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THORACIC SURGERY
FELLOWSHIP TRAINING PROGRAM
SECTION PAGE
Introduction 2
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■General Objectives つ４
III Specific Objectivesつ
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IV Admission Requirements 2
V Structure of Training Program
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DurationTraining CapacityFaculty QualificationsClinical RotationsRequire Basic KnowledgeFacilities & Resources
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VI Program Content 4‐ 5
VII Evaluation & Promotion 6
VIII Completion 7
IX Duties, Leaves. & Holidays 7
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I. INTRODUCT10N
King Faisal Specialist Hospital and Research Center (General Organization) [KFSH&RCGen.Org.], a major tertiary care referral institution in the Kingdom and the region"provides for advancement in medical postgraduate education. Outstanding teachingfacilities, with the latest in medical equipment and current technological expertise supportthe training programs for physicians at KFSH&RC (Gen.Org.). The Research Center, avaluable resource, provides a learning opportunity in basic and advanced research andoperative techniques. Academic and Training Affairs (ATA) is continually committed tothe development and maintenance of quality training programs responsive to the needs ofthe Hospital and the Kingdom.
Thoracic surgery (TS) is one section of the Department of Surgery providing advancedcare in a highly specialized structure according to the policy of the Department ofSurgery.
H. GENERAL OBJECTIVES
In keeping with the highest international standards of training, the TS Service atKFSH&RC (Gen.Org.) provides a training program for surgeons who wish to specializein thoracic surgery. We are in a period of rapid change in medicine, and this isparticularly true with regards to thoracic surgery where technology is being introduced atan ever-increasing rate. Our aim is to train highly skilled surgeons who are competent inthe specialty of TS.
HI. SPECIFIC OBJECTIVES
To have in place a structured program for candidates pursuing a career in thoracic surgeryconducive to a learning environment and to pursue the latest advances in patient care.The program aims to produce competent, safe and effective individuals who can providehigh-quality care while realizing any limitations within their own disposition or withinthe institution where they may practice.
IV. ADMISSION REQUIREMENTS
Candidates must have completed residency training in General Surgery. Applicantsshould possess a Saudi Specialty Certificate or must have at least passed the writtenexamination and registered for the final parts. Other candidates must possess anequivalent certification. Candidates must have successfully completed a personalinterview by the members of the department. Three recent letters of recommendationalong with other required documents of certification should support the application of thecandidate. A sponsorship letter should be submitted.
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Vo STRUCTURE OF TRAININC PROGRAⅣI
A. Duration
The program is a three-year f'ellowship training. The candidate has the option tospend the 3'd year abroad.
B. Training Capacity
One candidate can be accepted in the program every one to two years.
C. Faculty Qualilications
There are four consultants with broad range of surgical experience and expertise.Each surgeon has a minimum of eight years of post-residency surgical practice.Subspecialty rotations will be with recognized training programs, both within andoutside of KFSH&RC (Gen.Org.).
D. Clinical Rotations
33 months in thoracic surgeryI month in cardiac surgeryI month in pulmonary medicine / pulmonary functions lab.I month in upper GI endoscopy and esophageal function lab
E. Required Basic Scientific Knowledge
L Review of the anatomy, physiology, as well as management of acute andchronic surgical problems.2. Knowledge of surgical diseases.3. Endoscopic and surgical management skills.4. Indications/contraindications for thoracoscopic surgery.5. Preoperative assessment and postoperative care of surgical patients.6. Identify and manage acute thoracic surgery complications.7. Trouble shooting of thoracic surgery instruments and machines.
F. Facilities and Resources
l. The program will be conducted at KFSH&RC (Gen.Org.) with possiblerotations at other teaching hospitals.2. Two full OR days of elective surgery time are provided per week with anaverage of 250 major thoracic procedures per year including 150 thoracotomies.3. Five inpatient beds are assigned to the TS Service. Two surgical outpatientclinics per week with an average of 50 patients per month, of them 20o/o are newpatients.5. The surgical intensive care unit provides state-of-the-art support.6. State-of-the-art interventional radiological support for diagnostic andtherapeutic intervention.
7. Online access to surgical journals through the Health Sciences Library.8. A modern Endoscopy unit for performing the flexible Bronchoscopy andEsophagogastroscopy.
VI. PROGRAM CONTENT
This educational program is designed to offer broad clinical experience in themanagement of all disease processes relating to the specialty as described below. Alsocandidates will be obliged to interact with other specialties where there is overlap withregards to management of patients; for example, with pulmonology and radiology.The fellow will be expected to have a thorough knowledge of all of the following diseaseprocesses. including clinical presentations, diagnostic investigations and all aspects ofmedical and surgical care. The candidate should be fully familiar with both the minimallyaccess methods of surgical treatment as well as open techniques. A logbook of allprocedures performed under supervision, or independently, should be kept fordocumentation and presented at the end of each quarter for the fellow's promotion andcompletion of the program. Regular literature search of current surgical journals and forany unusual disease processes should be undertaken.
Following is a partial list of areas of main concern:
l. Diseases of the lung, including lung fibrosis, infections, inflammatory disease.tumors. & congenital anomalies.
2. Thymus diseases. including thymoma, myasthenia gravis, & types of resections.3. Mediastinal tumors, including benign & malignant germ cell tumors. benign &
malignant neuroginc tumors, & lymphoma.4. Mediastinal cyst (diagnosis & management).5. Chest wall diseases, includes tumors, congenital anomalies, & infections.6. Pleural diseases, including effusions, tumors, infections, & pneumothorax.7. Thoracic trauma (blunt & penetrating injuries, diaphragmatic injury, foreign body
inhalation, & ARDS).8. Esophageal disease, including trauma, benign & malignant tumors.9. Tracheal disease, including tracheal stenosis, benign & malignant tumors.10. Diaphragmatic disease, including tumors & congenital hernias.
Following is a partial list of procedures that the fellow will encounter:
1. Repair of congenital chest wall malformationa. Pectus excavatumb. Pectus carinatum
2. Thoracic trauma surgerya. Minor proceduresb. Major procedures
3. Chest wall tumors resection4. Mediastinal procedures
a. Mediastinscopyb. Tumor resection ( thymus, germ cell tumors .. etc)
5. Bronchoscopy
6. Pulmonary resectiona. PneumonectomYb. Lobectomyc. SegmentectomY
7. Lung transplant8. Video-assisted thoracic surgery
a. Lung biopsyb. Metastectomyc. SympathectomYd. Some esophageal surgery
9. Pulmonary Sepsis and Hydatid disease surgery10. Surgery of Diaphragmatic Hernias1 l. Pericardial surgery12. Esophageal surgery
a. Esophagescopy (rigid & flexible)b. Esophagectomy and Replacementc. Esophageal myotomy
13. Tracheal Surgery
OPERATIVE EXPERIENCE
By the end of training, the fellow should have performed the fbllowing numbers ofoperations:
l. Repair of congenital chest wall malformation 25 cases2. Thoracic trauma surgery 30 cases3. Chest wall tumors resection 25 cases4. Mediastinoscopy 100 cases5. Resection of mediastinal tumors 50 cases6. Bronchoscopy 150 cases7 . Pulmonary resection 100 cases8. Video-assisted thoracic surgery 100 cases9. Bronchiectasis and hydatid cyst surgery l0 cases10. Esophageal surgery 50 casesI I . Surgery for the Diaphragm l0 cases12. Tracheal surgery 15 cases
TEACHING ACTIVITIES
The fellow is expected to regularly attend the teaching activities. He/she should activelytake part in teaching activities by helping to provide teaching material, participate andcontribute enthusiastically in discussions at educational activities.
FELLOWS RESPONSIBILITIES
l. The fellow will take calls on a one-in-three schedule that will be on a day-by-dayor weekly basis. The fellow will generally be second on call, after the juniorresident. On call duties will comprise of evaluating new consultations throughout
the Hospital and fiom the emergency room. as well as providing coverage foipostoperative patients and evaluation of preoperative cases as required. Theseactivities will support the junior on call staff.The fellow shall be responsible for inpatient care. including admitting patients,ordering investigations, reviewing results, obtaining intbrmed consents,preoperative assessment, postoperative care, discharge summaries and any otherrelevant reports.The fellow will join the team of any other service during his/her rotation andparticipate and contribute as an active member of that team.The fellow shall attend clinics at least once a week and participate in themanagement plans of patients.The f'ellow shall attend and participate during operative sessions. conducted at theOperating Rooms, outpatient or day surgery units, based on their rotations.The fellow shall maintain healthy relations with the patients. patient's relatives,colleagues and hospital staff.The fellow shall maintain confidentiality and ethics of the profession.The fellow shall have the ability to communicate with the patients and health careproviders as an essential part in becoming a consultant. He should have an attitudetowards self-teaching, self-motivation and learning and performing clinicalresearch.
Log Book
The fellow will keep a logbook of all procedures performed and attended in the operatingroom. The book will be reviewed and signed on a three monthly basis.
Research
The fellow will be expected to undertake a research project and to aim to have at leastone publication in a reputable journal each year. He or she will also be eligible to presentat the Annual Research Day, or be a mentor to the junior staff with the preparation oftheir presentations.
VII. EVALUATION AND PROMOTION
The fellows level of competence and performance will be evaluated at a frequencydetermined by the Postgraduate Education Committee and in the manner as described inthe Policy for Fellowship Training Program. A self-assessment examination covering thedifferent topics in the subspecialty will be given at the end of each year of the fellowshiptraining. A fellow's advancement from year to year is contingent upon professionalperformance and personal growth. The criteria for promotion are as enumerated in thePolicy for lellowship Training Program. Unsatisfactory perforrnance may require thecandidate to repeat the year or be dismissed from the program in accordance with theHospital rules and regulations.
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VIII. COMPLETION
On completion of the program the fellow will be evaluated by the consultants of theSection. the surgery fellowship Program Director as well as other senior Hospital staff.Satisfactory completion and review will result in identifying the fellow as havingsatisfactorily completed the fellowship program. A certificate will be issued indicatingthat the fellow has successfully completed the fellowship program in Thoracic Surgery.
IX. DUTIES, LEAVES & HOLIDAYS
Regulations governing duties, leaves and holidays are as stipulated in the Policy forFellowship Training Program. He will be entitled to have one month annual leave andone Eid holiday.
n: l7Dec20l Ia dm i n/Tr a i n i n g/ P r ogr u m Ll a rut a I s _R es F e I /Sur ge ry
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