Cardiothoracic Fellowship Training
The Cardiothoracic Training Program of Boston Medical Center (the merged Boston University Medical Center and Boston City Hospital) provides residents, fellows, and medical students with a comprehensive academic and clinical experience in this surgical specialty. Participants benefit not only from the diverse resources offered at this major medical center and its affiliates, but also from the close interaction with the supervising staff, representing the participating institutions.
The Boston Medical Center Hospital's Department of Cardiothoracic Surgery is under the direction of its chief, Dr. Benedict D.T. Daly. General cardiac and thoracic procedures and the diagnosis and treatment of diseases of the lung and esophagus, as well as chest trauma are performed at the Boston Medical Center. A busy cardiac and general thoracic service works closely with cardiology, pulmonary medicine, oncology, and radiation medicine. The core training program of the Department is a three-year Cardiothoracic Surgery Residency Program, which is conducted in conjunction with Children's Hospital Medical Center. In addition, clinical and research fellowship positions are available in the Department.
The Thoracic Surgery Residency Program
The Residency Program is approved by the Accreditation Council on Graduate Medical Education. It features 30 months of training in adult thoracic and cardiac surgery at the Boston Medical Center and 6 months of training in pediatric cardiac surgery at Children's Hospital. The program participates in the Thoracic Surgical Residency Matching Program.
Applicants to the Thoracic Surgery Residency Program must plan to successfully complete five years of training in generally surgery and meet the guidelines of the American Board of Surgery for board certification.
Training at the Boston Medical Center
The first year of the program is spent at the Boston Medical Center during which time the resident becomes thoroughly familiar with preoperative and postoperative care, as well as with the details of intraoperative care and technical aspects of thoracic and cardiac procedures. The resident will serve as the first assistant or primary surgeon in cardiac and thoracic cases.
The resident will participate in general thoracic procedures, adult cardiovascular procedures, endoscopies, and major esophageal procedures. Dr. Benedict Daly is Director of the General Thoracic Surgery Service. The program has expanded the general thoracic surgery service with the recruitment of two nationally recognized surgeons including Dr. Daly. The resident is trained in a wide variety of cases incorporating cutting-edge technology and innovative approaches using minimally invasive technology.
The resident is responsible for organizing, coordinating, and presenting the weekly morbidity and mortality conference, and is expected to attend the weekly Cardiothoracic Surgery Teaching Conference, Cardiac Catheterization Conference, General Surgery Oncology Conference, and Surgical Grand Rounds. Operative experience is concentrated initially on thoracic (non cardiac) cases, in which the residents are expected to perform as surgeon. As their clinical experience and technical abilities increase, the first-year resident is expected to also fully participate in cardiac operations as first assistant or surgeon, when appropriate.
During the second six-month period of the first year, the resident has opportunity to broaden and consolidate experience in thoracic and esophageal disease involving both benign and malignant findings. In addition the resident will serve, primarily as a first assistant and occasionally as surgeon, in cardiac and complex aortic procedures. The second year is spent at the Boston Medial Center in further developing clinical and technical skills. The resident's role in the operative management of cardiac surgery is expanded, as appropriate to their technical skills, experience and the difficulty of the cases. The final six months as Chief Resident at Boston Medical Center is designed to mature and complete the third-year resident training. The Chief Resident is expected to take a leadership role in the teaching of anatomy, physiology and pathophysiology to the junior cardiothoracic residents, general surgery residents and medical students. In addition to leading the Cardiothoracic team, the Chief Resident will organize and lead, with the help of faculty, the Mortality and Morbidity Conference, Journal Club and selective topics for visiting lecturers.
In addition to performing all aspects of routine cardiac surgery as surgeon, the resident is expected to gain expertise in more complex cardiac problems such as valve replacement and repair, "off-pump" coronary bypass grafting, reoperative surgery, aortic surgery, aneurysmorraphy, traumatic aortic transections, and acute aortic dissections. The department is rich in innovative technology including the recently acquired technology for robotic assisted surgery; surgical treatment of atrial fibrillation; and surgical treatment for heart failure. The faculty oversees a strong clinical research program and serves as principle investigators on several multi-center trials to evaluate innovative surgical treatments for heart disease.
The Chief Resident is assigned the senior responsibility to manage the service, secure the maximal clinical and operative experience, direct preoperative evaluation, prioritize and recommend technical approaches to various problems in consultation with the faculty.
Training at Boston's Children's Hospital Medical Center
Boston's Children's Hospital is an affiliate of Harvard Medical School. The resident serves at Children's Hospital for six months as the senior resident in pediatric cardiac surgery, under the direction of Dr. Pedro del Nido, Chief of Cardiac Surgery. During this time, the resident participates in open cardiac surgery on children, including infants, as well as in closed operations. This training period provides the pediatric surgical experience required to comply with the Board of Thoracic Surgery requirements.
Training at Children's Hospital provides extensive clinical exposure to the surgical management of simple and complex congenital heart disease in neonates, infants, and older children. The senior resident is involved in preoperative work-up to prepare children for surgery, and participates in the operating room as surgeon or assistant. There is a superb exposure to complex congenital defects in neonates.
The resident participates in postoperative patient management in the Cardiac Surgical Intensive Care Unit, and monitors patients in the regular ward until the patient is discharged. Additional responsibilities include directing and training junior residents in the general surgical training program, as well as supervising the cardiac surgical fellows who participate in the management of the service.
The training at Children's Hospital is augmented by weekly pathology conferences on cardiac specimens and by a clinical cardiac catheterization and radiology conference held in conjunction with Children's Hospital's Department of Pediatric Cardiology.
The clinical thoracic fellow is under the tutelage of the attending staff of thoracic and cardiac surgery. During training, it is expected that the fellow will further familiarize him/herself with preoperative and postoperative care as well as with details of intraoperative care and all technical aspects of thoracic and cardiac procedures. The fellow participates fully in a variety of surgical procedures.
The Boston Medical Center Facility
Boston Medical Center is a modern medical complex located in the Boston's historical South End. The Medical Center includes the Boston Medical Center, Boston University School of Medicine, Boston University's Goldman School of Graduate Dentistry, and Boston University School of Public Health.
The Boston Medical Center is a major referral center offering care in all of the adult medical specialties. In addition to providing a full spectrum of surgical and medical services, the Boston Medical Center serves as a principal teaching hospital of Boston University School of Medicine, one of the country's most highly regarded medical schools. Boston University Medical Center Hospital was designated in 1989 as a Medicare CABG demonstration site.
Boston Medical Center consists of two modern hospitals. The Atrium Pavilion of the former Boston University Medical Center houses state-of-the-art operating rooms, all equipped with the latest in lighting and anesthesia technology, and each featuring camera mounts for closed-circuit television monitoring.
An expansive recovery room, combined with the preoperative area, is attached to the OR suite, and has room for 20 patients. A large Surgical Intensive Care Unit across the hall may hold up to 16 patients, and is equipped with the most sophisticated physiological monitoring equipment.
The Atrium Pavilion houses the majority of the former Boston University Medical Center Hospital's patient beds. The medical specialties located in this modern facility, as well as such centralized support services as the Laser Center and Imaging Department (which includes the Departments of Radiology and Nuclear Medicine, ultrasound facilities, and facilities for such special procedures as CT scan and MRI imaging) all complement the surgical facilities.
The Progressive Care Unit (PCU) is a 27-bed unit of which 17 beds are surgical telemetry beds and 10 are progressive care beds. Patient care is supported by a state-of-the-art cardiac monitoring system. The PCU beds are equipped with bedside monitoring capable of both cardiac and pressure monitoring.
Boston Medical Center is a private, not-for-profit, 547 licensed bed, academic medical center. Emphasizing community-based care, the hospital's mission is to provide consistently excellent and accessible health services to all. Alliances with Boston's Neighborhood Health Centers and Cardiac Network development should ensure a vibrant clinical environment for resident education in the coming decades.
FOR FURTHER INFORMATION
If you would like additional information on Boston Medical Center's training programs in Cardiac and Thoracic Surgery, please contact:
Dr. Benedict D.T. Daly
The Boston Medical Center
88 East Newton Street
Boston, MA 02118