Brigham and Women’s Hospital/Children’s Hospital Medical Center

Led by Dr. Raphael Bueno (Program Director and Associate Division Chief of Thoracic Surgery), Dr. R. Morton Bolman, III (Chief of Cardiac Surgery), Dr. Pedro Del Nido (Chair of Cardiac Surgery at Children’s Hospital), and Dr. David J. Sugarbaker (Chief of Thoracic Surgery), the Thoracic residency program at Brigham and Women’s Hospital (BWH)/Children’s Hospital Medical Center (CHMC) is distinguished by a large volume and diversity of cases in all three of its divisions (adult cardiac, pediatric cardiac and general thoracic surgery).  The program is resident-centered, emphasizing a thorough education in academic cardiothoracic surgery, as well as surgical innovation.  This 2-year ACGME-approved program offers 2 tracks, cardiac and general thoracic, each of which has 2 positions per year.  In July 2008, BWH/CHMC instituted a 4+3 training program.  This program allows the trainee to obtain American Board of Surgery certification, as well as American Board of Thoracic Surgery certification, and allows an extra year of concentration in the field of thoracic surgery.

Residents are exposed to a diverse spectrum of diseases and operations, while obtaining considerable operative experience.  As one of the largest programs in the country, there are ~3,000 general thoracic surgery cases/year, ~1,500 adult cardiac cases/year, and ~2,000 pediatric cardiac cases/year.  In fact, graduating residents have average caseloads that are at least 90% greater than the minimum ACGME requirements. Residents are exposed to a variety of innovative surgical techniques.  BWH has a long history of minimally invasive surgery (>10 years) and many cases are performed using a minimally-invasive approach including laparoscopic esophageal surgery, minimally-invasive valve surgery, and endovascular techniques.  BWH also is involved in developing robotic surgical techniques.  Furthermore, BWH is one of the few institutions with a hybrid-trained cardiac surgeon on faculty (full catheterization laboratory as well as cardiothoracic surgery privileges).  Cardiac surgeons at BWH work closely with both vascular surgeons and cardiologists to further develop endovascular techniques.  Recently, BWH built 2 new operating suites designed for hybrid cardiac and vascular operations. 

Residents in the cardiac track split their first year between cardiac surgery and thoracic surgery at BWH.  The second year is split between congenital cardiac surgery at Children’s Hospital and adult cardiac surgery at BWH.  Thoracic track residents split their first year as chief resident on the white thoracic surgery service and then as a resident on adult cardiac surgery.  Their second year is split between adult cardiac surgery at BWH and congenital cardiac surgery at Children’s Hospital followed by serving as chief resident on the blue thoracic surgery service.  In addition to the standard cardiac and thoracic clinical rotations, each track offers a 2-month elective that provides the resident to further focus on specific areas.  In the cardiac track the elective is designed for training in the catheterization lab as well as in the use of transesophageal echocardiography.  In general thoracic surgery the focus is on motility, radiology and pathology.  The program also funds an optional year before or after the ACGME-accredited fellowship for further training.

As an academic training program, clinical research by residents is strongly encouraged.  Indeed, one of the strengths of the program is the large number of surgeons with thriving research labs who can act as role models for the residents.  Currently there are 3-4 RO1 grants in the thoracic surgery division, 2-3 RO1 grants in the pediatric cardiac surgery division, and 1 RO1 grant in the cardiac surgery division.  Substantial support for clinical research by residents is provided by a comprehensive clinical database, among other resources.  It is expected that each resident present at least once at a major conference during their training and publish at least one manuscript.  The program provides support for each resident to attend one major surgical conference per year, regardless of whether he or she is presenting an abstract.

In July 2008, BWH/CHMC instituted a 4+3 training program.  BWH general surgery residents can apply during their third year of training to enter this program.  If accepted, their fourth year of general surgery is modified to contain more cardiothoracic training and their chief year is divided between years four and five.  The remainder of their training is completed in cardiothoracic surgery as a part of the BWH/CHMC program.  Because of the altered structure of this curriculum, these residents have more time for training in fields closely related to cardiothoracic surgery, as well as electives.  However, only general surgery residents within BWH are eligible for application to this 4+3 program (see CTSNet Residents’ Section article “Integrated and Fast-Track Cardiothoracic Surgery Training Programs” for more information on 4+3 programs).         

The program’s teaching philosophy is one that prepares residents for the field of academic cardiothoracic surgery of the future.  As Dr. Bueno stated, “Our goal is to provide residents with the tools that they will need in situations that don’t yet exist.  It is important to teach procedures.  But it is more important to teach principles of disease and principles of patient care that they can then apply to whatever situation they encounter in the future.”

In terms of applicants, the program is looking for academically-minded residents interested in innovative surgical therapies who will be future leaders in cardiothoracic surgery, and display clinical excellence, an inquisitive mind, and focus. The program encourages diversity in its trainees, and indeed has a track record of training residents from all backgrounds.  Last year, the program received ~50-55 applicants for the 4 positions available and each year the program interviews 15-20 applicants.  Applicants should be aware that there is only one interview date each year, and that no other opportunities for interviewing will be provided.  Because the program accepted two cardiac 4+3 residents, there are no cardiac spots open for the 2009 match.

Although the program is academic in nature, a substantial number of the program’s graduates (roughly 50%) enter private practice.  Roughly 40% of graduates pursue additional fellowship training in fields such as thoracic aortic disease and congenital heart disease. 

In conclusion, the BWH/CHMC CT residency program provides quality training in academic surgery with a focus on resident education.  The large number of diverse cases, substantial operating experience, and exposure to innovation that residents receive in this program will prepare them well to be successful cardiothoracic surgeons.  Indeed, cardiothoracic surgery continues to be an exciting career path with a bright future.  As Dr. Bolman stated, “It’s an incredible privilege to do what we do.  The future will continue to be bright as long as we continue to attract motivated people with a strong work ethic looking for a challenging, yet rewarding career.”

Acknowledgements

Special thanks to Dr. Bueno and Dr. Bolman for their contributions to this article.

Additional Resources

Program link: http://www.brighamandwomens.org/Departments_and_Services/surgery/ medical_professionals/surged/Medical_Professionals/Cardiothoracic.aspx