University of California Davis Medical Center

By Elizabeth H. Stephens and Michael E. Halkos

The cardiothoracic training program at University of California, Davis (UC Davis) is led by Dr. J. Nilas Young, who acts as both Chief of the Division and Residency Program Director. The program offers a breadth of clinical exposure along with close interaction with faculty. The program is well-rounded involving the three disciplines of thoracic surgery, adult cardiac surgery, and pediatric cardiac surgery, including major thoracic aortic and endovascular aortic repairs (TEVAR). Over 900 major cardiothoracic surgical procedures were performed in 2009. While a relatively small program offering one position per year, UC Davis’ size and limited number of residents allows for more one-on-one interaction with faculty. Additionally, because the program does not have distinct cardiac and thoracic tracks, residents acquire a broader range of clinical exposure.

The curriculum of the UC Davis 2-year ACGME accredited cardiothoracic training fellowship consists of 6 months of general thoracic and 6 months of adult and congenital cardiac training for each of the two years (approximately 10 months adult cardiac and 2 months congenital in total). Because there are only 2 residents, preferences of the residents for general thoracic, adult cardiac or congenital exposure can be entertained and the residents’ training schedules tailored accordingly.

Residents participate in daily didactic sessions, ranging from core curriculum lectures, to journal club and M&M. First-year residents receive training in diagnostics, such as echocardiography, endoscopy, and CT imaging one afternoon per week. Multidisciplinary conferences such as thoracic surgery/oncology conferences and catheterization/cardiac surgery conferences complement the residents’ education. Wet labs/operative simulation utilizing porcine hearts are led quarterly by Dr. Daren Danielson, and provide residents training in implanting valves, coronary grafting, and homograft implantation. UC Davis also utilizes simulation technology for a substantial amount of its training. A “virtual care center” is open 24 hours and includes simulation training for catheter techniques, including TEVAR technology, as well as bronchoscopy and laparoscopy simulation. While training for pediatric cardiac surgery occurs at the UC Davis Pediatric Heart Center under Dr. Gary Raff, the new Shriner’s Hospital for Children Northern California affords interested residents the additional opportunity for exposure to complex pediatric thoracic cases.

UC Davis continues to stay abreast of the evolving field of cardiothoracic surgery and pursues newer technologies. In the realm of adult cardiac surgery, TEVAR technology is actively utilized. Furthermore, UC Davis recently acquired the robotic expertise of Dr. W. Douglas Boyd, who performed the world’s first successful robotic beating heart coronary bypass procedure and is developing the robotic cardiac surgical program at UC Davis. Residents also gain valuable experience in minimally invasive thoracic procedures, such as VATS lobectomy, which is routinely used. Both VATS lobectomy and TEVAR programs were started by Dr. Royce F. Calhoun. Although there is not an active cardiac or pulmonary transplant program at UC Davis, there is an evolving ventricular assist device and an active ECMO program; Dr. Jerry Pratt and Dr. Gary Raff have particular interest in these areas. Other technologies that are being pursued include 3D CT guided Navigation pulmonary biopsy. In conjunction with pulmonary critical care, this technology allows parenchymal biopsies to be performed endoscopically in the OR using CT guidance, providing critical information for decisions such as whether to perform a wedge resection or more anatomic resection. This technology can also be used to mark lesions for metastectomy, and is being implemented by one of the thoracic surgeons, Dr. David Cooke, who said that what particularly attracted him to UC Davis was the program’s commitment to pushing the envelope in terms of innovation and research.

An adjunct to the UC Davis program that can enhance the residents’ training experience is a long-established collaboration at different sites in Russia, “Heart to Heart International Children’s Medical Alliance.” Founded by Dr. Young, this program has helped to build cardiac surgery infrastructure in Russia and now includes five cardiac surgery programs, principally for the treatment of congenital heart disease and adult cardiac disease. Interested thoracic surgery residents can be involved with these humanitarian missions.

Residents are encouraged to undertake at least one research project per year and publish at least one manuscript. Often these projects are clinical in nature, based upon data derived from the UC Davis database or national databases. However, basic research is also strong at UC Davis, varying from tissue engineering work in the lab of Dr. Boyd, to the recently hired stem cell expert Dr. Ming-Sing Si, another of UC Davis’ congenital cardiac surgery faculty. Residents are encouraged and supported to attend four national meetings over the course of their two years.

In terms of applicants, UC Davis is looking for bright individuals with a passion for cardiothoracic surgery. While residents are encouraged in academic endeavors during their training at UC Davis, those interested in private practice are also welcomed.

Mentorship is a strength of the UC Davis training program. The group involved in cardiothoracic surgery care is a very close-knit family, encompassing faculty, residents, and support staff, and this group meets daily to discuss patient care. Faculty members meet formally with the residents three times a year to discuss evaluations and progress, and conduct performance reviews. All faculty members invest in the education of the residents. Faculty are intimately involved in assisting graduating residents with employment or fellowship opportunities. Overall, approximately one third of UC Davis graduates pursue an academic career and three quarters pursue an additional fellowship.

In summary, the program at UC Davis provides comprehensive training in both standard and innovative techniques. Residents are actively involved in the educational process and their experience at UC Davis provides a strong foundation to succeed in their cardiothoracic surgery careers.

Acknowledgements

Special thanks to Dr. David T. Cooke and Dr. J. Nilas Young for their contributions to this article, as well as the assistance of Theresa Vinson.

Additional Resources

Program link: http://www.ucdmc.ucdavis.edu/surgery/education/cardio.html

Program contact information

Director: Dr. J. Nilas Young
Coordinator: Theresa Vinson
Address: Thoracic Surgery Residency, UC Davis Medical Center, 2221 Stockton Bl., Cypress Bldg., Suite 2112, Sacramento, CA 95817
Phone: (916) 734-7255

Heart to Heart International Children’s Medical Alliance website:  http://heart-2-heart.org