Tips to Excel on a CT Surgery Sub-I
Written by Jenna Aziz, MD (Howard University College of Medicine, Incoming Integrated Cardiothoracic Surgery Resident The Ohio State University)
Contributors: Lauren Bougioukas, MD (Larner College of Medicine at the University of Vermont, Incoming Integrated Thoracic Surgery Resident at North Shore University Hospital & Long Island Jewish Medical Center) and Matthew Brown, MD (Georgetown University School of Medicine, Incoming Integrated Cardiothoracic Resident University of Pennsylvania)
First of all, congratulations and welcome to the field of cardiothoracic surgery! It is an accomplishment to have the opportunity to rotate on a cardiac or thoracic service. This month will both advance your knowledge base as well as help determine if the institution you will rotate at could be your new home. If you are planning on asking for a letter of recommendation from this rotation, ask for a meeting with the program director EARLY on - take the initiative to go through expectations for the service and make known that you are hoping for a letter of recommendation.
Things to Ease Your Mind:
Oftentimes, the sheer idea of rotating on a new service, or, in a new location can seem daunting. Here are a few general tips for how to acclimate before beginning:
If possible, ask the program coordinator or one of the residents to give you a hospital tour. It is much easier to navigate the hospital when you know you can find the scrub machine, ICU, OR, and access to caffeine!
On a similar note, ask about workflow. As Matthew Brown states, when you learn how each day works “you can be proactive instead of asking ‘what should I be doing?’
Set expectations for the people in your life. Ensure that they know that the days might be long in the upcoming months but that you care- this sets the tone for both ends. It is so important that your support system will hold you up when you are feeling down.
I know we often feel overwhelmed because there is a lot to learn in cardiothoracic surgery! The team will be conscious of the level you are at (i.e. a fourth-year medical student), and show that you are teachable and can grow. This is what residency is all about!
Etiquette and Attitude
Throughout this month you will be auditioning for a potential job. It is ALWAYS important to treat every human on the team with dignity, kindness, and respect. No task is too big or too small - as Lauren states “try to be helpful not just with physicians but all staff.” Help prep the patients, ask to place the Foley, run to grab blood, and take initiative to do tasks that help the team. Soon you will find them helping you learn to close, place chest tubes, and seek you out as opportunities arise to gain skill and knowledge on the service. Each member of the team, from scrub nurse to resident to attending will be constantly vigilant of how you fit into the team dynamic - be a team player!
Matt also emphasizes the importance of being the first one everywhere. “Rounds at the ICU at 7am, be there at 6:50. If the patient is rolling back at 7:30, arrive before the assigned resident arrives.” Moments and actions like this demonstrate initiative.
When in a case, self-awareness is key because surgery ebbs and flows. He also shares, “when you're going to ask a question, make sure it is thoughtful and consider the timing of when to ask.”
Patient Care
We become physicians to serve our patients. Ensure you take time to pre-round, establish rapport and know the patient. Great patient care benefits our patients and will also make your day-to-day easier. As Lauren Bougioukas, who matched integrated cardiothoracic “know your patient and plan for treatment and common postoperative complications. Diligently read on cases the evening before, know the anatomy and steps for each surgery.” Similarly, follow up on post-operative care - learn when the chest tube should be pulled, the residents and ancillary team members on the CTICU often have handbooks and will often be willing to go through post-operative management with you!
Be sure to take initiative (but ask ahead) to go through their cases/imaging with residents either the night before or the morning of the case. Finally, If you have the flexibility to go to the clinic, use this as an opportunity to understand the preoperative workup or post-operative management of each patient.
Resources To Help with ALL of the Above:
Combination of recommendations from Me, Lauren Bougioukas, and Matthew Brown. Be sure to ask your institution if they have access to any resources!
To Improve Technical Skills:
The Modern Surgeon (https://beacons.ai/themodernsurgeon (FREE Access)
Cardiothoracic Surgery Simulation Box: https://mmcts.org/tutorial/1614 (Free Access)
Always Have Ties on Your ID! This is my fav - I always have 1-2 ties hanging from my ID and would practice throughout the day.
Cardiothoracic Surgery Resources:
Easily Digestible Resources:
TSRA Review of Cardiothoracic Surgery ($60) - Ebook OR Hard Copy
STS Cardiothoracic Surgery Ebook: This was a great resource - each chapter is easily digestible and I would keep it handy on my iPad and iPhone to quickly review in the downtime between cases. ($100-300, ask about institutional access)
CTSNet: a HUGE resource for operative videos!
Your team: As stated before, TAKE INITIATIVE: Do your reading and then ask a resident to go through the cases with you!
Cardiothoracic Surgery Textbooks - In-Depth:
‘Cardiac Surgery in the Adult’ Lawrence Cohn and David Adams
‘Thoracic Surgery: Cervical, Thoracic and Abdominal Approaches’ (Claudiu E. Nistor, Steven Tsui, et al)
For Perioperative Management:
Inquire about your institution’s CTICU handbook
‘Manual of Perioperative Care in Adult Cardiac Surgery,’ Robert Bojar ($22 to rent, $65 to buy, inquire about institutional access)
General ICU Care: ‘The ICU Book’ (appx $40 used - $90 new, ask about institutional access) or ‘The Little ICU Book,’’ ($35, ask about institutional access) Marino. Oftentimes these will be floating around the ICU or a kind resident will share their copy with you.
