Course Director Ivan Crosby MD
Attendings Irving Kron MD
John Kern MD
James Gangemi, MD
Gorav Ailawadi, MD
The Cardiac Surgery Clerkship has been designed to give students a hands-on experience with the cardiac surgical problems of patients, whether it is in the O.R., the outpatient clinic, or in the post op unit or 4 West. Students will be exposed to adult surgical procedures such as coronary surgery, valve repair or replacement, ventricular assist device implantation, or cardiac transplantation. Dr. James Gangemi has a very active congenital cardiac surgical program and it will be important to participate in that area also. The rotation is designed to have free and collegial interaction between Attendings, Fellows, PAs, and students. These people are all committed to education, and want to give you a very positive experience on the Cardiac Surgery rotation.
Upon completion of the cardiac surgery rotation all medical students should be able to:
1. Describe basic cardiovascular physiology including volume management and the management of congestive heart failure.
2. Discuss the management of the pleural space with “pig tails,” thoracentesis, and chest tubes.
3. Describe methods of anti-coagulation.
4. Discuss.cardiac electrophysiology including the rudimentary aspects of pacemaker management, arrhythmia control, and arrhythmic pharmacology.
5. Describe the basic management of ventilation and oxygenation in thoracic patients, including the management of supplemental oxygen, nasal CPAP, incentive spirometry, and respiratory therapy.
6. Describe the management steps during a cardiac arrest and near arrest.
7. Describe the basis of thoracic imaging, including CT scans of the chest and vasculature as well as the interpretation of chest x-rays.
8. Discuss the medical management of acute coronary ischemia and acute valvular heart disease.
9. Discuss the basics of the management of acute aortic emergencies.
After rotating in the TCV Post Operative Unit medical students should be able to:
1. Describe the use of intra balloon pumps as well as other cardiac assist devices including ventricular assist devices, ECMO, and right ventricular assist devices.
2. Describe the management of cardiac arrest and near arrest with both closed techniques, pharmacological techniques, and open cardiac massage and resuscitation.
3. Describe the use of advanced measures to deal with problems of the pleural space including every form of thoracic drainage.
4. Describe the management of acute respiratory insufficiency including acute pulmonary disease, management of the airway, and bronchoscopy both for diagnosis and therapy.
5. Knowledge of and indication for invasive monitoring in the ICU.
Planned Clerkship Experience
A. Each student will be attached to a Cardiac Fellow or an Attending as a mentor for the three weeks of the clerkship.
B. The Fellow will organize the student to see each afternoon the patient in whose operation the student will participate the next day (usually the second case). The student will then read up about the operation the night before, and be prepared to answer questions from the Attending or Fellow.
C. Students will report/present on rounds on every such patient post-operatively.
D. Students will go to Clinic with the Fellow.
E. Fellows to encourage students to scrub in on one pulmonary resection case and one vascular surgical case to broaden their overall experience on TCV.
F. Students to attend the TCV teaching rounds in the 4 North Break Room during ICU renovations from 7:00 a.m. to 8:00 a.m. on Monday, Tuesday, Thursday and Friday. Dr. Kern also has a didactic session with cardiac students every Thursday pm. Each student will deliver a Power Point presentation on a topic at the TCV teaching rounds during the clerkship.
G. Once each week of the Clerkship, the students will meet with Dr. Crosby.
H. The student will ask the fellow for Performance Evaluations. The Cardiac Fellow will give the student feedback on the student’s performance each week, and will fill out an evaluation form at the end of the three weeks.
I. The students will learn from the Cardiac Interns the protocols/techniques for pulling pacing wires, chest tubes, etc.
J. The students will ask the PA to assist in skin closure of legs and will ask to assist the Fellow in sternotomy incision.
K. Each student will be loaned a copy of Baumgartner’s “Cardiac Surgery” Third Edition, for the three weeks of the clerkship.
Medical students should participate in all clinical patient and educational activities, both inpatient and outpatient, while on this rotation.