Index Case Requirements-2012

Index Case Requirements
Effective July 1, 2012 to June 30, 2017

The Index Case Requirements for residents who start their thoracic surgery training between July 1, 2012 and June 30, 2017 are listed below. This affects the following residents:

Residents in 2-year traditional programs starting between July 1, 2012 and June 30, 2017
Residents in 3-year traditional programs starting between July 1, 2012 and June 30, 2017
Residents in 6-year integrated programs starting between July 1, 2012 and June 30, 2017
Residents in 4/3 joint training programs starting between July 1, 2012 and June 30, 2017

Cardiothoracic Focused Total Subtotal		Requirements	General Thoracic Focused Subtotal Total
		CONGENITAL HEART DISEASE
10		Primary surgeon
10		First assistant		10
20		Subtotal Congenital Heart Disease		10

		ADULT CARDIAC

50		Acquired Valvular Heart Disease Any combination of mitral valve, aortic valve, and/or tricuspid valve replacement or repair. **Tricuspid valve procedures performed with CABG can be double-counted with CABG		25

80		Myocardial Revascularization		40

	15	Re-Do Sternotomy Can be double-counted with any cardiac procedure	5

20		Interventional Skills or Procedures Any combination of intra-aortic balloon pump (IABP), intravascular ultrasound, angiography, transvenous pacemaker insertion, image-guided intervention over a wire, percutaneous tracheostomy, tracheal/esophageal stent placement, PleurX® catheter (or similar pleural drainage catheter) insertion, ultrasound-guided pigtail catheter placement for pleura drainage, radiofrequency ablation, and TEVAR.		20

10		Conduit Dissection and Preparation Open or Endoscopic Saphenous/Radial Vein harvest and preparation **Can be double-counted with CABG		5

10		Aortic Procedures Any combination of Ascending Aorta/Aortic Root Replacement, Descending Aortic Replacement, TEVAR, Aortic Dissection, Aortic Trauma **TEVAR can be double-counted as an aortic procedure and interventional skills		5

5		Arrhythmia Surgery Left atrial or biatrial maze, plumonary vein isolation, right-sided maze, isthmus ablation Can be double-counted with CABG/valve procedures		0

4		Cardiopulmonary Bypass set-up and pump run with Perfusionist		4

10		Circulatory Assist/Cardiac Transplant Any combination of IABP, ECMO, VAD, Cardiac Transplant Can be double-counted with another operation		5

189		Subtotal Adult Cardiac Experience		104

		GENERAL THORACIC

60		Lung		100
	30	Major Anatomic Resections: (Segmentectomy, Lobectomy, Pneumonectomy, Lung Transplantation) Only 1 Pneumonectomy can be counted along with Bilateral Lung Transplant.	50
	5	Major VATS/robotic anatomic resections	10
	25	Open or VATS Lung Biopsy/Wedge Resection, lung procurement for transplantation	40

10		Pleura		20
		Major (Decortication, Pleurectomy Decortication, Extrapleural Pneumonectomy (EPP), or other tumor resection)	5
		Minor (Biopsy, Pleurectomy, VATS Sympathectomy, VATS Bleb Resection, VATS Pleurodesis) ** EPP can be double-counted as Pleura and Lung procedures	15

3		Chest Wall and Diaphragm Chest Wall Resection, Pectus Repair, Diaphragm Resection or Plication, Repair of Morgagni, Bochdalek, Traumatic Hernia Can be double-counted with Pulmonary Resection		6

5		Mediastinum Tumor/Cyst/Mass Resection via Open, VATS, or Robotic Technique		10

0		Tracheobronchial – Airway Surgery Tracheal-bronchial Resection/Reconstruction, Laryngotracheal Resection/Reconstruction, Airway Anastomosis Sleeve Lobectomy and Carinal Pneumonectomy can be double-counted with Major Anatomic Lung Resection **Lung transplantation can be counted as either Tracheobronchial or Lung		5

15		Esophagus		30
	10	Esophagectomy (Open or Minimally Invasive)	20
	5	Benign Esophagus-Major Repair of Perforation, Drain Perforation, Diverticulectomy, Myotomy, Hiatial Hernia Repair For the GT Focused Pathway, at least 5 of the 30 esophageal procedures must be performed minimally invasively.	10

93		Subtotal General Thoracic Experience		171

302		TOTAL MAJOR OPERATIVE EXPERIENCE		285

		MINOR PROCEDURES All may be double-counted

30		Bronchoscopy		40
		Simple (BAL, Diagnostic, TBBx, Bx)	30
		Complex (Laser, Dilation, Stent, Navigational Bronchoscopy, Photodynamic Therapy)	10

10		UGI Endoscopy		25
		Simple (Diagnostic, Bx)	20
		Complex (Dilation, Stent, EUS, EMR)	5

20		Mediastinal Assessment		30
	10	Mediastinoscopy	15
		EBUS/FNA	10
	5	Chamberlain or Mediastinal Node Dissection	5

60		Subtotal Minor Procedures		95
362		TOTAL OPERATIVE EXPERIENCE		380

		ADDITIONAL REQUIREMENTS

100		Consultation Experience		100
	50	New Patients	50
	50	Follow-up Patients	50

20		Multidisciplinary Patient Management Conferences Any combination of Tumor Board, Cardiac Catheterization Conference, Multidisciplinary Clinics, Transplant Selection Committee Meetings, etc.		20

75		Cardiothoracic Critical Care Case Management experience (Provide log sheet for each case with at least one case from each of the seven categories. See details below)		75
	20	General Thoracic	20
	20	Cardiac and Congenital	20
	35	Any additional Cardiothoracic Critical Care case	35

20 hrs		Simulation (Hours required from any technique-based simulation curriculum or simulation of Cardiopulmonary Bypass Management)		20 hrs
X		Previous or current FLS, ATLS, ACLS certification required		X

CT Critical Care Management Documentation

Select the patients who best represent all the essential aspects of intensive care unit management. Each resident is to develop a CT Critical Care Index Case (CCIC) log of at least twenty patients who best represent the full breadth of critical care management. At least two out of the seven categories listed below should be applicable to each chosen patient. The completed CCIC log should include experience, with at least one patient, in all seven of the following essential categories:

1. Ventilatory Management

a. Etiology/indications

b. Ventilatory modes/techniques

c. Ventilator days

d. Weaning method

2. Bleeding (non-trauma) greater than 3 units necessitating transfusion/monitoring in ICU setting

a. Etiology

b. Coagulopathy: yes no

c. Hypothermia: yes no

d. Autotransfusion: yes no

3. Hemodynamic Instability

a. Etiology

b. Volume resuscitation

c. Inotropic/pressure support: yes no

d. Mechanical assistance of cardiac failure: (IABP, LVAD, BiVAD)

4. Organ Dysfunction/Failure (etiology/mode of management)

a. Pulmonary

b. Renal

c. Hepatic

d. Central nervous system

e. Endocrine (Hypothyroidism, Adrenal insufficiency, Panhypopituitarism, Diabetes insipidus, SIADH)

5. Dysrhythmias

a. Etiology

b. Drug management

c. Therapeutic interventions

d. Monitoring

6. Invasive Line Management/Monitoring

a. Arterial cannulation

b. Pulmonary artery catheter

c. Intracardiac catheter

d. Complications

7. Nutrition

a. Route (parenteral/enteral)

b. Indications/contraindications