it was it's own seperate program, had it's own aplication and everything

    The Duke program (commonly known as the decade with dave; because the dept. chair of surgery, Dr. David Sabiston, was also a CT surgeon and trained you for 10 years) was at least 10 years long

    Intern 1 year
    Junior Assistant Resident 1 year
    Lab time (at least 2 years)
    Senior Assistant Resident (at least 2 years)
    Cheif Resident 1 year
    CT Fellow 3 years

    but it was just a promise not a garuntee.

    Anyway, I brought them as examples not for the program structure, but as the places most likely to be among the first who will implement these integrated programs into their residency training (I know because I was told during the interview trail that this was one of their goals)

    Hope this helps
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  8. droliver

    Moderator Emeritus 10+ Year Member

    May 1, 2001
    Likes Received:
    Attending Physician
    I talked to a recent CTVS graduate from John Hopkins who interviewed here for a job & he told me that they were no longer accepting applications for their program you matched to out of med school & it had been phased out. Again, their program really wasn't much of an abbreviated program in the sense of what's coming down the pike.

    I took, from the ACS bulletin, that there will only be a very few pilot programs allowed for awhile to get some idea of the product produced. The only place I know that's advertising itself as an early adopter has been Wash U. which has been telling applicants for 2 years that they'll have the oppurtunity for these short-track programs in house.

    We'll see. The whole thing is going to be massively disruptive to training programs in General Surgery. Can you imagine how hard it will be to guess the manpower you'll have if there's such an unpredictable # of PGY-5 residents in a program? It could effectively reduce the number of residents in a program by 10-20% in an era where work-hours are down by up to 20-30%+ with the new ACGME rules. I do not envy the job of many PD's in the future!
  9. Johnny Cash

    Johnny Cash Member
    7+ Year Member

    Nov 1, 2003
    Likes Received:
    Just to toss in my few cents of information on the topic as an individual who has a deep interest in cardiothoracic (although not 100% committed to it as a career as of yet)...

    It doesn't matter where your friend goes to medical school, Tulane, UT-Houston, LSU, wherever. I can speak from having friends at both medical schools that this past year both did well in placing 4th year medical students in competitive general surgery categorical residencies. I know Tulane matched people in the following General Surgery Categorical Programs this year, UAB, Mayo-Rochester, NYU, UCLA (2 4th year students). I also know that UT-Houston sent people to Vanderbilt and UPenn from their 4th year class.

    As far as strength of surgery departments, I would say UT-Houston is much stronger than Tulane. Many well known surgeons at UT-Houston and the Texas Medical Center; while Tulane's General Surgery department is in a rebuilding phase and has some great people, but is still growing.
  10. Gleevec

    Gleevec Peter, those are Cheerios
    7+ Year Member

    Nov 24, 2002
    Likes Received:
    It probably doesnt matter as people have said, but Houston and Cleveland are two of the biggest centers in terms of heart research. St Luke's which is affiliated with Baylor and UTH has one of the best CT surgery programs in the nation, as it was the site of several firsts in CT surgery (including artificial heart, etc).

    So while it probably wont matter in the long-run, it couldnt hurt to go to UT-Houston because the TMC is one of the best in the world at heart surgery. Plus, the tuition is much nicer than Tulane. Tulane is a great school too, but you get more resources for less money at UT-H.
  11. Johnny Cash

    Johnny Cash Member
    7+ Year Member

    Nov 1, 2003
    Likes Received:
    Have to second what Gleevec just posted. Tulane is insanely high priced, and the facilities are crap. The Texas Medical Center, well....is the Texas Medical Center.....its like the Disney World of Medicine & Surgery. Assuming your friend would get in state tuition for UT-Houston, there is a lot to be said for being in an environment with lots of surgical resources around. Plus UT-Houston & Baylor, like Gleevec said has some really great people in CT surgery (DeBakey [and all the people he trained], Cooley, Saffi, Bud Frazier, etc).

    I have a friend I could put you in touch with who was a medical student at Tulane, but is a PGY-1 General Surgery Categorical at UT-Houston. He could offer some unique insight into your friends possible medical school decision. Just PM me if you want the contact info.

Share This Page