CARDIAC SURGERY

DEFINITION:Cardiac Surgery is that branch of surgery concerned with diseases of the pericardium, heart and great vessels. The resident who has completed training in Cardiac Surgery is expected to function as an independent consultant with respect to the diagnosis and management of patients with cardiovascular disease, including the provision of surgical intervention when indicated and postoperative care. Appropriate roles for the cardiac surgeon include: medical expert and clinical decision maker, communicator, collaborator, manager, health advocate, scholar, and research scientist. As a dedicated professional, and consistent with the obligations of a physician, the cardiac surgeon must endeavour to deliver highest quality care with integrity, honesty and compassion, exhibit appropriate personal and interpersonal professional behaviours and practice medicine ethically giving priority to the needs of individual patients. Continuing education and evaluation are expected throughout the cardiac surgeon's professional life including an appreciation of the role of research and the need for critical analysis of current scientific and practice developments related to the specialty.

GENERAL OBJECTIVES:On completion of the examination program, the graduate physician will be competent to function as a consultant in Cardiac Surgery. He must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to cardiac surgery.

SPECIFIC OBJECTIVES:On completion of qualification, the specialist will have acquired the following competencies and will function effectively as:

Medical Expert/Clinical Decision-Maker

General Requirements

    • Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
    • Access and apply relevant information to clinical practice.
    • Demonstrate effective consultation services with respect to patient care, education and legal opinions.

Specific Requirements

Acquire knowledge of the principles essential to care of cardiac surgical patients including:

    • Thoracic incisions: types, indications.
    • Wound complications and their management including sepsis: causes, prevention, presentation, treatment.
    • Surgical nutrition.
    • Anticoagulation: indications, complications, management of heparin induced thrombocytopenia.
    • Cardiac medications: inotropes, antiarrhythmics, vasoactive agents; use and complications.
    • Recognition and management of concomitant medical conditions including diabetes, renal failure, respiratory failure.
    • Principles of diagnosis and management of the trauma patient particularly thoracic injury.
    • Recognition and management of vascular, neurological and general surgical complications in cardiac patients including peptic ulcer disease, hepatobiliary disease, limb ischemia, etc.
    • Natural history, presentation, investigation and management of extracranial cerebral vascular disease, particularly when presenting with cardiac disease.
    • Anesthetic management including the use of sedatives, analgesics and local anesthetic agents.

Acquire the following clinical skills:

    • Recommend appropriate surgical approach.
    • Recognize and treat wound complications including infections, dehiscence, mediastinitis and prescribe appropriate prophylactic measures for infection prevention.
    • Institute and monitor surgical nutrition via enteral or parenteral route.
    • Recognize need for and appropriate use of cardiac medications.
    • Manage patients with concomitant medical problems including control of diabetes and other endocrine imbalances, renal failure, respiratory insufficiency.
    • Diagnose and institute appropriate management of trauma patients.
    • Diagnose and institute appropriate management of gastrointestinal complications in cardiac patients.
    • Diagnose and institute appropriate management of generalized atherogenesis.
    • Recommend appropriate investigations and therapeutic interventions for patients with cerebrovascular disease, particularly when presenting with concomitant cardiac disease.

Acquire the following technical skills:

    • Perform sternotomy and thoracotomy incisions: understand and perform techniques for safe redo sternotomy.
    • Perform wound debridement, resuturing of sternum.
    • Insert central venous cannulas for parenteral nutrition and dialysis.
    • Insert chest tubes, resuscitate trauma patients.
    • Perform repair of traumatic injuries to chest including thoracic aortic tears, cardiac lacerations, and lung lacerations.
    • Implant appropriate devices including pacemaker and defibrillator systems, intraaortic balloon pumps and other cardiopulmonary support devices.
    • Manage airway problems including performance of tracheostomy.

The following specific objectives describe the knowledge, clinical and technical skills required of a physician upon completion of the educational program in cardiac surgery. The list of operations included under technical skills is neither exclusive nor compulsory but rather is included as a guide.

1.Cardiopulmonary Bypass

Knowledge

      • Use and pathophysiology of cardiopulmonary bypass including deleterious effects.
      • Design and function of components of cardiopulmonary bypass circuits including alternate types of pumps and oxygenators.
      • Catastrophic complications of cardiopulmonary bypass (CPB).
      • Effects of CPB on inflammatory, coagulation and hematological systems as well as end organ damage.

Clinical Skills

      • Recommend appropriate method of CPB including cannulation, temperature management.
      • Recognize and manage catastrophic complications including air embolism, mechanical failure of CPB equipment, clotting on CPB.
      • Recognize deleterious effects of CPB and recommend methods to minimize them.

Technical Skills

      • Institute CPB using a variety of cannulation devices and techniques.
      • Conduct bypass appropriately including venting and cooling techniques.
      • Institute appropriate action for CPB accidents.

2.Myocardial Protection

Knowledge

      • Mechanisms of myocardial injury and their prevention.
      • Myocardial metabolic pathways and their response to ischemia and reperfusion.
      • Cardioplegia composition, temperature, alternate delivery methods and assessment of myocardial protection.

Clinical Skills

      • Recognize the need for myocardial protection and recommend appropriate methods to achieve it.

Technical Skills

      • Institute effective myocardial protection using a variety of delivery methods.
      • Demonstrate ability to assess effectiveness of protection.

3.Ischemic Heart Disease

Knowledge

      • Principles of management of patients with ischemic heart disease
      • Anatomy and physiology of coronary circulation and effects of obstruction.
      • Pathophysiology of atherosclerosis and acute ischemic syndromes.
      • Principles and use of imaging techniques for myocardial ischemia including electrocardiography (EKG), stress tests, coronary angiography, nuclear medicine scans, stress echocardiography.
      • Medical and surgical management of chronic coronary insufficiency including indications, timing and outcomes for revascularization.
      • Management of unstable angina and acute myocardial infarction and its complications including ischemic ventricular septal defect (VSD), cardiac rupture and mitral insufficiency.
      • Role of primary and secondary prevention; current recommendations.

Clinical Skills

      • Use and interpret appropriately tests of myocardial ischemia.
      • Use and interpret appropriately tests of myocardial viability including differentiation of stunned/hibernating myocardium from necrotic/scar tissue.
      • Recognize and manage acute and chronic coronary ischemia.
      • Recommend appropriate timing of alternative treatment strategies including medical, interventional catheterization and surgical treatment.
      • Recognize and recommend treatment for complications of coronary ischemia including low cardiac output, ischemic VSD, mitral insufficiency.
      • Provide appropriate risk reduction recommendations and use appropriate drug therapy properly.

Technical Skills

      • Perform coronary bypass grafting using a range of venous and arterial conduits.
      • Perform surgical repair of complications of ischemia: repair of VSD, mitral insufficiency, left ventricular aneurysm.
      • Insert intraaortic balloon pumps and ventricular assist devices.

                 4.Valvular Heart Disease

Knowledge

      • Principles of management of patients with valvular heart disease.
      • Anatomy of the cardiac valves and relationships to adjacent structures.
      • Natural history of all forms valvular heart disease.
      • Principles and use of imaging techniques for valvular heart disease including cardiac auscultation, echocardiography including transesophageal echocardiography (TEE), cardiac catheterization and hemodynamic evaluation, magnetic resonance imaging (MRI).
      • Indications for medical and surgical intervention.
      • Advantages and disadvantages of available valve repair methods/prostheses.
      • Techniques for valve surgery including methods of valve repair, aortic root enlargement, and management of complications of valve surgery.
      • Guidelines for reporting valve results including time-related multivariable analysis of morbidity/mortality.

Clinical Skills

      • Use and interpret appropriately tests of valvular heart disease.
      • Recommend and institute appropriate medical therapy for valve patients including antifailure medication and anticoagulants.
      • Recommend appropriate timing of surgical intervention.
      • Recommend appropriate valve operation and prosthesis.
      • Recognize complications of valve surgery including residual obstruction / insufficiency, infection, thrombosis, degeneration and recommend treatment.

Technical Skills

      • Perform routine valve replacements for aortic and mitral valve disease.
      • Perform complex valve operations including mitral valve reconstruction, aortic root enlargement, and stentless valve/homograft/autograft surgery.

5.Thoracic Aortic Pathology

Knowledge

      • Principles of management of patients with thoracic aortic disease at an independent consultant level.
      • Anatomy of aorta including its intrathoracic branches.
      • Pathophysiology of aortic disease including atherosclerotic disease, Marfans, and cystic medial necrosis.
      • Pathophysiology of thoracic and thoracoabdominal aortic aneurysms and dissections.
      • Natural history of aortic disease.
      • Sensitivity and specificity of methods for diagnosing aortic disease including emergencies.
      • Indications for medical and surgical intervention.
      • Methods of surgical repair including choice of conduits, techniques for preventing brain and spinal cord damage, management of complications of aortic surgery.
      • Indications for postoperative surveillance of patients, and investigation of relatives.

Clinical Skills

      • Recognize and diagnose thoracic and thoracoabdominal aortic disease including emergency presentations: use appropriate diagnostic tests.
      • Recommend and institute appropriate medical therapy for thoracic and thoracoabdominal aortic pathology including emergency dissections.
      • Recommend appropriate surgical intervention including strategies to minimize neurological and other complications.

Technical Skills

      • Perform repair of thoracic and thoracoabdominal aortic pathology including aneurysms and dissections, using appropriate techniques for distal aortic perfusion and prevention of complications.

                  6.Transplantation and Cardiac Failure

Knowledge

      • Principles of management of patients with end-stage heart failure.
      • Pathophysiology and endocrinology of heart failure.
      • Natural history of cardiac failure.
      • Indications for medical therapy and pharmacology of available agents.
      • Indications for surgical therapy for heart failure including conventional revascularization, valve surgery, transplantation as well as unconventional therapy: laser revascularization, left ventricular reduction, and cardiomyoplasty.
      • Indications for alternative transplantation procedures including heart-lung or lung transplantation with repair of cardiac lesions in patients with primary or secondary pulmonary hypertension.
      • Indications for and complications of temporary/permanent mechanical cardiac support.
      • Pathophysiology of brain death, donor management including biochemistry and pharmacology of donor heart preservation.
      • Immunology of rejection, and management of immunosuppression.

Clinical Skills

      • Recognize end-stage cardiac failure.
      • Institute appropriate medical therapy for heart failure.
      • Recommend appropriate surgical therapy including instituting mechanical support, conventional surgery and transplantation.
      • Manage donor patient appropriately including criteria for brain death.
      • Manage immunosuppression and its complications.

Technical Skills

      • Institute mechanical cardiac support.
      • Perform donor heart procurement and cardiac transplantation.

                  7.Electrophysiology

Knowledge

      • Principles of management of patients with dysrrythmias.
      • Pathophysiology and electrophysiology of atrial and ventricular dysrrythmias.
      • Pharmacology, indications and results of medical management of dysrrythmias.
      • Indications for and results of medical and surgical ablation for dysrrythmias.
      • Indications for implantation of pacemakers including automatic implantable cardioverter devices (AICDs) and management of their complications.

Clinical Skills

      • Recognize and treat patients with dysrrythmias.
      • Recommend appropriate pacemaker device for implantation.
      • Recognize and recommend appropriate treatment for complications of cardiac pacing including pacemaker syndrome and infections.

Technical Skills

      • Implant various types of pacemakers including single and dual chamber, AICDs; endocardial and epicardial leads.

                    8.Cardiac Tumours

Knowledge

      • Principles of management of patients with cardiac tumours.
      • Incidence, pathology, natural history and presentation of cardiac tumours.
      • Principles and use of imaging techniques for cardiac tumours including echocardiography, cardiac catherization, computed tomography (CT) and MRI.
      • Indications for surgical intervention for cardiac tumours.
      • Surgical techniques for resection of cardiac tumours.

Clinical Skills

      • Use and interpret appropriately tests for cardiac tumours.
      • Recommend appropriate surgical approach for cardiac tumours.
      • Recommend appropriate follow-up for surgical patients following operation.

Technical Skills

      • Perform surgical resection of appropriate cardiac tumours.

                     9.Pericardial Disease

Knowledge

      • Principles of management of patients with pericardial disease.
      • Anatomy and physiology of the pericardium.
      • Pathophysiology of the pericardium including congenital and acquired pericardial diseases.
      • Pathophysiology of acute cardiac tamponade and chronic pericardial constriction.
      • Principles and use of diagnostic techniques for pericardial pathology including physical examination, echocardiography, CT and MRI.
      • Role and interpretation of cardiac catheterization and hemodynamic studies as they pertain to pericardial disease.
      • Indications for medical and surgical intervention for pericardial disease.
      • Surgical techniques for pericardial disease including relief of cardiac tamponade, pericardectomy.
      • Principles of postoperative care of patients with pericardial disease.

Clinical Skills

      • Use and interpret appropriately tests of pericardial disease, and recognize cardiac tamponade.
      • Recommend appropriate surgical intervention for cardiac tamponade and pericardial disease.
      • Recognize and treat appropriately patients with postpericardotomy syndrome.

Technical Skills

      • Perform pericardial aspiration, biopsy and pericardectomy.

                     10.Pediatric Cardiac Surgery

Knowledge
Principles essential to care of neonatal, infants and pediatric cardiac patients including:

      • Embryology and nomenclature of congenital cardiac defects.
      • Physiology and pathophysiology of fetal, neonatal and pediatric circulations.
      • Principles of intensive care management of pediatric cardiac patients including ventilator management, inotropes, treatment of pediatric dysrrhythmias and the manipulation of the pulmonary and systemic circulations.
      • Design and functional requirements of CPB circuits for pediatric patients.
      • Principles of CPB management for pediatric cases: myocardial protection strategies, use of profound hypothermia and circulatory arrest.
      • Principles and use of techniques for support of failing circulation in pediatric population.
      • Principles and use of imaging techniques in congenital cardiac disease including auscultation, echocardiography, cardiac angiography and hemodynamic assessment, as well as MRI.
      • Pathophysiology, indications and techniques for repair of simple and complex congenital cardiac defects.
      • Principles of management of adults with congenital cardiac defects including pathophysiology and evaluation of pulmonary vascular disease; indications and contraindications for repair.

Clinical Skills

      • Classify and describe accurately congenital cardiac defects.
      • Recognize and recommend appropriate treatment for ill neonates and children including maintenance of ductal patency, and control of pulmonary vascular resistance problems support of systemic circulation.
      • Recommend appropriate size of circuit components, and techniques for safe conduct of CPB in all ages of children.
      • Recognize signs of cardiac failure in children and recommends appropriate support including inotropes, pacing and use of mechanical support.
      • Use and interpret correctly tests for congenital cardiac defects for common congenital defects.
      • Recommend appropriate timing of surgery and choice of operation for specific congenital cardiac defects in both children and adults.

Technical Skills

      • Establish cardiopulmonary bypass for most pediatric cases including extracorporeal membrane oxygenation or ventricular assist device where appropriate.
      • Repair selected pediatric cases including: coarctation of aorta, patent ductus arteriosus (PDA), vascular rings, epicardial pacemakers, atrial septal defect (ASD), partial atrioventricular septal defect (AVSD), VSD, and non-neonatal tetralogy.
      • Repair most adult congenital lesions including pulmonary valve replacement, hypertrophic cardiomyopathy coarctation of aorta and ASD.

            11.Other

Residents should have the knowledge, clinical skills and technical skills pertinent to cardiac surgery from General Surgery, Thoracic Surgery, Vascular Surgery and Cardiology.

Communicator

General Requirements

    • Establish therapeutic relationships with patients and families.
    • Obtain and synthesize relevant history from patients and families, and their communities.
    • Listen effectively.
    • Discuss appropriate information with patients and families, and the health care team.

Specific Requirements
In order to achieve these objectives the resident must develop the ability to:

    • Obtain and synthesize relevant history from patients and family.
    • Inform patients and families about their condition at an appropriate and understandable level.
    • Be sensitive and respond appropriately to issues of gender, culture and ethnicity in dealing with patients and families.
    • Write a preliminary report on operations on chart.
    • Dictate concise, clear description of operation.
    • Write clear consultation note/discharge summary/clinic note.
    • Prepare and present ward and intensive care unit (ICU) rounds in an organized manner.
    • Participate actively in scheduled rounds.

Collaborator

General Requirements

    • Consult effectively with other physicians and health care professionals.
    • Contribute effectively to other interdisciplinary team activities.

Specific Requirements
In order to achieve these objectives the resident must develop the ability to:

    • Work with ward, ICU, operating room and expanded role nurses to manage patients appropriately.
    • Identify social, rehabilitative, dietetic concerns with patients and consult appropriate allied health professionals.
    • Consult and work with medical specialists appropriately.
    • Assist allied health professionals though active participation in their training and educational rounds.

Manager

General Requirements

    • Utilize resources effectively to balance patient care, learning needs, and outside activities.
    • Allocate finite health care resources wisely.
    • Work effectively and efficiently in a health care organization.
    • Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements
In order to achieve these objectives the resident must develop the ability to:

    • Understand the importance of and mechanisms to safely utilize resources in a cost-effective manner to benefit all patients.
    • Recommend practices to effectively utilize resources including undertaking studies to assess effectiveness of standard care procedures.

Health Advocate

General Requirements

    • Identify the important determinants of health affecting patients.
    • Contribute effectively to improved health of patients and communities.
    • Recognize and respond to those issues where advocacy is appropriate.

Specific Requirements
In order to achieve these objectives the resident must understand the:

    • Principles and data supporting primary and secondary prevention of coronary artery disease.
    • Triage system for the surgical wait list; its rationale, and how patients are added or upgraded.
    • Value of outcomes research for surgical procedures.

In order to achieve these objectives the resident must develop the ability to:

    • Assess all patients for risk factors for cardiovascular disease and advise appropriate interventions.
    • Utilize appropriate lipid lowering agents correctly.
    • Participate in outcomes research and assist in disseminating resulting information.
    • Develop and support constructive relationships with hospital administrators; Regional, Provincial and Federal Government Agencies and Representatives.
    • Support the activity of local and national organizations promoting health advocacy.

Scholar

General Requirements

    • Develop, implement and monitor a personal continuing education strategy.
    • Critically appraise sources of medical information.
    • Facilitate learning of patients, housestaff/students and other health professionals.
    • Contribute to development of new knowledge.

Specific Requirements
In order to achieve these objectives the resident must:

    • Recognize gaps in knowledge and develop strategies to correct this by self-directed reading, and consulting with other professionals.
    • Contribute knowledge learned to service rounds.
    • Understand principles and practice of basic and applied research including the scientific method, design and conduct of clinical trails, critical appraisal of literature and the use of statistics.
    • Understand need to incorporate gender, cultural and ethnic perspectives in research methodology.
    • Read around clinical cases.
    • Prepare and present scheduled rounds.
    • Participate actively in scheduled morbidity and mortality conferences.
    • Actively participate in journal club.
    • Prepare and present clinical research papers at peer-reviewed meetings/ publish in medical literature.
    • Participate effectively in teaching fellow professionals including junior housestaff.

Professional

General Requirements

    • Deliver highest quality care with integrity, honesty and compassion.
    • Exhibit appropriate personal and interpersonal professional behaviours.
    • Practise medicine ethically consistent with obligations of a physician.

Specific Requirements
In order to achieve these objectives the resident must develop the ability to:

    • Deliver care with integrity, honesty and compassion.
    • Understand the professional, legal, and ethical codes to which physicians are bound.
    • At all times function professionally at an independent consultant level.
    • Be sensitive to and respond appropriately to patients of different social status, ethnic groups, age and gender.

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty.

The content and organization of each accredited program in cardiac surgery must be consistent with the specialty training requirements.

The resident must be provided with progressively increasing responsibility for the management of cardiac patients. Operative experience ultimately including the major procedures in the specialty must be provided under appropriate supervision. Each resident should keep a validated record of all operative procedures in which he or she has participated either as assistant or operating surgeon.

RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in cardiac surgery.

In those cases where a university has sufficient resources to provide most of the training in cardiac surgery but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

  1. Teaching Faculty

There must be a sufficient number of qualified teaching staff acceptable to supervise residents at all levels and in all aspects of the specialty and provide teaching in the basic and clinical sciences related to the specialty. Each institution must have a sufficient number of staff teachers in cardiac surgery to provide adequate and continuous instruction and supervision for residents.

  1. Number and Variety of Patients

The clinical services of the program must provide an adequate volume of patients to give experience in all areas of cardiac surgery practice. The operative experience of residents must be adequate in each of the following areas: congenital heart disease, valvular heart disease, coronary artery disease, conduction disorders requiring pacemakers, surgery for thoracic and thoracoabdominal aneurysms, and the surgical treatment of end stage heart failure including transplantation. Experience in major trauma to the thorax is essential for every resident including participation in the initial management of multiple injuries as a member of an interdisciplinary team.

There must be an adequate volume and range of major general, thoracic and peripheral vascular surgery for the resident to gain experience in those areas likely to be encountered in cardiac surgery patients including thoracic surgery and its complications, and concomitant cerebral vascular and coronary artery disease.

  1. Clinical Services Specific to Cardiac Surgery

The program must be organized into one or more clinical services, each with an adequate number of patients available for teaching and administered by a chief-of-service to whom the senior resident is directly responsible.

There must be an integrated teaching service that provides access to pre-operative evaluation, operative and post-operative care, and sustained clinical follow-up is mandatory.

    1. Surgical

Operative experience ultimately including the major procedures in the specialty, must be provided under appropriate supervision. There must be adequate operating room time and appropriate facilities to provide increasing surgical responsibility for residents in the program.

    1. Ambulatory

In-patient and out-patient clinical services should be integrated so far as possible, in order to provide continuity of observation of patients both in and out of hospital. Organized clinics or other facilities must provide opportunities for pre-admission investigation and post-discharge follow-up of patients in all categories mentioned above.

Assignment to interdisciplinary clinics or centres is highly desirable in order that exposure to the respective roles of medical and surgical therapy for the management of complex cardiac conditions be obtained.

    1. Pediatric Cardiac Surgery

There must be an organized teaching service for the cardiac surgery of infants and children. There must be a close association with the pediatric service, which must include a pediatric cardiologist.

    1. Consultations

Residents require an active consultation service to gain experience in primary consultation on other services such as internal medicine and other branches of surgery including trauma. Residents should participate in consultations, both elective and emergency, on a continuing basis throughout training.

  1. Supporting Services — Clinical, Diagnostic, Technical
    1. Liaison with Other Specialties and Subspecialties

There must be appropriate liaison with services in other disciplines that relate to cardiac surgery. It is particularly important that the cardiac surgical service have a close relationship with a teaching cardiology service.

Facilities must be available in a teaching setting for all common diagnostic procedures associated with the practice of the specialty. These should include cardiac catheterization, angiography, echocardiography and non-invasive studies of cardiac function and viability.

    1. Intensive Care

Units organized for teaching are required within the program to provide experience in the care of critically ill and injured patients in all age groups. The organization of intensive care units admitting cardiac surgical patients must be such that residents may assume major responsibility under appropriate supervision.

    1. Emergency Experience

There must be systematic supervision of residents to ensure expertise in the initial management of all types of emergencies related to the specialty, including those presenting in the emergency department. Experience in responding to emergencies and providing a consultative service under such conditions is essential.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM:

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.

  1. Organized Scholarly Activities

A coordinated educational program must be provided in cardiac surgery and related fields. This should include lectures and seminars, which may be interdisciplinary in nature, technical demonstrations and journal clubs. Attendance at rounds of other services should be arranged if educationally advantageous.

  1. Quality Assurance/Improvement

The program must provide residents with exposure to the process of systematic review of surgical results and complications and with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments.

SPECIALTY REQUIREMENTS:

1.      Approved residency training in core surgery.

2.      Approved residency training in Cardiac Surgery

PROGRAMS (WITH TRAINING REQUIREMENT):

Master of Surgery(M.S):

Thirty six months of approved residency training.

Doctor of Philosophy(Ph.D):

Sixty months(five years)of approved residency training.