Education

Since the early 1950s, Allegheny General Hospital has sponsored training opportunities in cardiothoracic surgery. This highly regarded and experienced program offers a rich case mix of adult cardiac and general thoracic patients drawn from a network of affiliated clinical sites serving western Pennsylvania. The Department of Thoracic and Cardiovascular Surgery comprises the Divisions of Cardiac Surgery, General Thoracic Surgery, Vascular Surgery and Critical Care Medicine. Five cardiac surgeons, three general thoracic surgeons, and five vascular surgeons serve as faculty for the Allegheny General training programs. All are board-certified in their specialties and participate fully in teaching.

The ACGME accredited training programs sponsored by the Department of Thoracic and Cardiovascular Surgery at Allegheny General offer a unique opportunity for collaborative education.

These programs include:

Traditional two-year residency in thoracic surgery

Traditional two-year vascular surgery fellowship

(NEW) Integrated seven-year sequential program in vascular and cardiothoracic surgery (leading to board certification in both Thoracic and Vascular Surgery.)

Thoracic surgery training is supervised by:

George J. Magovern Jr., MD, program director, Thoracic Surgery

Robert J. Keenan, MD, program co-director, General Thoracic Surgery

Stephen Bailey, MD, program co-director, Cardiac Surgery

Satish C. Muluk, MD, program director, Vascular Surgery, directs the vascular surgery training programs, including co-direction of the integrated seven-year program, and all collaborative training in vascular surgery and vascular interventional procedures.

Victor O. Morrell, MD, chief, Pediatric Cardiothoracic Surgery, Children’s Hospital of Pittsburgh, is responsible for resident training in Pediatric Cardiac Surgery.

Residents and fellows in the department benefit from readily available access to all department teaching opportunities. The comprehensive endovascular program is a cooperative effort of the Division of Vascular Surgery, the Division of Vascular and Interventional Radiology and the Division of Cardiac Surgery with dedicated support from the thoracic aortic surgery team.

Integrated Sequential Program in Vascular and Cardiothoracic Surgery

The new Allegheny Integrated Sequential Program in Vascular and Cardiothoracic Surgery, under the direction of George J. Magovern, Jr., MD, and Satish C. Muluk, MD, enrolled its first resident in July 2010. The program is designed to provide a focused clinical and didactic curriculum for the medical school graduate, leading to board certification in both Thoracic and Vascular Surgery.

The program begins with five years of integrated vascular surgery training, preparing the resident to sit for the board examination in vascular surgery. The resident then completes two years in the Allegheny thoracic surgery program leading to certification by the American Board of Thoracic Surgery.

Curriculum in Thoracic and Vascular Surgery

The first year of training comprises three four-month blocks, supervised by vascular, general thoracic or cardiac surgeons. A faculty member meets with the first-year resident twice each month for one-on-one medical knowledge review and mentoring. A skills laboratory under the direction of a thoracic surgeon is held bi-monthly during years one through three, with additional and/or remedial training available in subsequent years.

The curriculum is structured to allow the resident to complete board requirements for vascular surgery certification following year five. The commitment to complete thoracic surgery training (sixth and seventh year) and sit for the board exam in thoracic surgery is made at the end of post-graduate year four.

The curriculum is designed with rotations which are clearly relevant to the fields of thoracic, cardiac and vascular surgery. All of the procedures learned comprise important elements of the requisite skill set. The development of competencies is enhanced by the fact that the resident works with leaders in cardiothoracic and vascular surgery throughout his or her training.

Graduates of the program will possess a skill set which is uniquely attractive to those healthcare facilities looking for flexibility in meeting their service requirements. Obviously, a small but important set of graduates will be attracted to this training to enhance concentration in one of the three disciplines by development of an advanced skill set. It also appeals to those planning an academic or research career.

Examples of practice options include:

1. Adult cardiac surgery in a university hospital with an emphasis on high acuity end-stage heart failure procedures, including heart transplantation, left ventricular assist device implantation, minimally invasive valve and coronary bypass procedures, percutaneous valve procedures, robotic procedures, great vessel endovascular procedures and atrial fibrillation procedures.

2. Adult general thoracic surgery in a university hospital, with an emphasis on either thoracic oncology or lung transplant.

3. Vascular surgery in a university setting with an emphasis on endovascular therapies, including great vessel procedures.

4. Community hospital cardiovascular surgery performing conventional cardiac and vascular procedures.

5. Community cardiothoracic surgery performing conventional cardiac surgery and general thoracic procedures.

6. Community hospital practice in conventional thoracic and vascular surgery.

7. Surgical critical care in a unit devoted to thoracic and cardiovascular surgery.

In addition, the graduate would bring unique skills to training programs in pediatric heart surgery.

Traditional two-year residency in thoracic surgery

Under the direction of George J. Magovern Jr., MD, the Allegheny Thoracic Surgery Residency Program comprises two years of clinical training. A pediatric cardiac surgery rotation is provided by the Children's Hospital of Pittsburgh under the direction of Victor O. Morell, MD.

Residents may elect to concentrate in either cardiac surgery or general thoracic surgery but must meet all current requirements for ABTS certification in cardiothoracic surgery.

The Allegheny Thoracic Surgery Program is noted for the collegial teaching environment engendered by the faculty. The faculty currently includes eight board-certified cardiothoracic surgeons; residents are rotated among all of the cardiothoracic faculty to provide a broad range of experience and teaching styles. The faculty and staff of the program are committed to offering a high quality educational environment and receive strong support in this effort from the Allegheny General leadership.

Senior thoracic surgery residents serve as the first line of supervision for cardiothoracic services, functioning as "junior attending surgeons" under the guidance of the faculty. Residents take no in-house call and their home call assignments are supported by the general surgery residents rotating on the cardiothoracic services. The department's Division of Critical Care Medicine provides 24/7 in-house coverage for patients on the critical care units. The home call resident is responsible for returning to the hospital to participate in the evaluation and care of patients requiring emergency surgical intervention. The in-house critical care specialist is available to advise the home call resident on all patient care issues. While on home call, residents report to and are supported by the attending cardiac and general thoracic surgeons on call, and by the patient's attending surgeon.

Clinical services are also supported by physician assistants, nurse practitioners and dedicated clinical trial managers.

Amenities for thoracic surgery residents include generous office space, individual computers and standard office software. Two weeks of vacation are provided annually, with an additional five days off during December. In addition, attendance at one national conference is supported.

Academic achievement is fostered by an active clinical and laboratory research program. The McGinnis Center for Innovation and Research, located within the clinical facility, houses fully equipped and staffed research laboratories and ORs.

Resident participation in research and other scholarly pursuits is expected and supported. Department personnel skilled in data management, statistical analysis and technical writing are readily available to assist the resident. The department maintains comprehensive databases focused on in-patient quality assurance and outcomes analysis, including risk stratification modeling. Residents can access this data for patient review and research.

Allegheny General Hospital

Allegheny General Hospital, part of the West Penn Allegheny Health System, was founded in 1885 on Pittsburgh's historic North Side. Allegheny General Hospital is a tertiary care facility which has earned an international reputation for excellence and innovation in patient care, medical education and research. Serving Pittsburgh and the surrounding five-state area, the 631-bed academic health center offers a wide array of medical and surgical services.

Division of Cardiac Surgery
Stephen Bailey, MD, Director
The Division of Cardiac Surgery has expertise in all types of adult cardiac surgery, including coronary artery bypass and cardiac valve repair and replacement, performing more than 500 cases per year. The division is the region's most experienced center for surgical treatment of acute and chronic thoracic aortic disease and thoracic aortic trauma. Minimally invasive endovascular aortic repair is offered by a unique multidisciplinary team comprising cardiac surgeons, vascular surgeons and interventional radiologists. The cardiac arrhythmia service provides standard and minimally invasive approaches to the treatment of atrial fibrillation. As leading partners in the Allegheny General multidisciplinary Heart Failure Service, division surgeons direct active heart transplantation and mechanical heart assist programs. Innovative surgical therapies for heart failure, including left ventricular reduction surgery are also offered.

Division of General Thoracic Surgery
Robert J. Keenan, MD, Director
In western Pennsylvania, non-cardiac thoracic disease is a particularly prominent healthcare problem. The Division of General Thoracic Surgery, and the multidisciplinary Allegheny Center for Lung and Thoracic Disease, provides comprehensive and innovative diagnosis, treatment and surgery specifically directed to benign and malignant diseases of the lungs, esophagus and mediastinum. Seasoned clinicians using the latest techniques and technologies offer the best possible care and convenience for patients and families confronting cancer. Access to a full range of ACOSOG protocols and other innovative clinical trials is provided in collaboration with the Allegheny Cancer Center. The division supports these efforts with a staff of four clinical research specialists.

General thoracic surgery specialists now perform over 550 major procedures each year, more than half employing minimally invasive techniques. In addition to curative and palliative procedures for thoracic malignancies, the division has long-term expertise in thoracic surgery for benign conditions, including lung volume reduction, gastroesophageal reflux, hyperhidrosis and thymectomy for myasthenia gravis.

Division of Vascular Surgery
Satish C. Muluk, MD, Director
The Division of Vascular Surgery at Allegheny General comprises five board certified vascular surgeons. More than 2000 major surgical procedures are performed each year for all types of vascular diseases including abdominal aortic aneurysm, carotid stenosis, peripheral arterial disease and venous disorders. The Division is a regional leader in the use of endovascular techniques for aortic aneurysm, carotid stenosis and lower extremity arterial disease. Allegheny vascular surgeons have a long tradition of working in cooperation with cardiac surgeons and members of the division of vascular and interventional radiology As noted above, the Division faculty supports ACGME accredited training programs in vascular surgery and welcomes thoracic surgery resident participation.

Division of Critical Care Medicine
Peter K. Linden, MD, Director
An essential component of training in perioperative patient care is provided by the Allegheny critical care specialist team. Five board-certified critical care physicians work with thoracic surgery residents in both clinical and didactic settings. The critical care team provides 24/7 coverage for department patients; members of the team are always available to advise the resident on patient care issues.
 
Children's Hospital of Pittsburgh
Victor O. Morell, MD, Director of Pediatric Cardiothoracic Surgery

Children’s Hospital of Pittsburgh is renowned for cardiology, cardiothoracic surgery, critical care medicine, diabetes, hematology/oncology, neurosurgery, organ and tissue transplantation, orthopaedics, otolaryngology (ENT) and pediatric surgery. Children’s Hospital is also the only accredited Level 1 Regional Resource Pediatric Trauma Center in western Pennsylvania and one of only three in the state. Residents in the Allegheny thoracic surgery training programs complete two-month rotations in pediatric cardiac surgery under the direction of Dr. Morrell and his team. This rotation consistently receives enthusiastic reviews from Allegheny residents based on the collegial teaching atmosphere and case mix.

Gerald R. McGinnis Cardiovascular Institute

In September 2006, Allegheny General Hospital officially dedicated the Gerald R. McGinnis Cardiovascular Institute (CVI). Located on the grounds of the hospital, CVI comprises 18,000 square feet of space dedicated to outpatient consultation and diagnostic services in a multi-disciplinary clinic dedicated to research, diagnosis and treatment for cardiovascular disease. This critically important initiative was endowed by a federal seed grant and the generosity of regional business leaders. CVI is designed to operate as a unifying structure for delivery of exceptional patient-centered care and state-of-the-art clinical research. Established CVI centers focus on:

• Valvular heart disease / complex valve disease
• Heart failure
• Ventricular assist
• Cardiac transplant
• Pulmonary hypertension
• Atrial fibrillation
• Vascular disease
• Comprehensive aortic repair / replacement
• Chronic wound management

The CVI serves as an outstanding venue for recruiting some of the nation's finest physicians and researchers to join the legacy of the highly regarded and experienced Allegheny team. The Institute is headed by surgical director George Magovern, Jr., MD, and medical director Srinavas Murali, MD. CVI-sponsored educational programs bring nationally recognized clinicians and researchers to Allegheny in a variety of forums which emphasize the role of both medical and surgical approaches to cardiovascular disease.

In a unique approach to connecting the medical community with the public it serves, CVI also sponsors a popular annual event featuring prominent speakers from non-medical fields. Past speakers include author David McCullough, journalist Tim Russert, film-maker Ken Burns, political commentator David Gergen and presidential author Doris Kearns Goodwin.