Thoracic Surgery

Attendings

Gary M. Hochheiser, MD
Gary M. Hochheiser, MD		 https://www.mainehealth.org/Provider-Directory/Q/Quadri-Syed-M
Syed M. Quadri, MD		 https://www.mainehealth.org/Provider-Directory/Q/Quadri-Syed-M
Jennifer M. Burg, MD

Thoracic Surgery Service Resident Expectations

Updated March 10th, 2024.

  1. General surgery residents will assess patients with thoracic surgical disease processes in both the inpatient and outpatient settings.
  2. General surgery residents will become proficient in the medical and surgical management of thoracic surgery patients in the pre and post-operative periods.
  3. Residents will learn appropriate testing specific to the diagnosis, staging, and general work-up of malignant and benign thoracic disease.
  4. Residents will learn indications (including cardio-pulmonary evaluation) and timing of thoracic procedures.
  5. Residents will develop an understanding for multi-disciplinary management of thoracic oncologic disease
  6. General surgery residents will develop their communication skills and become comfortable counseling patients with advanced oncologic disease and poor prognosis.

Goals and Objectives by post-graduate year

PGY2

Knowledge base:

  • Anatomy of relevant thoracic structures
  • Cardio-Pulmonary & esophageal physiology
  • Workup for pulmonary nodules, esophageal obstruction, and mediastinal masses
  • Workup of benign esophageal disease
  • Workup and management of pleural disease
  • Decision algorithm for pneumothorax & pleural effusion management
  • Molecular biology of neoplasms and cell cycle control
Patient assessment:
  • Role and assessment of pulmonary function testing
  • Arrhythmia recognition and treatment

Radiographic assessment:

  • Assessment of normal and abnormal CXR
  • Evaluation of chest and abdominal CT scans

Technical skills:

  • Competency in: suturing, cautery, and handling tissue
  • Competency in assessment and management of chest drains
  • Progressing toward competence:
    • Chest tube / pigtail catheter insertion and/or removal
    • Establishing access into chest for VATS procedures
    • Bedside assist for ROBOTIC procedures
    • Bronchoscopy/UGI endoscopy

PGY 3-5

(In addition to expectations and goals for PGY-2)

Knowledge base:

  • Staging of lung and esophageal malignancies
  • Multidisciplinary management (medical / radiation / surgical) for thoracic malignancies:
    • Lung cancer
    • Esophageal cancer
    • Mediastinal malignancies

Patient assessment:

  • Esophageal manometry & pH studies
  • Barium swallow studies

Technical skills:

  • Progressing toward competency:
    • VATS or robotic or open pulmonary wedge resection
    • Understanding anatomy for anatomic lung resection (lobectomy / segmentectomy)
    • Teaching console proficiency for portions of ROBOTIC procedures Thoracotomy incision / Sternotomy incision
    • Esophageal & Gastric mobilization
    • VATS or open Pulmonary Decortication

Clinic

Residents are mandated to attend at least 1/2 day clinic per week.
Clinic is located at100 Campus Drive, Scarborough, ME
  • Monday: SMQ
  • Wednesday: GH / JB
  • Friday: GH / SMQ / JB

OR Schedule

  • Monday - GH
  • Tuesday - JB
  • Wednesday - SMQ (usually robotic)
  • Thursday - GH/ SMQ/JB

Rounds, education, meetings

  • Thoracic Tumor Board Conference, Fridays 0700-0800 (Zoom)
  • Matrix Nodule Conference, Fridays 0800-0900 (Zoom)
  • Resident Teaching Conference / Journal Club Thursdays 1100-1200 (scheduled by Attendings)

Morning on service

  • Morning Routine Night Sign Out: 5:30-5:45am – resident call room from night resident
  • Morning Report: 6:15-6:30am M-F @ R1 chart room
  • Present admits/transfers, complications, escalations of care, o/n events
  • Daily Rounds: M-F 6:30am-7:15am – (Time w attendings TBD)
  • DC Planning: Update dc planner(s) prior to 11:00am DC rounds and PRN

Rounding

  • All notes should ideally be written no later than noon.
  • Primary patients: Progress note daily (ideally by 10am)
  • Consult: Progress note minimum 2-3x/week; daily PRN
  • ICU: Progress note daily (ideally before 9am), we remain primary, CVCC will consult but not take over

Orders

  • Utilize pathway sheet PRN
  • Use Thoracic Surg Thoracic Surg Adult post op set for lobe, wedge, decortication
  • Use Thoracic Surg Esophagectomy Adult post op set for esophagectomy
  • Use any General Admit Order Set comfortable utilizing and add orders PRN for admits and re-admits

Charting

  • Change your service to Thoracic Surgery or Thoracic Oncology
  • Admission / Consult / Progress Note: utilize admission template you are most comfortable using
  • Discharge Summary: utilize thoracic surgery discharge template (ask APP)
  • Discharge Instructions: utilize smart phrase for specific procedure, approach, and discharge location (created at direction of Attendings, ask APP)

Arranging Follow-Up

Send new message via in-basket to “mmc thoracic onc clinical pool” with patient name and date of discharge; the office will then reach out to the patient to arrange appropriate follow up appointment with any necessary imaging.

Other daily tasks

  • Update sticky note frequently especially on Friday with weekend plans
  • Update DC summaries on primary patients PRN
  • Review primary pt’s orders; update/clean up PRN
  • ENSURE THAT labs/XRay’s are ordered for next day or over weekend

Schedule