General Thoracic Surgery

Sites: BWH
Director(s): Erik Alexander, Ciaran McNamee
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month.
Location: BWH - Brigham and Women's Hospital (23)
Open to Exclerks: Yes (may be restricted for international students)
Description: PGY-4 students can be sub-interns on one of the busiest Thoracic Surgery Services in the US. This service currently performs 3000 cases per year. Operations range from open extrapleural pneumonectomies to minimally invasive esophageal and lung resections, to airway and esophageal stents. Starting with responsibility for 2 patients, students are expected to increase their clinical load as comprehension and confidence increases. Participants will develop knowledge of clinical tests of cardiorespiratory reserve, and become comfortable with postoperative management of non-cardiac thoracic surgery patients. Working knowledge of basic measurements of cardiac and pulmonary function is required. Students will be supported by didactic conferences, including multi-disciplinary conferences with participation of radiology, pathology, medical oncology and thoracic surgery faculty. They will interact with a dynamic faculty of 18 Thoracic Surgery attendings: Raphael Bueno, Philip Camp, Daniel Cohen, Yolonda Colson, Marco DaSilva, Christopher Ducko, Michael Jaklitsch, Avi Lebenthal, Hari Mallidi, Ciaran McNamee, Steven Mentzer, Gita Mody, Scott Swanson, Hisashi Tsukada, Jon Wee, Brian Whang and Daniel Wiener. Students will have the opportunity to participate in an actively growing lung transplant program, with an average of 30 lung transplants per year. They will make clinical rounds on the Thoracic Surgical Service on a daily basis, and are expected to increase their knowledge and skill up to the capacity of an intern for their assigned patients. This is an operative rotation, and participation in the OR is an integral part of the experience. This includes teaching of basic surgical skills and encouragement of technical excellence. Students will become facile with bronchoscopy and endoscopy. This course is specifically designed to increase the confidence and skill of well prepared PGY-4 students as they move toward surgical internship. Close personal contact with a large Thoracic Surgery Faculty is a major benefit of this course.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Anatomy and cardiopulmonary physiology are essential components to the management of each patient. Intra-operative discussions are dominated by these topics. Pre-operative selection and post-operative care are based on knowledge of risks, benefits, and outcome variables. The Thoracic Surgery Faculty leading this course have been leaders in the application of outcomes research to general thoracic surgery problems.
Grade Criteria:
Honors with Distinction: Student is completely comfortable working at an intern level for 5 patients. He has an excellent performance rating from at least 8 faculty, with an "exceptional" score on the oral presentation. Exceptional score requires a short but accurate case presentation and critical review of at least 3 major papers. Honors: Student is comfortable working at an intern level for 4 patients, has an excellent performance rating from at least 5 faculty, and has an "excellent" score on the oral presentation. Excellent score requires a short but accurate case presentation and critical review of at least 1 major paper. Satisfactory: Student is comfortable working at an intern level for at least 2 patients, and has a "good" performance rating from the majority of the faculty. Oral presentation is still required. Unsatisfactory: Absent from clinical days, inability to improve dexterity skills, lack of advancement of medical knowledge, rudeness to patients or staff, "poor" performance in the oral presentation, and violations of ethical behavior will be graded as "unsatisfactory."