Program Director

Francis Robicsek, MD, PhD

Chairman, Department of Cardiothoracic and Cardiovascular Surgery; Program Director, Cardiothoracic Surgery Residency; Medical Director, The Carolinas Heart & Vascular Institute (CHVI); Clinical Professor of Surgery, University of North Carolina Chapel Hill.

Due to the exceptional position of the Department of Cardiothoracic and Cardiovascular Surgery (DTCS) within a wide hospital affiliated network of the Carolinas Medical Center (CMC), the Carolinas Heart & Vascular Institute (CHVI), the Sanger Clinic, and the James H. Heineman Vascular Center, our cardiologists, as well as the cardiothoracic surgical faculty assure that both thoracic and cardiac patients are available for the teaching program. During the past four years, the number of cardiologists associated with the Carolinas Heart & Vascular Institute (CHVI) grew from 20 to 43. CMC now has four full-time pulmonologists on the faculty, and several additional pulmonologists. The institution also significantly enhanced and streamlined the trauma program and CMC is now a level III trauma center.

The faculty of the Carolinas Heart & Vascular Institute (CHVI) includes four full-time pediatric cardiologists who see an increasing amount of pediatric cardiac patients both at the CMC campus and at three additional referring offices. The cardiac volume of the DTCS showed a moderate increase in both adult cardiac and appears to be steady in the number of thoracic patients. There is a significant increase in the number of congenital heart patients.

Our residents participate in every aspect in pre-operative evaluations, beginning from the moment of admission until discharge and beyond. They are to obtain the history, perform the physical examination, order appropriate tests, and direct the patient's entire workup. During all of these activities, they are to remain under close contact and report to the attending faculty member assigned to that particular patient. The resident is also to formulate and present an operative plan, participate in the operation as surgeon, co-surgeon or first assistant. The resident is to direct the patient's management during the entire postoperative period. He participates in postoperative care of patients discharged at the Outpatient Clinic; again, under direct supervision of the faculty, which is to be physically present during every operative intervention as well as in every phase of the pre- and post-operative workup, review, and countersigns daily of all progress notes written by the resident.

The two-year training period is divided into cardiothoracic surgery, non-cardiac thoracic surgery, congenital cardiothoracic surgery, and adult thoracic surgery. The daily activity is by the surgical volume of that particular day; thus, during the "non-cardiac thoracic" segment, the resident is expected that about 75 percent of his activity will involve patients with pulmonary and esophageal disease, and 25 percent cardiac disease. During the pediatric cardiothoracic segment the situation is similar; about 75 percent of the activity involves children, and about 25 percent of the activity involves adult cardiac surgery. During the six months of adult cardiac surgery, the resident's activity encompasses 75 percent of adult cardiac surgery, and 25 percent of non-cardiac cardiothoracic surgery.

During the first year of training, the resident's responsibilities are that of a junior house officer and are under the scrutiny of the chief resident as well as the faculty. During the first month of his training, he serves usually as a second assistant in major procedures. His responsibilities gradually expand during the upcoming period, and within the first six months of his training, he is expected to be able to open and close thoracotomy incisions, first assist, and under the close supervision of the faculty, start performing simpler cardiothoracic procedures as a co-surgeon. During the second semester of his first year, depending on the resident's progress, he is allowed to obtain more responsibility in patient care as well as in the Operating Room. For that time, he should be able to perform uncomplicated cases of lung resection, proximal coronary anastomoses, etc. During the second (senior) year, the resident is allotted more freedom of judgment and action and more independent patient care. In the senior residency year, the resident is expected to perform as a surgeon or co-surgeon on virtually all procedures in cardiothoracic surgery with the degree of supervision of guidance depending upon his ability and progress shown.

During the second year of his training, for six months the resident is assigned as Chief Resident in charge of all assignments and surgical scheduling in close cooperation with the Program Director, and act as an independent operator in most cardiothoracic interventions. The residents have free access to the institutional as well as to the departmental library, and to computer facilities. They are encouraged but not obliged to participate in either clinical and/or experimental research. In the latter case, they are allotted time, funds and personnel to perform the same. They are to attend one or more national or international meetings per year or a course in thoracic and cardiacs surgery. They are invited to additional meetings if they present papers, or papers are presented in which the resident participated. Full attendance by the faculty is required to most teaching conferences.

The thoracic resident is not subordinate to house officers of other services. Residents from the Department of General Surgery are subordinated by the Chief Thoracic Resident while on rotation in the DTCS. In the operating room, the thoracic resident acts as either surgeon, co-surgeon, or first assistant. Second assistance is provided by PA's, whose activity also includes removal of saphenous veins for coronary bypass surgery. Exceptions to this rule are cases of exceptional teaching importance where more than one resident is involved in the operation. Residents also serve as second assistants during the initial month of their service.