If the trainee is following the ABTS cardiothoracic surgery pathway, the fellow will focus on advanced cardiac surgery (mechanical circulatory support and/or minimally invasive cardiac surgery) or congenital cardiac surgery. Understand the principles of thoracic surgery including hemostasis, wound healing, wound complications, electrolyte and fluid replacement, surgical nutrition, and oncology. Clinical Skills: During the training program the fellow: participates in or performs the operative repair of ventricular septal defects; participates in or performs the repair of more complex cardiac anomalies; performs the preoperative evaluation of patients with each of these anomalies. A recently developed virtual tour showcases locations across Penn State Health and Penn State College of Medicine in Hershey, Pa. A new guide to the Hershey, Pa., area showcases the highlights of life in central Pennsylvania. Demonstrate the ability to be honest, reliable, and respectful of the religious, racial, and gender characteristics of pediatric patients, their families, and other members of the health care team. Understand the importance of and mechanisms to safely utilize resources in a cost-effective manner to benefit all patients. As primary surgeon, the fellow should perform flexible and rigid bronchoscopy, with understanding of bronchial segmental anatomy.
(5) Interpersonal and communication skills, (7) Practice-based learning and improvement, Method of assessment of fellow performance. A thoracic surgery fellow is seen in surgery in February 2016.
Trainees can expect to perform at least 350 operations as primary surgeon.
Understand the importance of, and mechanisms to, safely utilize resources in a cost-effective manner to benefit all patients.
Arrive at an acceptable plan of management for the disease process, including differential diagnosis. Clinical Skills: During the training program the fellow: reads and interprets mediastinal plain radiographs, CT scans and contrast studies. Ancillary staff members, including a cadre of nurse practitioners and physician assistants, assist with health care service. Clinical Skills: During the training program the fellow: performs diagnostic tests and operations on the mediastinum; recognizes the histologic appearance of mediastinal tumors; diagnoses and manages mediastinal infection. Understand the pharmacology, indications, and complications of drugs commonly used in the specialty, including anti-arrhythmics, diuretics, anticoagulants, vasopressors and inotropes. Learner Objectives: Understands the indications, techniques, and complications of rigid and flexible bronchoscopy of the larynx and tracheobronchial tree. space problem, persistent air leak, bronchopleural fistula, empyema, cardiac arrhythmia). Clinical Skills: During the training program the fellow: evaluates and manages patients with tracheobronchial trauma; manages the airway of patients with tracheobronchial injuries; performs nonoperative management of pulmonary contusion; performs emergency operations to repair peripheral pulmonary and hilar injuries; uses precautions to avoid air embolism in patients with penetrating and blunt injuries. Learn the physiology of extracorporeal bypass, techniques for extracorporeal bypass, and indications for mechanical circulatory support.
Learner Objectives: Understands the clinical presentations, types, diagnosis and treatment of esophageal atresia and congenital tracheoesophageal fistula; understands the clinical presentation and diagnosis of esophageal duplication cysts. Describe the general principles of preoperative assessment and postoperative management of thoracic surgical patients. Learner Objectives: Knows arterial and venous cannulation techniques for different intracardiac defects; knows the indications for the various techniques of bypass; understands the techniques of myocardial protection in the neonate and young infant; understands the use of varying levels of hemodilution and anticoagulation; understands perfusion flow and pressure control; knows the methods of body temperature manipulation, and the indications for, and techniques of, profound hypothermia with and without total circulatory arrest. Learner Objectives: Understands the arterial, venous, and bronchial anatomy of the lungs and their interrelationships; understands the lymphatic anatomy of the lungs, the major lymphatic nodal stations, and lymphatic drainage routes of the lobes; knows the indications for various thoracic incisions, the surgical anatomy encountered, and the physiological impact; knows the indications for plain radiography, CT scan, MRI, and PET scanning for staging of lung cancer; Knows the indications, interpretation, and use of nuclear medicine perfusion scanning to determine the operability of candidates for pulmonary resection; understands the methods of invasive staging (e.g.
Finally, it is expected that the fellow will be able to perform most adult cardiac surgery cases as the operative surgeon with graded responsibility in the operating room as the year progresses. Fellows will learn how to recognize and care for critically ill children. Within the limits of variability found in a clinical practice, an equivalent experience will be afforded each fellow, under the guidance and supervision of qualified teaching staff. In this setting, they will be intimately involved in the pre-operative and post-operative evaluation of patients. Clinical Skills: During the training program the fellow: performs cannulation for extracorporeal bypass using appropriate access routes; uses left and right heart bypass. Learner Objectives: Understands the natural history, evaluation and treatment of coronary anomalies, congenital complete heart block, hypoplastic left heart syndrome, pulmonary atresia (with and without VSD), corrected transposition, single ventricle, cor triatriatum and cardiac tumors. D. Congenital and Acquired Abnormalities of the Pericardium. Penn State is an equal opportunity, affirmative action employer, and is committed to providing employment opportunities to all qualified applicants without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Manage the patient throughout as much of the hospital stay as possible, demonstrating knowledge and ability to recognize potential complications of the disease process and operative procedures. Provide an excellent clinical education and graduated clinical advancement accomplished by directed expert clinical, academic, and social instruction promoting self-directed education, and fostering the refinement of the individual fellows clinical, professional, social and academic pursuits. Clinical Skills: During the training program the fellow: performs a variety of surgical incisions to expose components of the chest wall and internal thoracic organs; performs surgical resections of primary and secondary chest wall tumors; identifies the need for major flaps of the chest wall.
The core curriculum continues to follow the Thoracic Surgery Curriculum established by the Thoracic Surgery Directors Association, covering thoracic, pediatric and adult cardiac surgery. Learner Objectives: Understands the types of cardiac tumors and their frequency, anatomic location, physiologic and pathologic derangements, diagnostic methods and surgical management; understands myocarditis and its causes, physiologic changes, treatment, prognosis, and radiographic, EKG and echocardiographic changes; understands hypertrophic cardiomyopathy (HMC) and its genetic linkage, pathologic and anatomic changes, physiologic derangements, clinical features, diagnostic tests, natural history, medical and surgical treatment; knows the types of cardiomyopathies and their causes, natural history, diagnostic methods, operative and nonoperative treatment; understands cardiac transplantation and related immunology/rejection and treatment, physiology, indications, operative techniques, diagnostic techniques in follow-up. Understand the professional, legal, and ethical codes to which physicians are bound. Evaluation by all faculty, as well as ICU staff, nurses, PAs, NPs (360-degree), using New Innovations every six months. Clinical Skills: During the training program the fellow: uses an understanding of abnormal physiologic findings to diagnose pericardial pathology; performs diagnostic tests and therapeutic interventions for the treatment of pericardial tamponade, pericardial effusions, and constrictive pericardial disease; evaluates and manages patients with pericardial cysts or tumors. Critically appraise sources of medical information and be aware available of resources.
In addition, the institution does not tolerate discrimination, biases, microaggression, harassment or learner mistreatment of any kind, and any concerns are immediately addressed by the Office for a Respectful Learning Environment. Understand the professional, legal, and ethical codes to which physicians are bound, particularly when caring for children. Communicate effectively with allied health care professionals. Clinical Skills: During the training program the fellow: interprets esophageal contrast studies, CT scans, manometry, pH studies and EUS; performs esophagoscopy, foreign body removal and biopsy; uses various operative approaches to different parts of the esophagus; performs anti-reflux operations including management of strictures; performs resection and reconstruction using various esophageal substitutes; evaluates and manages patients with esophageal motility disorders, performs myotomy and resection of diverticula; manages the complications of esophageal operations; uses laparoscopy and VATS for esophageal diseases where appropriate; diagnoses, manages and performs operations for esophageal perforation, chemical burns and trauma. Learn more about the Office for Culturally Responsive Health Care Education, Office for a Respectful Learning Environment. Establish and effective relationship with young patients and families. In light of COVID-19, Penn State Health will be conducting all interviews virtually for the 2022-2023 residency and fellowship application cycles.
The fellow will have major responsibilities for operative, intra-operative and post-operative patient care and clinical decision-making. P.O. Clinical Skills: During the training program the fellow: evaluates pleural effusions and recommends appropriate therapy; performs invasive diagnostic studies (e.g. Have the medical knowledge, operative skills, judgment, and leadership to perform common adult cardiac, pediatric cardiac and thoracic surgical procedures without supervision.
Demonstrate knowledge in the interpretation of laboratory investigations, CXR, ECG, angiography and echocardiography. Penn State Health is a multi-hospital health system serving patients and communities across 29 counties of Pennsylvania. There is a pediatric cardiac surgery outpatient clinic once weekly, and the junior fellow is expected to include this setting in the core of outpatient clinics, which are to be attended regularly. The chief fellow has primary responsibility for administrative duties, including operative case assignments. If the trainee is pursuing the American Board of Thoracic Surgery (ABTS) general thoracic pathway, the fellow will focus on thoracic surgery.
Skills to be acquired include those of medical knowledge, patient care, practice-based learning and improvement, communication and interpersonal skills, professionalism, and systems-based practice. The trainees are expected to communicate with the attending staff about operative planning, pre- and post-operative management, and all clinical care decisions for each case in which they participate. The pediatric cardiac surgery first year (three-month) rotation will serve as the exposure to congenital cardiothoracic surgery including pre-operative work-up and post-operative care. Demonstrate ability to direct daily fellow work rounds efficiently, including dictation of operative cases performed, daily progress notes, dictation of discharge summary, prescription writing. Learner Objectives: Is able to diagnose mediastinal cysts. Obtain graduated responsibility as first assistant, as well as surgeon when feasible, in the operating room for common congenital cardiac surgery cases including sternotomy, arterial and venous cannulation for bypass, ASD and VSD repair, and other congenital cardiac anomalies.
Office for Diversity, Equity and Inclusion. Learner Objectives: Understands the types of benign esophageal neoplasms, their clinical presentation, diagnosis, and treatment; understands the types of malignant esophageal neoplasms, their clinical presentation, diagnosis, histologic appearance and treatment; understands the AJCC staging of esophageal cancer; understands the principles of patient management after esophageal resection; understands the nutritional management of patients with esophageal neoplasms; understands the role of chemotherapy and radiotherapy in esophageal cancer; understands the operative approaches, methods and complications of esophageal resection and reconstruction; understands the indications for operative and nonoperative treatment of esophageal cancer. Columbia University Irving Medical Center. Learner Objectives: Understands diagnostic procedures used to evaluate non-neoplastic lung disease; Knows the common pathogens that produce lung infections, including their presentation and pathologic processes, and knows the treatment and indications for operative intervention; understands the natural history, presentation and treatment of chronic obstructive lung disease; understands the pathologic results and alterations of pulmonary function due to bronchospasm; understands the mechanisms by which foreign bodies reach the airways, how they cause pulmonary pathology, and the management of patients with airway foreign bodies; knows the indications for bullectomy, lung reduction, and pulmonary transplantation; Understands the principles of surgical resection for non-neoplastic lung disease; understands the causes, physiology, evaluation and management of hemoptysis. Exhibit appropriate personal and interpersonal professional behaviors. Prepare and present ward rounds in an organized manner. Organize staff conferences as well as departmental conferences as assigned.
Demonstrate ability to perform daily fellow work rounds efficiently, including dictation of operative cases performed, daily progress notes, dictation of discharge summary, prescription writing. The learning objectives of the first year include planning, implementation and mastering of the clinical skills that are listed in the Competency-Based Goals and Objectives. In keeping with this, Penn State Health has an active Office for Diversity, Equity and Inclusion with various programs, networks and resource groups, including: Learn more about the Penn State Health Office for Diversity, Equity and Inclusion, Learn more about the College of Medicines Office for Diversity, Equity and Belonging, Office for Culturally Responsive Health Care Education. Further, the fellows participate in the weekly multi-discipline thoracic case conference, which includes participation by a core group including thoracic oncologists and radiation oncologists, interventional pulmonologists, and thoracic radiologists. radial, brachial, femoral and pedal arteries); manages complications of central venous and arterial lines. Clinical Skills: During the training program the fellow: performs transvenous and epicardial lead and ICD/pacemaker/biventricular pacemaker insertion using single and dual chamber methodology. Learner Objectives: Understands the anatomy and blood supply of the trachea and bronchi; understands the endoscopic anatomy of the nasopharynx, hypopharynx, larynx, trachea, and major bronchi; understands and interprets pulmonary function studies of the trachea and bronchi; understands the radiologic assessment of the trachea and bronchi. Clinical Skills: During the training program the fellow: performs preoperative evaluation and preparation; manages postoperative care; participates in or performs the major palliative operations for these congenital cardiac anomalies. Attendings round daily with house staff on their own patients; intensivists in the cardiovascular intensive care unit round independently with the cardiothoracic surgery team, concurrently managing ICU patients. Clinical Skills: During the training program the fellow: uses knowledge of the normal anatomy and physiology of the diaphragm to treat primary or contiguous abnormalities; evaluates and interprets radiographic studies of the diaphragm, including fluoroscopy and CT scan. Learner Objectives: Evaluates patients with blunt or penetrating chest wall injury; understands the physiology and mechanics of operative drainage of the thoracic cavity; understands the operative and nonoperative management of chest wall injuries; Understands the pathophysiology of flail chest. Box 850, MC H159 It is the chief fellows responsibility to conduct daily pre-operative and post-operative rounds for the purpose of both providing patient care and for education of the house staff. Fellows participate in the performance of transplant and circulatory assistance procedures, as well as donor organ procurements. The emphasis in the second year is placed on completing index cases to meet the operative numbers entirely from one pathway. Understand common postoperative care issues in the thoracic surgery patient, including pain management, exercise expectations/limitations, need for home oxygen, indications for a skilled nursing/rehabilitation facility. Develop academically and professionally.
Learner Objectives: Understands clinical presentation and radiologic findings of tracheobronchial injury; understands the principles of airway management; understands the bronchoscopic findings of tracheobronchial and pulmonary injury; understands the injuries associated with tracheobronchial and pulmonary injury. If the trainee is pursuing the American Board of Thoracic Surgery (ABTS) general thoracic pathway, the fellow will focus on thoracic surgery. There are two adult clinical teams, cardiac and thoracic. The goals of the training program are fostered within an environment of progressively graded clinical and operative experience and responsibility. Know the anatomy and embryology of the normal heart and of major cardiac anomalies. Prove the ability to give and receive advice in a manner that is consistent with the harmonious operation of a health care team. Clinical Skills: During the training program the fellow: performs rigid and flexible bronchoscopy for diagnosis and endobronchial resection; uses ablative techniques in the management of endoluminal tumors; Uses stents, tracheal T-tubes, and tracheostomy tubes in the management of tracheal neoplasms; uses adjunctive therapy for the management of tracheal tumors.
Clinical Skills: During the training program the fellow: evaluates and participates in the pre-operative and post-operative management of patients requiring mechanical support; manages the complications from the use of mechanical support and ECMO; manages the anticoagulation of patients on mechanical support and ECMO; uses appropriate mechanical cardiac support and ECMO; weans patients from mechanical support and ECMO; manages patients bridging to transplantation. Therefore, if the fellow has chosen the general thoracic pathway, they will complete the index adult cardiac cases for that pathway and then focus on increasing general thoracic cases to meet required operative experience (eighth-block elective).
Manage pneumonia, hypoxia, pain, cardiac arrhythmias, and common postoperative conditions (atrial fibrillation/flutter, ventricular tachycardia/fibrillation, sinus bradycardia/tachycardia, wound infections, low urine output, and post-operative bleeding). The final assessment of whether these objectives are being achieved is made by the program director as recommended by the faculty of the Division of Thoracic Surgery. B. Myocarditis, Cardiomyopathy, Hypertrophic Obstructive Cardiomyopathy and Cardiac Tumors. The divisions of thoracic surgery, cardiac surgery and pediatric cardiac surgery run three busy services: one that covers the gamut of adult cardiac surgery, one that focuses on thoracic surgery procedures, and one that offers broad exposure to congenital cardiac surgery. There are outpatient congenital cardiac and thoracic surgical clinics weekly. Learn the general principles of pre-operative assessment and post-operative management of pediatric cardiac surgical patients. Serve as primary surgeon, performing sternotomy, cannulation for bypass and conduit procurement. Finally, this rotation will teach surgical and endoscopic techniques. Clinical Skills: During the training program, the fellow: reads and interprets plain radiographs, CT scans and contrast studies of congenital abnormalities of the mediastinum; diagnoses and manages patients with congenital abnormalities of the mediastinum. Clinical Skills: During the training program the fellow: manages ventilators for infants and children with and without obligatory intracardiac shunts; assesses the cardiac output and pulmonary and systemic resistance in infants and children; uses physiologic and pharmacologic manipulation of preload, myocardial contractility, heart rate and afterload to optimize cardiac output in critically ill infants and children; evaluates the metabolic reserve of neonates and infants and provides prompt therapeutic intervention as indicated; anticipates problems and complications of post-operative pediatric patients and provides appropriate treatment.
Deliver highest quality care with ethics, integrity, honesty and compassion. See details here: Wellness, including emotional, spiritual, social and physical health, is a crucial component to training and to becoming a professional, compassionate and resilient physician. The fellows are exposed to congenital cardiac surgery during the first year. Learner Objectives: Understands the physiology of coronary circulation and the physiologic derangements caused by stenosis and obstruction; understands the risks and complications of coronary artery bypass operations, coronary angiography and percutaneous coronary artery interventions; understands the pre-operative and post-operative care of patients undergoing coronary artery bypass grafting; understands the rationale for and techniques of coronary artery bypass operations as well as the use of various conduits. Responsibilities include familiarity with peri-operative management of patients undergoing cardiac transplant, as well as techniques of mechanical circulatory support, including the total artificial heart, extracorporeal membrane oxygenation (ECMO) and a cadre of ventricular assist devices (VADs). The senior fellow (chief fellow) is assigned to attend the outpatient adult cardiac surgery clinics (blocks 4 to 7). Fellows are expected to follow patients post-operatively and to work in concert with the attending Pediatric Cardiac Surgeons, the Pediatric Cardiology Service, and the Pediatric Cardiac Intensivists. Clinical Skills: During the training program the fellow: evaluates patients for tube thoracostomy; performs tube thoracostomy under local, regional and general anesthesia; treats the complications of tube thoracostomy. Learner Objectives: Understands the anatomy of congenital diaphragmatic hernias; understands the physiologic consequences of diaphragmatic hernias; knows the indications for operative repair of diaphragmatic hernias.
decortication, rib resection, Eloesser flap, Claggett procedure, closure of bronchopleural fistula). Understand common postoperative care issues in the adult cardiac surgery patient, including anticoagulation, cardiac rehabilitation, and indications for skilled nursing/rehabilitation facility. Manage hemodynamics, inotropic support, cardiac arrhythmias, and common postoperative conditions (atrial fibrillation/flutter, ventricular tachycardia/fibrillation, sinus bradycardia/tachycardia, wound infections, low urine output, and post-operative bleeding).
Clinical Skills: During the training program the fellow: interprets esophageal plain radiographs, contrast studies, CT scans, and EUS; requests and interprets manometric and pH studies of the esophagus; performs rigid and flexible endoscopy of the pharynx and esophagus. The award, given monthly by the Office for a Respectful Learning Environment, accepts nominations from College of Medicine students who are invited to submit narratives about faculty members, residents, fellows, nurses or any other educators who challenge them and provide an exceptional learning experience. Learner Objectives: Understands normal fetal circulation; understands the transitional nature of circulation as the fetus becomes a neonate; understands the physiology of obstructions, of intracardiac and extracardiac shunts, of abnormal connections to the heart, and of combinations of these anomalies in the fetus, neonate and child. Learn the natural history of treated and untreated diseases of the specialty, including benign and malignant tumors, pulmonary infectious disease, emphysema/COPD, interstitial lung disease, benign and malignant esophageal disease, esophageal dysmotility disorders, and Barretts esophagus. Clinical Skills: During the training program the fellow: evaluates and treats chest wall injuries; performs emergency operations to repair chest wall injuries and provides postoperative management. Fellows are assigned to these outpatient venues with documentation of this experience. Administrative responsibilities include coordination of the junior thoracic surgery fellow, general surgery residents, medical students, nurse practitioners, and physician assistants that comprise the services, including assignment of daily responsibilities and coordination of the call schedule. Clinical Skills: During the training program the fellow: evaluates, diagnoses, and selects management strategies for patients with valvular heart disease, including participation in and interpretation of cardiac catheterizations and echocardiograms; makes use of the therapeutic options and relative risks of operative and non-operative treatment for valvular heart disease in planning interventions; manages pre-operative clinical preparation and early and intermediate post-operative care; performs valve repair and replacement for valvular disease, interprets intraoperative echo. Clinical Skills: During the training program the fellow: performs arterial and venous cannulation and initiates cardiopulmonary bypass; directs the perfusionist in the intraoperative management and conduct of cardiopulmonary bypass; performs or participates in the repair of congenital heart defects using cardiopulmonary bypass. Participate actively in scheduled morbidity and mortality conferences. Additionally, a core curriculum follows the Thoracic Surgery Curriculum established by the Thoracic Surgery Directors Association, covering thoracic, pediatric and adult cardiac surgery annually. Learner Objectives: Understands the standard techniques for extracorporeal bypass; understands the techniques of cannulation for extracorporeal bypass; oversees the management of patients undergoing extracorporeal bypass.
Learner Objectives: Knows the embryology and anatomy of the normal heart; knows the embryology and anatomy of major cardiac anomalies. Learner Objective: Understands the anatomy and physiology of obstructive anomalies of the left and right sides of the heart and aorta, their diagnosis, management and postoperative care, and performs the operative and non-operative treatment; knows the anatomy and physiology of each anomaly; knows the methods of diagnosis; understands the role of medical management and interventional cardiology; understands the principles of postoperative care; knows the technical components of operative repair; knows the expected outcome, long-term results and complications. Learner Objectives: Understands the indications, contraindications, management and complications of central venous lines and arterial lines. Contribute to planning for patient follow-up. See more about the award here. Service obligations are minimized but not eliminated. bronchoscopy, mediastinoscopy, mediastinotomy, EBUS and VATS); performs bedside bronchoscopy and placement of tracheostomies (open or percutaneous); performs operations to extirpate lung cancer (e.g. Clinical Skills: During the training program the fellow: evaluates and manages patients requiring esophagoscopy; performs rigid and flexible esophagoscopy using various anesthetic techniques; uses ablative techniques via esophagoscopy; understands the use of stents via esophagoscopy. Learner Objectives: Understands the indications for cardiac support with mechanical devices or ECMO; Understands alternatives to mechanical support (e.g., intra-aortic and intrapulmonary balloon pumping); understands the principles of weaning patients from these devices; understands federal regulations that apply to the use of these devices. The shared goal of Highmark and Penn State Health is to ensure patients in the community are within: Penn State Health Childrens Hospital (left), Penn State Health Milton S. Hershey Medical Center (center) and Penn State Cancer Institute (right), 500 University Dr., Hershey, Pa., 17033 (Derry Township, Dauphin County), Learn more about Milton S. Hershey Medical Center, 600 University Dr., Hershey, Pa. 17033 (Derry Township, Dauphin County), Learn more about Penn State Health Childrens Hospital. The general thoracic surgery first-year experience will serve as the introduction to general thoracic surgery, including pre-operative workup and post-operative care.