Cardiothoracic Surgery Pathway (curriculum as of Class of 2026) Introduction Sites and Personnel Description of Pathway Cardiothoracic Surgery Course Cardiology Elective Pulmonary Elective Radiology Elective Free Elective Goals and Objectives Textbooks Evaluation Faculty Curriculum Committee

REVIEW FOR PATHWAY 2025-2026:

Introduction

Heart disease is the most common cause of death in the Western world. In the United States alone, 5.5-7.5 million individuals have symptomatic myocardial ischemia because of atherosclerotic CAD. In 1945 the first shunt operation for "blue babies" was introduced. In 1953, extracorporeal circulation was successfully performed in Philadelphia, opening the doors to a world capable of treating congenital and adult cardiac disease. In 1961, replacement of heart valves became a reality. In 1967, the birth of modem coronary revascularization was realized. Since then, coronary artery bypass grafting (CABG) has become the most commonly performed major operative procedure in the adult U.S. population. At present, over 400,000 CABG operations are done annually in. the U.S. The Tenet Delaware Valley hospital network is one of the country's largest providers of cardiovascular care. The volume of open heart surgery within the system exceeded 4,600 cases for 1996. Every aspect of adult and congenital cardiac surgery is represented at the various Divisions, including CABG, valve repair and replacements, transplantation, Ventricular Assist Devices (VAD), cardiomyoplasty, ventricular remodeling, laser recanalization and minimally invasive techniques are being performed.

In addition to the abundance of open heart procedures, a variety of non-cardiac thoracic surgery is available within the system. Thoracic oncology, video-assisted thoracoscopic surgery (VATS), lung volume reduction and thoracic trauma are within the spectrum of chest diseases treated. A close relationship between several specialties, including pulmonary medicine, oncology, internal medicine, radiology, pathology and emergency medicine is fostered by the multidisciplinary nature of thoracic disorders.

Finally, a strong exposure to critical care management in the intensive care unit and technical skills in the operating room is provided. The interaction with attendings, residents, fellows, physician assistants and perfusionists provide additional educational resources. Furthermore, laboratory and clinical research continues to flourish with student and resident participation.

In summary, the fourth year discipline-based pathway in cardiothoracic surgery is an educational, multidisciplinary experience whose purpose is to produce a high quality, motivated and well-rounded student-physician capable of recognizing cardiothoracic pathology and knowledgeable about its treatment.

Return to top of page

Pathway Director:
Joseph T. Costic, D.O.
costicj@deborah.org

Email is the preferred method of contact.

Drexel Administrative Support for Cardiothrocic Surgery:
Linda Greco
215-991-8520
lag64@drexel.edu

Associate Directors, and Teaching Sites:

Site	Site Director	Site Coordinator
	Joseph T. Costic, D.O.
AGH	George J. Magovern, Jr., M.D. Allegheny General Hospital 320 E. North Avenue Pittsburgh, PA 15212 (412) 359-3715 Phone (412) 359-3878 Fax	Kathleen Simpson (412)359-4713 Phone (412)359-3878 Fax

Return to top of page

Emergency Medicine Subinternship
Emergency Medicine Subinternship is required by the University as a senior year course. During this course we would expect that the student will learn the principles of rapid assessment and stabilization of critically ill and injured patients; learn the initial evaluation and management of the wide range of undifferentiated patient complaints in the Emergency Department; gain skills, specialized examination technique and real-time interpretation of diagnostic studies; participate in common and more advanced procedures.

Required Subinternship Objectives: Cardiothoracic Surgery Pathway students may select between a required Medicine Subinternship or Surgery Subinternship
By the end of the rotation learners will be able to:

1. Take ownership of their patients and be the primary point person regarding their care.
2. Demonstrate the ability to care for patients with increasing independence while seeking help when appropriate
3. Handle the daily tasks of an intern including preparing for rounds, presenting on rounds, interprofessional knowledge and communication skills, and patient interactions, histories and physicals, note writing of all varieties, and sign-out in a proficient and efficient manner.
4. Apply their knowledge towards diagnosis and management of common acute complaints and chronic conditions, creating care plans and communicating with consultants as necessary.
5. Perform general procedures through demonstration of the necessary preparation and key issues required for the performance of procedures, including understanding patient-specific factors, indications, contraindications, risks, benefits, and alternatives. 
6. Demonstrate reliable mechanical skills in performing procedures in most situations and knows when to seek help for procedures or situations beyond the learner’s abilities.
7. Perform safe transitions of care, coordination of care, and discharge planning.

Cardiothoracic Surgery Course
AGH
Fourth year students rotating on the Cardiothoracic Surgery Service at AGH will be provided with a complementary experience to the one they receive at HUH. In addition to the coronary and valvular cardiac operations, AGH surgeons offer cardiomyoplasty and laser recanalization. Furthermore, the AGH preoperative evaluation, intraoperative techniques, and postoperative management will provide the student with additional experience by which to compare and contrast with the HUH approach. Specific research projects are available. Students interested in these areas are welcome to investigate the possibility of participating in these fields.

Cardiology Elective
A rotation in cardiology is a natural complement to cardiac surgery. It is fundamental to the understanding of cardiovascular disease to appreciate both the surgical and medical aspects of this discipline. Therefore, we strongly recommend a rotation in cardiology at one of the major Delaware Valley institutions. Exposure to heart failure, electrophysiology, echocardiography, nuclear cardiology, and cardiac catheterization will be provided during this rotation.

Pulmonary Elective
An understanding of pulmonary medicine is critical to the application of thoracic Surgery. Since most pulmonary diseases are treated non-surgically, it becomes imperative to understand the pathophysiology of thoracic disorders and to be knowledgeable of the indications for surgical intervention. By rotating through this service, an additional exposure to pulmonary function tests, bronchoscopy, pulmonary radiography and clinical assessment of patients will be provided.

Radiology Elective
For both cardiac and non-cardiac thoracic diseases, a necessary skill is the interpretation of chest films. By rotating through a formal radiology course, the exposure to plain films, CT scans and MRI is maximized, and the expertise of the radiologist is directly available.

Free Elective
During this rotation, students may choose a course or experience at their discretion. However, we recommend several options. One option is a rotation at St. Christopher's Hospital for Children. This is a unique environment from which to learn high quality pediatrics. The cardiothoracic care for children is top quality, and any student rotating in the cardiology or cardiothoracic services will be rewarded by this experience. A cardiothoracic rotation at an away site is another option. Students who have an interest in a particular institution may want to exercise this option.

Return to top of page

Goals and Objectives

1. A thorough understanding of cardiac anatomy and physiology
2. A thorough understanding of thoracic anatomy and physiology
3. A thorough understanding of adult cardiac disease, specifically coronary artery disease, aortic and mitral valve disease, end-stage-heart disease/cardiomyopathy as it relates to transplantation and mechanical ventricular assistance, pericardial disease and cardiac trauma
4. A thorough understanding of adult thoracic and mediastinal disease specifically bronchogenic carcinoma, interstitial lung disease, emphysema, thoracic infection (tuberculosis, fungal, empyema), mediastinal pathology (tumors, infection cysts, etc.), pleural diseases and chest trauma
5. A thorough understanding of critical care management, including cardio-pulmonary resuscitation, ventilatory care, central venous and Swan-Gans catheters, inotropic agents, antiarrhythmic agents, intraaortic balloon pumps, ventricular assist devices, recognition of low cardiac output states, etc.
6. A thorough understanding of cardiopulmonary bypass
7. Exposure to endoscopy, including bronchoscopy, mediastinoscopy and thoracoscopy
8. Exposure to cardiac catheterization, echocardiography, nuclear cardiology and electrophysiology
9. A thorough understanding of normal and abnormal chest roentgen ography, including chest CT-scan, Magnetic Resonance Imaging and angiography
10. A thorough, hands-on experience in the Operating room to assist in all cases, with emphasis on an appreciation for the indications for surgery, principles in technique and conduct of the operation
11. Exposure to laboratory and clinical cardiothoracic research with potential for manuscript preparation and publication
12. An opportunity to experience organ procurement (via ambulance, helicopter, or airplane) and implantation for orthotopic heart transplantation
13. An opportunity to observe transplant follow-up and endomyocardial biopsy to detect rejection at the Heart Failure/ Transplant Clinic
14. An opportunity to follow-up on cardiac and thoracic cases at the weekly clinic.

Return to top of page

Manual of Perioperative Care in Cardiac and Thoracic Surgery. Second edition. Bojar, RM. Blackwell Scientific Publications, Boston, MA, 1994.

Surgery of the Chest. Sixth edition. Sabiston, DC, Jr. M.D., Spencer FC, M.D.. W.B. Saunders, Philadelphia, 1995.

Return to top of page

Evaluation of the Student
The student's performance in each rotation will be evaluated by supervising physicians, and residents when appropriate, using the standard Drexel University College of Medicine clinical evaluation form. Students not receiving a grade of satisfactory or higher will be counseled and provided with remediation.

Evaluation of 4th year Courses
Upon completion of each rotation, students are encouraged to complete the end-of-rotation evaluation form in DOCSS. Students have the opportunity to provide feedback on the rotation as well as on specific faculty (and residents) with whom they worked in DOCSS. All feedback is de-identified.

Evaluation of the Pathway
Students are encouraged to complete an end-of-year Pathway evaluation for the Pathway. The feedback from this evaluation will help in advising future students more effectively.

Return to top of page