Currently, there are three training pathways in cardiothoracic surgery, including:
1. Independent Programs (also known as the Traditional Pathway — 5 years of general surgery, plus 2-3 years of cardiothoracic surgery residency);
2. Integrated Pathway (also known as I-6 — 6 years of cardiothoracic surgery residency); and
3. Joint Thoracic/General Surgery Track (also known as the Fast-track Pathway — 4 years of general surgery, plus 3 years of cardiothoracic surgery residency), all completed at one institution.
The application process, curriculum, and board certifications involved in each of these pathways varies dramatically.
Traditional Pathway (5 Years General Surgery, plus 2-3 Years Cardiothoracic Surgery)
Medical students apply to and complete a general surgery residency program (5 clinical years), consisting of clinical rotations through the various surgical disciplines. During the fourth general surgery clinical training year, residents apply for a residency position in cardiothoracic surgery. Clinical training in cardiothoracic surgery varies between 2 and 3 years in length. Following successful completion of training, residents are able to apply for certification by both the American Board of Surgery and the American Board of Thoracic Surgery. Additional experience, if desired, can be obtained in a number of different fellowship opportunities, including heart failure/transplantation, thoracic aortic surgery, congenital heart surgery, or thoracic surgery. The Accreditation Council for Graduate Medical Education (ACGME) website provides a listing of traditional thoracic surgery residency programs. Visit https://apps.acgme.org/ads/public/ for more information.
Fast-track Pathway (4 Years General Surgery, 3 Years Cardiothoracic Surgery)
Medical students apply to one of the participating general surgery residency programs that offer a fast-track pathway. Residents interested in fast-track programs generally apply after their second year of general surgery residency, although at many institutions the application process is informal, involving discussions between the general surgery and cardiothoracic surgery program directors. For a given institution’s fast-track program, only general surgery residents at that same institution are eligible. Residents who complete this track are eligible for board certification by both the American Board of Surgery (after General Surgery Training) and the American Board of Thoracic Surgery. Residents continue having exposure to the different fields of surgery before deciding on cardiothoracic surgery (conversely, programs can assess residents’ performance in general surgery) and residents maintain the experience of the general surgery chief resident year. Contact ACGME at 312-755-5000 for a listing of 4/3 programs.
Integrated Pathway (6 Years Cardiothoracic Surgery)
Medical students apply directly to an integrated cardiothoracic surgery residency program, similar to standard applications for other residency programs. The overarching objective of this training program is to provide a more comprehensive and rational total immersion in the diagnosis and management of all aspects of cardiovascular and thoracic diseases through multidisciplinary training, including rotations in interventional radiology, interventional cardiology, endovascular surgery, oncology, and pulmonary disease. Upon completion of an integrated residency, residents are eligible to sit for American Board of Thoracic Surgery certification, but not for the American Board of Surgery certification. Visit https://apps.acgme.org/ads/public/ for a listing of integrated thoracic surgery residency programs.