Vanderbilt Cardiothoracic Surgery, Nashville, Tennessee

Vanderbilt’s Department of Thoracic Surgery, founded in 1955, has established a long and storied tradition from Alfred Blalock to Senator Bill Frist. Since 2004, Dr. Joe B. Putnam as both Chair and Program Director has built on this tradition to train and prepare cardiothoracic fellows for the future of CT surgery.

Set in an upscale part of Nashville, a city of 600,000, Vanderbilt Medical Center is the only major medical center in a hundred-mile radius. Thus, according to Dr. Putnam, the fellows are exposed to “a broad spectrum of disease in all disciplines, from simple to complex.” The program strongly believes in the 3-year training model as it allows the full maturing of the fellow’s surgical and clinical skills. The 3 years allow for experience in specialty-aligned services where the fellow develops skills that will be increasingly important to the practice of CT surgery. An evolution to include a 6-year integrated program, in addition, is planned.

The first year includes the conventional 6 months of thoracic surgery and 6 months of cardiac surgery. During the second year, 2 months are spent in the catheterization lab, where fellows may do up to 100 different procedures including the deploying of coronary and aortic stents. Another month is spent in an outpatient Echo lab to hone TTE and TEE skills. In addition, the 2^nd year includes other experiences through the pulmonary function, esophageal function, and extracorporeal bypass “school.” The experience on these specialty-aligned services provides a deeper and richer understanding of commonly-ordered tests. Also, the catheter-based skill-set gained here, according to Dr. Putnam, will be vital to the future of CT surgery. A clinical outcomes project, chosen by the fellow, is completed annually. The bulk of the 2^nd year is still spent on CT surgical services with 6 months of mixed Cardiac and Thoracic surgery at the VA Hospital and 3 months of pediatric Cardiac Surgery

The third year allows for an emphasis on both major and minor emphasis. Nine months on either cardiac or thoracic constitutes the major emphasis, and 3 months on the other service completes the minor emphasis. This choice is made based on the fellow’s vision of future career direction.

By the end of training at Vanderbilt, the fellows will have completed sufficient cases to comply with both cardiac and thoracic tracks (regardless of emphasis). The thoracic experience includes lung volume reduction surgery, esophagectomies (fellows often graduate with more than 30 cases), and the complex re-do surgery inherent to a large quaternary care center. Approximately, 25 heart transplants are performed along with 15-20 lung transplants each year. The pediatric cardiac surgery experience includes the full breadth of pediatric operations. The VADs experience at Vanderbilt is limited with only 2-3 cases per year.

Once graduated from the program, over 90% of fellows choose to practice in an academic setting. Around three-quarters focus on cardiac surgery, and a quarter, on thoracic. A few recent fellows have elected to do further fellowship training. Most fellows pass both written and oral boards on the first attempt.

Recent developments in the program involve the development of a surgical simulation lab, spearheaded by Dr. Jon Nesbitt. At present, the simulations are geared toward first-year fellows. Perfused beating heart models of pig tissues within a mannequin chest are utilized for practice of cannulation, coronary anastomoses, off-pump bypass, and valve replacement. During the 1^st year, time is dedicated to ensure the fellow has adequate experience in the lab to perform 200-300 simulated coronary anastomoses.

Another development is the recent approval by the ACGME of two fellows per year for a total of six fellows in the program. This will go into effect for the 2010-2011 academic year.

Dr. Putnam describes that his goal as program director is to provide “a unique, robust, engaging, and nurturing environment” in which fellows can tailor their own experience within the bounds of the program. He describes faculty as very collegial with a dedicated focus on the fellows’ education and maturation as a surgeon. The mutual respect and teamwork between fellows and attendings is reflected by a program design that has derived equally from fellow and attending ideals.

Finally, Nashville as a city, like Vanderbilt itself, is very family-friendly. It has a Southern charm with a cosmopolitan feel. Mild weather and great attraction make it a popular place to live and visit in the South.

Acknowledgments

Special thanks to Dr. Joe B. Putnam (Program Director and Chairman of the Department of Thoracic Surgery) and Wendy Wilson (Program Coordinator) for their contributions to this article.

Additional Resources

http://www.mc.vanderbilt.edu/root/vumc.php?site=thoracic

http://www.mc.vanderbilt.edu/root/vumc.php?site=reseduthoracic

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