REQUIREMENTS FOR HIGHER SURGICAL TRAINING IN
THORACIC SURGERY IN THE UNITED KINGDOM
A Trainee opting to undertake a Thoracic Surgical Consultant appointment in the UK at the end of his/her training will spend at least one year in the 1st 3rd year of the Specialty Registrarship in non-cardiac Thoracic surgery, and in the 4th and 5th year, undergo further specialized training in non-cardiac Thoracic surgery.
A Trainee opting to undertake a Cardio-thoracic Surgical Consultant appointment at the end of his/her training will spend at least one year in the 1st 3rd year of the Specialty Registrarship in non-cardiac Thoracic surgery, and in the 4th and 5th year, undergo a balanced programme of cardio-thoracic training, the details of which are currently being discussed and will be finalised during the course of year 2000
Specialization in a specific field (e.g. Transplantation and emphysema surgery, VATS, oesophageal, etc) would be possible in the final or 6th year.
A Training Programme undertaking to provide non-cardiac Thoracic surgical training should have certain facilities, personnel, case-mix and case-load as indicated below. One or more centres may be involved in providing such a programme, and should have in their midst an Approved Thoracic Trainer who will take overall responsibility for the programme
The Curriculum for the Intercollegiate Board Examination in Cardio-thoracic surgery is an entirely separate document prepared by the Training Board with the assistance of the specialty and should not be confused with this document.
Facilities
Essential:
Protected cardio-thoracic surgical beds with flexible access for cardiac and thoracic patients dictated by demand and contractual obligations.
Protected thoracic surgical operating lists.
Separate thoracic surgical out-patient sessions.
Surgical intensive care beds, shared with general surgery or with cardiac surgery.
Surgical high dependency beds shared with general surgery or with cardiac surgery.
Access to pulmonary function laboratory.
Access to pathology laboratory and a consultant pathologist with a special interest in thoracic diseases.
Access to VATS equipment in the operating theatre.
Access to Radiology department with contrast screening, computed tomography, ultrasonography and isotope scanning.
Desirable:
Facilities for clinical and laboratory based research.
Access to thoracic emergencies and trauma.
Access to magnetic resonance imaging.
Access to endo-ultrasonography and facilities for stenting the upper GIT and respiratory tract.
Laparoscopy facilities in the operating room.
Educational Requirements
Essential:
Satisfactory on-call and study arrangements in keeping with current regulations.
Multidisciplinary Calman-Hine and audit meetings with facilities for computerized data collection.
Access to medical Library, PC with Internet connections including Medline (or similar).
Personnel
Essential:
A minimum of the Equivalent of a Full-time Consultant in non-cardiac thoracic surgery is an absolute requirement. This is best achieved with at least One full-time consultant in non-cardiac thoracic surgery.
Where the above is not available, an absolute requirement would be that the full-time equivalent be made up of no more than three cardio-thoracic consultants, one of whom should have a greater than fifty percent commitment to non-cardiac thoracic surgery.
In either case there should be adequate additional consultant support in the totality of the cardio-thoracic surgical specialty.
Consultant anaesthetist with a special interest in thoracic surgical anaesthesia.
Access to consultant radiologist, oncologist, histopathologist with special interest in thoracic diseases.
Consultant support in respiratory medicine.
Desirable:
Consultant support in gastro-enterology.
Case-mix and Case-load
Essential:
The training unit/units should be performing no less than 250 major operations per year (this figure to include pulmonary, oesophageal, mediastinal and chest-wall procedures).
The unit/units should in addition be undertaking 50 100 VATS procedures per year.
Rigid and flexible endoscopy for the Respiratory and upper GI tracts of a significant number
Desirable:
Access to emphysema surgery.
Access to pulmonary and cardio-pulmonary transplantation.