Index Case Requirements-2017

Index Case Requirements
Effective July 1, 2017

The Index Case Requirements for residents who start their thoracic surgery training on or after July 1, 2017 are listed below. This affects the following residents:

Residents in 2-year traditional programs starting on or after July 1, 2017
Residents in 3-year traditional programs starting on or after July 1, 2017
Residents in 6-year integrated programs starting on or after July 1, 2017
Residents in Joint Training programs starting on or after July 1, 2017

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

		ADULT CARDIAC

60		Acquired Valvular Heart Disease		30
	25	Aortic Valve Repair/Replacement	15
	15	Mitral Valve Repair/ Replacement	5
	5	Tricuspid Valve Repair/Replacement, Annuloplasty	5
	5	TAVR as primary
	10	TAVR as assistant	5

80		Myocardial Revascularization		35

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

15		Interventional Wire-based Procedures		5
	5	Left Heart Catheterization, PCI, TEVAR, Mitral Clip
	10	Intra-aortic Balloon Pump	5

5		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, Aortic Dissection, Aortic Trauma Can be double-counted with CABG/Valve Procedures		5

10		Arrhythmia Surgery**
	5	Left Atrial or Biatrial Maze, Pulmonary Vein Isolation, Right-sided Maze, Isthmus Ablation **Can be double-counted with CABG/Valve procedures
	5	Pacemaker insertion or Pacemaker removal

5		Cardiopulmonary Bypass set-up and pump run with Perfusionist		5

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

195		Subtotal Adult Cardiac Experience		90

		GENERAL THORACIC

60		Lung		105
	30	Major Anatomic Resections: Open, VATS, or RATS (Segmentectomy, Lobectomy, Pneumonectomy, Lung Transplantation) Only 1 Pneumonectomy can be counted along with Bilateral Lung Transplant.	50
	5	VATS/RATS Lobectomy specifically	25
	25	Open or VATS Lung Biopsy/Wedge Resection	30

10		Pleura		25
		Major (Empyema Decortication, Pleurectomy Decortication, other Pleural Tumor Resection)	5
		Minor (Biopsy, Pleurectomy, VATS Sympathectomy, VATS Bleb Resection, VATS Pleurodesis, Evacuation of Hemothorax)	15
		Interventional: In-dwelling Cuffed Pleural Catheter Insertion	5

5		Chest Wall and Diaphragm Chest Wall Resection, Rib Resection, Rib Plating, Pectus Repair, Diaphragm Resection or Plication, Repair of Morgagni, Bochdalek, Traumatic Hernia Can be double-counted with Pulmonary Resection		10

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

0		Tracheobronchial – Airway Surgery Tracheal Resection, Laryngotracheal Resection, Sleeve Lobectomy, Carinal Pneumonectomy, Transplantation Airway Anastomosis Sleeve Lobectomy and Carinal Pneumonectomy can be double-counted with Major Anatomic Lung Resection		5

10		Esophagus		35
	5	Esophagectomy (Open or MIE)	20
	5	Benign Esophagus-Repair of Perforation, Drain Perforation, Diverticulectomy, Myotomy, Hiatial Hernia Repair	10
		Laparoscopic Hiatal or Paraesophageal Repair	5

90		Subtotal General Thoracic Experience		190

305		TOTAL MAJOR OPERATIVE EXPERIENCE		290

		MINOR PROCEDURES All may be double-counted

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

10		UGI Endoscopy		30
		Simple (Diagnostic, Bx)	20
		Complex (Dilation, Stent, EUS, EMR)	10

15		Mediastinal Assessment		55
	5	Mediastinoscopy, Chamberlain (Mediastinotomy)	15
		EBUS/FNA	10
	10	Mediastinal Node Dissection/Systematic Sampling during Lung Resection	30

55		Subtotal Minor Procedures		125

		ADDITIONAL REQUIREMENTS

50		Consultation Experience		50
	25	New Patients	25
	25	Follow-up Patients	25

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

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