Index Case Requirements
Effective July 1, 2022 

The Index Case Requirements for residents who start their thoracic surgery training on or after July 1, 2022 are listed below. This affects the following residents:

     Residents in 2-year traditional programs starting on or after July 1, 2022
     Residents in 3-year traditional programs starting on or after July 1, 2022
     Residents in 6-year integrated programs starting on or after July 1, 2022
     Residents in Joint Training programs starting on or after July 1, 2022

  

Requirements

Cardiothoracic

Pathway

General Thoracic

Pathway

Cardiac

Pathway

 

Total 

Subtotal 

Total 

Subtotal 

Total 

Subtotal 

CONGENITAL CARDIAC            
 

 

   



 

Congenital Heart Disease

20

  10


20

 

Primary surgeon


5

 

0

 

5

First assistant

 

15

10

 

15

Subtotal Congenital Heart Disease

20


10

 

20

 

 

 

 

 

 

 

 

ADULT CARDIAC

 

 

 

 

 

 

 

 

 

 

 

 

 

Acquired Valvular Heart Disease

60

 

30


90


Surgical Aortic Valve Repair/Replacement

 

25


15


25

Mitral Valve Repair/ Replacement

 

15


5


N/A

Mitral Valve Repair

 

N/A


N/A


10

Mitral Valve Replacement

 

N/A


N/A


5

Tricuspid Valve Repair/Replacement, Annuloplasty

 

5


5


5

TAVR as primary

 

5


0

 

20

TAVR as assistant

 

10


5


20

Transcatheter Mitral/Tricuspid Intervention

 

0


0


5

 

 

 

 

 

 

 

Myocardial Revascularization

80

 

35


80

 

Primary CABG

 

0

 

0

 

60

Complex CABG (Multiple Arterial, Hybrid, Beating Heart, Redo)

 

0

 

0

 

20

 

 

 

 

 

 

 

Re-Do Sternotomy1

15

 

5

 

15


 

 

 

 

 

 

 

Interventional Wire-based Diagnostic Procedures4

5

 

0


35


Left Heart Catheterization, PCI,TEVAR, and Mitral Clip

 

5


0

 

N/A 

Intravascular Ultrasound4

 

0


0


5

Heart Catheterization (coronary angiogram)

 

0

 

0

 

20

Transeptal puncture4

 

0

 

0

 

5

 Ultrasound guided access4

 

0

 

0

 

5

             

Conduit Dissection and Preparation2 

5

 

5


10


Radial Artery Harvest (open or endoscopic)

 

0

 

0

 

5

Saphenous Vein Open Harvest

 

0

 

 

 

5

 

 

 

 

 

 

 

Aortic Procedures3 

10

 

5


25


Any combination of Ascending Aorta/Aortic Root Replacement, Descending Aortic Replacement, Aortic Dissection, Aortic Trauma

 

10

 

5

 

0

TEVAR and EVAR

 

0

 

0

 

15

Aortic Root Replacement (including VSRR or Composite Valve Graft)

 

0

 

0

 

5

Replacement of Ascending Aorta, Arch, Descending Aorta; Surgery for Aortic Dissection

 

0

 

0

 

5

 

 

 

 

 

 

 

Arrhythmia Surgery3

10

 

0

 

15

 

Left Atrial or Biatrial Maze, Pulmonary Vein Isolation, Right-sided Maze, Isthmus Ablation 

 

5


0

 

10

Pacemaker Insertion or Pacemaker Removal

 

5


0

 

5

 

 

 

 

 

 

 

Cardiopulmonary Bypass set-up and pump run with Perfusionist

5

 

5


5


 

 

 

 

 

 

 

Circulatory Assist4

20

 

10


35


Intra-aortic Balloon Pump

 

10

 

5

 

5

Any combination of ECMO, VAD

 

10

 

5

 

N/A

Ventricular Assist Device Implant (Temporary Endovascular, Paracorporeal Ventricular Assist or implantable Durable Ventricular Support)

 

0

 

0

 

15

Extracorporeal membrane oxygenator support (VA or VV)

 

0

 

0

 

10

Thoracic Transplant (Any combination of heart or lung implant, heart or lung procurement)

 

0

 

0

 

5

 

 

 

 

 

 

 

Subtotal Adult Cardiac Experience

210

 

95


310


 

 

 

 

 

 

 

GENERAL THORACIC

 



 

 

 

 

 

 

 

 

 

 

 Lung

60


105


45


Any Major Anatomic Resection: Open, VATS, or RATS (Segmentectomy, Lobectomy, Pneumonectomy, Lung Transplantation5)

 

30


50


30

VATS/RATS Lobectomy specifically


5


25


0

Open or VATS Lung Biopsy/Wedge Resection


25


30


0

MIS Lobectomy, Biopsy, Wedge Resection

 

0

 

0

 

15

 

 

 

 

 

 

 

Pleura

10


25


10


Major (Empyema Decortication, Pleurectomy Decortication, other Pleural Tumor Resection)

 

0


5


0

Minor (Biopsy, Pleurectomy, VATS Sympathectomy, VATS Bleb Resection, VATS Pleurodesis, Evacuation of Hemothorax)

0


15


0

Interventional: In-dwelling Cuffed Pleural Catheter Insertion

 

0


5


0

 

 

 

 

 

 

 

Chest Wall and Diaphragm

5


10


3


Chest Wall Resection6, Rib Resection, Rib Plating, Pectus Repair, Diaphragm Resection or Plication, Repair of Morgagni, Bochdalek, Traumatic Hernia 

 

5

 

10

 

3

 

 

 

 

 

 

 

Mediastinum

5


10

 

0


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

 

5

 

10

 

0

 

 

 

 

 

 

 

Tracheobronchial – Airway Surgery7

0


5

 

0


Tracheal Resection, Laryngotracheal Resection, Sleeve Lobectomy, Carinal Pneumonectomy, Transplantation Airway Anastomosis

 

0

 

5

 

0

 

 

 

 

 

 

 

Esophagus

10


35


5


Esophagectomy (Open or MIE)


5


20


0

Benign Esophagus-Repair of Perforation, Drain Perforation, Diverticulectomy, Myotomy, Hiatial Hernia Repair


5


10


0

Laparoscopic Hiatal or Paraesophageal Repair

 

0


5


0

 

 

 

 

 

 

 

Subtotal General Thoracic Experience

90


190


63


 

 

 

 

 

 

 

TOTAL MAJOR OPERATIVE EXPERIENCE

320


295


393


 

 

 

 

 

 

 

MINOR PROCEDURES8

 



 

 

 

 

 

 

 

 

 

 

Bronchoscopy

30


40


20


Simple (BAL, Diagnostic, TBBx, Bx)

 

0


30


0

Complex (Laser, Dilation, Stent, Navigational Bronchoscopy, Photodynamic Therapy, Cryotherapy)

 

0


10


0

 

 

 

 

 

 

 

UGI Endoscopy

10


30


5


Simple (Diagnostic, Bx)

 

0


20


0

Complex (Dilation, Stent, EUS, EMR)

 

0


10


0

 

 

 

 

 

 

 

Mediastinal Assessment

15


55


10


Mediastinoscopy, Chamberlain (Mediastinotomy)


5


15


0

EBUS/FNA

 

0


10


0

Mediastinal Node Dissection/Systematic Sampling during Lung Resection


10

 

30


0

 

 

 

 

 

 

 

Subtotal Minor Procedures

55


125


35


 

 

 

 

 

 

 

ADDITIONAL REQUIREMENTS

 

 

 

 

 

 

 

 

 

 

 

 

 

Consultation Experience

50 

 

50

 

50 

 

New Patients

 

 25

 

25 

 

25

Follow-up Patients

 

 25

 

25 

 

25

 

 

 

 

 

 

 

Multidisciplinary Patient Management Conferences

20 

 

20

 

55 

 

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

 

20

 

20

 

20 

Structural Heart Team Conference

 

N/A

 

N/A

 

25

Coronary Disease Heart Team Conference 

 

N/A

 

N/A

 

10

 

 

 

 

 

 

 

Cardiac Imaging (Assist with Interpretation)

N/A

 

N/A

 

60 

 

TAVR CT

 

N/A

 

N/A

 

25

Transesophageal Echocardiography

 

N/A

 

N/A

 

25

Cardiac MRI

 

N/A

 

N/A

 

10

 

 

 

 

 

 

 

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

 

75

 

75

 

General Thoracic

 

20

 

20 

 

10 

Cardiac and Congenital

 

20

 

20

 

30 

Any additional Cardiothoracic Critical Care case

 

35

 

35

 

35 

 

 

 

 

 

 

 

Simulation (Hours required from any technique-based simulation curriculum or simulation of Cardiopulmonary Bypass Management)

20 hrs 

 

20 hrs

 

20 hrs 

 

 

Key

N/A Category is not allowed for that pathway.
Can be double-counted with any Cardiac procedure
Can be double-counted with CABG
Can be double-counted with CABG/Valve Procedures
Can be double-counted with any other procedure
Only 1 Pneumonectomy can be counted along with Bilateral Lung Transplant.
Can be double-counted with Pulmonary Resection
Sleeve Lobectomy and Carinal Pneumonectomy can be double-counted with Major Anatomic Lung Resection
All Minor Procedures may be double-counted

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