University of Texas Health Science Center at San Antonio

University of Texas Health Science Center–Cardiothoracic Surgery

The mission statement of the Cardiothoracic Surgery Residency Program at University of Texas Health Science Center at San Antonio, led by Dr. John H. Calhoon since 1994, is “to become the best place in the world to train as a cardiothoracic surgeon.” The faculty at San Antonio believes that cardiothoracic surgery education should not be a spectator sport. Residents are given a wealth of hands-on experience in the operating room, as well as outside the operating room via wet lab and simulation classes. As Dr. Calhoon states, “This is a small program with highly individualized instruction and close, daily interaction with faculty and senior residents, which is designed to address the strengths and weaknesses of each student in a collegial, yet challenging environment, and with the constant goal of producing surgeons of the highest caliber.” Particular strengths of the program include lung transplantation, congenital heart surgery, mitral valve repair, and esophageal reconstruction, although the program also excels at on- and off-pump coronary artery bypass surgery, aortic and valvular disease, open and endoscopic aortic reconstruction, and minimally invasive lung resection. The program continues to incorporate new technologies and techniques as the specialty of cardiothoracic surgery evolves, including the endovascular expertise of Dr. Seenu Reddy from Emory and minimally invasive expertise of Dr. Daniel DeArmond from UCLA. Recent graduate Sandeep Khandhar (2004-2006) attests to the teaching at San Antonio, “I can’t think of better teachers than down in San Antonio. They are experts at taking your skill set as an incoming resident and taking you to the next level. It was hands-on from day one. I was on the surgeon’s side of the table doing complex cases from the time I entered the program.”

As of July 1, 2009, the San Antonio program will offer a new 6-year integrated thoracic training program, along with the traditional 2-year traditional thoracic surgery program that will continue to accept residents until 2012. Each program has one position per year.

Unlike some cardiothoracic training programs, San Antonio does not have separate cardiac and thoracic tracks, allowing residents substantial training in both fields, which Dr. Khandhar found key to well-rounded training. In the traditional 2-year training program at San Antonio, residents spend their time split between the VA Hospital and the University Hospital, with one month each year spent on the pediatric cardiac surgery service at Santa Rosa Children’s Hospital. While on the cardiothoracic surgery service at the University Hospital, the residents spend 4 months per year on the cardiac service and 4 months on the thoracic service; however, flexibility exists in being able to choose between cases on the different services to further individualize training. At the VA Hospital, residents cover both cardiac and thoracic cases, allowing continued exposure to both cardiac and thoracic fields. In the field of cardiac surgery, residents become proficient in coronary artery bypass surgery, valve replacement and repair, aortic surgery, endovascular techniques, aortic disease, as well as surgery for heart failure, such as assist device insertion and transplantation. Within the realm of thoracic surgery, residents become proficient in lobectomy, esophagectomy, chest wall resection and reconstruction, as well as minimally invasive procedures such as VATS lobectomy.

In the newly instituted 6-year integrated Cardiothoracic Surgery Residency Program at San Antonio, residents matching immediately after medical school receive focused cardiothoracic surgery training through a multi-disciplinary, competency-based approach. In the first 2 years of the program, residents receive introductory training including general surgery, anesthesia, cardiology, pulmonary medicine, surgical critical care, transplant/organ procurement, echo/CT imaging, vascular surgery, and catheterization lab rotations. Throughout this period residents attend cardiothoracic surgery conferences, continue to interact with the cardiothoracic surgery faculty and residents, and receive cardiothoracic simulation training, including training in anastomotic techniques. Residents also have a research elective as a part of their ongoing research component to the program. During years 3 and 4, residents receive more cardiothoracic surgery-directed training including adult cardiac and thoracic, pediatric surgery, radiology, and catheterization lab rotations. The final 2 years of the integrated program are similar to that of the traditional program with rotations as a senior level cardiothoracic surgery resident on the cardiac and thoracic services. This curriculum also allows for substantial personalization based on the resident’s particular interests. In Dr. Calhoon’s view, the success of this new integrated program depends on the strong commitment of faculty to train cardiothoracic surgeons out of medical school. Continued curriculum development, led by Dr. Edward Sako, and simulation training, led by Dr. A.J. Carpenter, are key components. The faculty continues to develop metrics for evaluating proficiency in didactic understanding, technical skill, and personal professionalism and maturity that will be necessary for residents graduating from this new program to be successful.

Residents are encouraged to pursue research during their training, and a longitudinal research component has been incorporated into the integrated program. Residents in both traditional and integrated programs attend one major cardiothoracic surgery conference per year, with residents attending additional conferences for which they have accepted abstracts.

In terms of applicants, the Cardiothoracic Surgery Residency Program at San Antonio seeks people with a keen interest in cardiothoracic surgery, “didactic prowess,” as well as a strong character, professional demeanor, and maturity. While the majority of residents graduating from San Antonio’s program have gone into private practice, a number of residents have successfully pursued academic careers. A number of graduates also pursue additional training, such as in minimally invasive lung surgery.

In conclusion, the Cardiothoracic Surgery Residency Program at San Antonio can be summarized by education and commitment. The program continues to seek ways to refine the educational experience it gives its residents as the field of cardiothoracic surgery continues to evolve, with the advent of the 6-year integrated curriculum being a major milestone for this program’s evolution.

Acknowledgements

Special thanks to Dr. John H. Calhoon and Dr. Sandeep Khandhar for their contributions to this article, as well as the assistance of Irma Garcia.

Additional Resources

Program links:
6-year integrated program: http://www.surgery.uthscsa.edu/education/residencies/thoracic.asp
Traditional 2-year program: http://surgery.uthscsa.edu/education/fellowships/ct/index.asp

Program contact information