Hamilton General Hospital
St. Joseph's Hospital
McMaster University Medical Centre
Hospital for Sick Children
The cardiac surgical residency program is a small program, that facilitates a large degree of direct interaction between resident trainee and attending staff. There are 8 cardiac surgeons with an annual pump case volume of 1800. This provides a substantial clinical volume to which residents are exposed and eliminates competition from other residents or fellows. Rotations on other services involve some resident interaction and supervision by more senior resident staff, as well as group teaching sessions and seminars.
The initial two years of the program — the Core years — involve surgical rotations that introduce the resident to the Principles of Surgery. The resident is exposed to assessing and examining patients preoperatively and managing them postoperatively. On the general surgery service the resident is also be involved in resuscitating trauma patients. Operating room experience introduces the resident to issues in anesthesia, coagulation as well as to surgical techniques, procedures and instruments including newer video technology. During the Intensive Care Unit rotation the resident deals with patients requiring hemodynamic monitoring, inotropic support and mechanical ventilation. The rotations will include both Cardiac ICU and General ICU. Cardiology rotations include patients requiring coronary care, hospital ward care, out-patient visits and rehabilitation. The resident is exposed to various cardiac investigations including stress testing and various imaging modalities: nuclear studies, PET scanning, echocardiography and cardiac catheterization. There will be an opportunity to learn more about specialized areas such as arrhythmias, EP studies and pacemakers. The rotations are divided into the following block rotations: coronary care unit, ward/consults, EP, echo and cath lab.
The resident will take part in the weekly Department Core surgery seminars, where material covered not only helps prepare the resident for the Principles of Surgery examination, but raises the resident's awareness of issues in medical ethics, liability, quality assurance and stress management. A review of issues in epidemiology and critical appraisal is also part of the Core program sessions.
The third year of the residency program is an enrichment year.
The fourth year of the residency program will have a greater focus on operative skills in cardiovascular and thoracic surgery. Each rotation includes preoperative patient assessment, postoperative management and follow-up in an outpatient setting as well as a role for hospital and emergency consultations.
The junior cardiac surgery rotation will expect the resident to learn to perform sternotomy, cannulate the patient for cardiopulmonary bypass, harvest conduits for coronary artery bypass such as the long saphenous vein and the left internal mammary artery. The resident will assume a gradually increasing role in performing parts of coronary artery bypass procedures.
The vascular surgery rotation will provide additional opportunity for the resident to perform arterial anastomoses. In addition, the resident is exposed to management of conditions involving venous disorders and acute ischemia.
During the thoracic surgery rotation the resident will learn to perform thoracotomy incisions and has the opportunity to perform bronchoscopy, mediastinoscopy, thoracoscopy, lung biopsy, apical bullectomy and tracheostomy. He/she assists in pulmonary and esophageal resections.
The pediatric cardiac surgical rotation will occur at a senior level at the Hospital for Sick Children at the University of Toronto. The resident will be introduced to congenital conditions, their embryologic origin, the methods of investigation and imaging and the indications and outcome of surgical interventions. He/she takes part in a large number of different procedures, some palliative, some staged and some definitive.
Elective time is available to the resident during all the clinical years, except the final senior year, to learn more about a potential area of special interest, which the resident may be considering pursuing upon completion of residency training.
The senior year in cardiac surgery provides the resident with a large volume of cardiac surgery. Upon its completion the resident is capable of independently performing coronary artery bypass surgery and valve replacement. He/she will have gained experience in "redo" surgery. Arrangements are made to ensure maximal resident exposure to procedures that are performed less frequently, such as those involving aortic root enlargement, aortic arch surgery, pericardial resection, emergency cases such as aortic dissections and ruptured VSD repair, and specialized cases such as mitral valve repair and pulmonary thromboendarterectomy. The resident attends weekly rounds of the cardiac surgery service. In preparation for the final fellowship examination, arrangements are made for regularly scheduled sessions with staff to assist in thoroughly covering the necessary material and by providing cases for discussion and participating in topic reviews.
Rotations during PGY-1 include: Principles of surgery core year 1, general surgery (Trauma), emergency, cardiac anaesthesia, cardiac surgery and elective.
The PGY-2 rotations include: Principles of surgery core year 2, cardiology, ICU, cardiac surgery and elective.
The PGY-3 year is an academic enrichment year.
The PGY-4 rotations include thoracic surgery, vascular surgery.
The PGY-5 rotations include pediatric cardiac surgery, heart failure/mechanical circulatory assistance/transplantation, adult cardiac surgery
The final training year is spent as senior resident in cardiac surgery.
The academic enrichment year (PGY-3) provides an opportunity for research. Additional involvement in research projects is required during residency training.
Seminars vary with rotation and training year. Most services have at least one weekly teaching round, in addition to Mortality rounds or Journal clubs. During PGY-1 & PGY-2 years, residents attend 1/2 day core surgery teaching seminars with other surgery residents.
- An acceptable academic record, particularly in areas related to cardiac diseases, for example.
- Proven interest in cardiac surgery demonstrated by elective choices or research activities.
- Letters of reference reflecting on candidate's interests, motivation and learning ability. Comments should include opinion about candidate's interpersonal interactions, reliability, maturity and professionalism.
- Demonstrated interests in research: basic or clinical or epidemiological (e.g. surgical outcomes)