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Cardiothoracic Surgery | Jason Kho

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Summary

In a lively and engaging session, Jason Co, a SC3 C surgery registrar based in Southampton, shares insights about a career in cardiothoracic surgery. He offers an overview of cardiac and thoracic specialties, the history of cardiac surgery, and various subspecialities within adult cardiac surgery. His presentation includes detailed discussions about procedures, as well as tips and resources. He also talks about various training pathways to becoming a cardiothoracic surgeon and the competitive nature of recruitment in this field. This on-demand teaching session will be beneficial for medical professionals inclined towards cardiothoracic surgery or those who are in the process of application.

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Description

Kickstart your surgical journey with one of the UK’s most popular surgical careers events!

Virtual format

Kickstart your surgical journey with one of the UK’s most popular surgical careers events! Explore every surgical specialty, gain invaluable insights, and discover what it takes to succeed. Connect and get personalised career advice through one-on-one sessions with surgical trainees to enhance your portfolio and address your burning questions. Don’t miss this chance to lay the foundation for your future surgical career!

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Learning objectives

  1. Define and distinguish between different types of cardiothoracic surgeries, including the subspecialties within this field.
  2. Understand the history and evolution of cardiothoracic surgical techniques and the impact of breakthroughs such as the heart lung bypass machine.
  3. Identify the various patient care aspects specific to cardiothoracic surgery, including pre and post-operative care and long term treatment strategies.
  4. Familiarize with current technological trends and advances in cardiothoracic surgery, such as minimally invasive procedures and the use of robotics.
  5. Understand the structure and requirements of the training pathway for cardiothoracic surgery in the UK.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

So, next we have Jason who will be speaking about a career in cardiothoracic surgery. He's currently a registrar and, uh, I'm sure we'll be swinging you towards, uh, his specialty today. Um, hi, Jason. How's it going? Hi, how are you? Not too bad. Not too bad. Are you able to share your slides? Uh, yeah. How's it looking? That's perfect. The floor ready? Ok. All right. Thanks Jono. Uh, Jono did pre war me that I might overrun. So I do apologize in advance. I think it's so difficult to, um, to, to sort of sum up everything in, in such a short, uh, amount of time. Um, anyhow, my name is Jason Co, I'm, I'm currently in SC three C surgery based in Southampton. And, um, this is just a little talk to about cacic surgery as a career. Hopefully, I will inspire some of you to pursue this route and for those of you who are applying, um, I will be talking a little bit about the application process. So this is just an overview of, of, of my presentation. Um, I'll talk a bit about the history and the subspecialties, um, the training pathway, my personal experience, pros and cons of the specialty and some, some tips and resources that might be useful. So broadly speaking, um uh cardiothoracic surgery is divided into cardiac and thoracic. And then within uh cardiac, there's adult cardiac and congenital cardiac. Um Some may say that if you enjoy the resection, uh work, taking things out, then you might wanna do thoracic. And for those of you who enjoy uh reconstructing or, or putting things back to what it should look like, then you might enjoy cardiac more. But essentially within these specialties, there are, there are further uh subspecialties which I will uh sort of briefly mention. Um I think it's, it's um it's essential to talk about uh history uh whenever we talk about surgical specialties and certainly uh cardiac surgery has a very interesting history. Um It is uh probably one of the um uh sort of infant um surgical specialties, I might say because the history sort of dates back to only about 100 years ago. Um and it used to be thought as a taboo to operate on the heart. Um And most of the operations to begin with um was carried out by, by maverick surgeons who who operated on mainly trauma related um um injuries and then following on some of the congenital stuff. Uh but essentially at that time, they could only operate on, on the vessels or the things outside the heart, but not really the heart itself. And what really enabled us to operate on the heart itself was uh the advent of the heart lung bypass machine, um where we could stop the heart and essentially operate on the bloodless field. Um That then further on allowed us to evolve the specialty we then carried out the procedures on on the coronary vessels, the valves, and then enabled us to do heart transplantation as well as we were able to cool patients down. Um And obviously, uh more, more recently, we, you know, most of the procedures nowadays are uh quite interventional based and, and perhaps, you know, the so the cardiology surgery was. But you know, it, it uh at the end of the day, it's all about a multidisciplinary approach to how, how we look after patients. And increasingly we, we have a, we have very, very frequently speak to our cardio cardiology colleagues about what's the best thing for our patients. Um It is obviously a very interesting specialty where you do need a lot of um knowledge and physiology, pharmacology, anatomy intensive care medicine, which makes it even more interesting and, and very variable in terms of what we do and what we have to manage. This is uh Mr uh doctor who is a poly surgeon who did the first heart transplant in Poland. Um You may have seen this uh picture showcase in National Geographic uh magazine, but essentially um he performed the first heart transplant. Um You can see that you know, the registrar after a 23 hour long operation is taking a nap, then that's doctor himself looking after his patient babysitting them. And on the right, that's his, uh, that's one of his heart heart transplant recipient who actually outlive uh the surgeon himself. Um, but you know, it, the one of the key aspects of, of chiropractic surgery as well is, is about looking after after our patients. Um, and as much as you know, we can be perform the operation. Um One of the interesting aspects of the specialty is actually looking after them and understanding their physiology and, and seeing them improve day by day. These are some of the subspecialties within uh card adult cardiac surgery. Um The bulk of our workload is is coronary vascularization or, or, or C ABG operations or caps as we, as some of us call it. Um and, and also aortic and mitral valve surgery. Um uh the emergencies that we mainly deal with uh things like aortic dissections and very rarely trauma. Um There are few transplant centers uh in the UK and in these transplant centers, there's usually also heart failure surgeries such as um ventricularis devices. Um Increasingly, we are trying to adopt a minimally invasive approach uh towards cardiac surgery. Traditionally, we have always done a soot toy where we sort of um go through the, the sternum in order to access the heart. But nowadays, we try, we try to do it um through smaller cuts to reduce the risk of infection. Generally speaking, it helps our patients recover quicker as well. So, um there, there are operations like a mini mitral, a mini sonos A A VR. Um unfortunately, we, we haven't really adopted robotic cardiac surgery in the UK, but I know in other parts of the world it is something that is routinely being done. Uh And of course, um sometimes we do do combined procedures with our cardiology colleagues um doing uh uh transeptal valve insertions. Um and also some of the mitral valve interventions. These are just some of the um images. Um So on the top uh left hand corner, that's edema, harvesting your left internal mammary artery below is ST vein and then radial artery at the most bottom. Um You can see that most of the work you do is quite intricate. And if this is something that you are interested in sort of fine dissections and fine stitching, um this might be a career you wanna consider uh with the valve valve replacements and valve repair where it requires a lot of knowledge about sort of physiology and, and physics and how, how, how sort of hemodynamics and blood flow and the contraction of the heart relates with with the valve function. Um There's just a short clip to show um an aneurysmal aorta. Actually, this patient percent of aortic dissection, you can see how thinned out the aorta is. Um So that's one of the interesting surgeries that we do in thoracic surgery, bulk of the workload is lung cancer resection, particularly since the advent of the lung cancer screening. Um We work very closely with our respiratory oncology and radiology colleagues in deciding what's the best treatment for our patients with lung cancer. Um Generally speaking, it, it is a more friendly environment for our consultants tend to be uh more friendly and approachable compared to our cardiac counterparts. Um But that's obviously um uh relative to the unit and, and the surgeons themselves, um it routinely uh we do minimally invasive surgeries. Um thats and uh on this image is a subcycle incision um for things like anterior mediastinal masses. And nowadays we try and do operations here, the portal ie we just use one port to do our uh lung cancer resections. So, these are some of the subspecialties um that thoracic surgeons may, may go into um lung lung resections, uh benign work such as lung volume reduction surgery for diseases like CO PD, um chest wall deformities, pe uh uh procedures, uh tracheal surgery. Uh and, and a lot of uh rib factors, uh rib fixations. Um uh uh those are the sort of the bulk of the referrals that we get. Um we don't perform esophageal surgery in the UK, these are, are being performed by our upper gi uh counterparts. Although um thoracic surgeons in other countries do do um esophageal surgeries. So nowadays we do a lot of robotic work. We have sort of moved away from bats, um for various reasons. Um, but obviously the robot has the advantage of giving us excellent views and allows us to, to sort of maneuver within the chest quite well. Um, uh, in theory, it sort of, it reduces trauma to the tissues and also allows quicker recovery. Um, so a little bit about congenital heart surgery. Um, it's a very interesting um specialty. Um It, it is obviously very technically challenging. You are operating on very small hearts of the. Um but uh but the other uh interesting aspect is actually uh congenital surgeons are always thinking about, about the next steps ahead because these patients are usually uh they usually require multiple reoperations um due to the nature of the heart defect. Um And in fact, some may say that the congenital heart surgeons are palliative surgeons because they operate on patients who, who would have otherwise died without the surgery. And, and essentially they, they require multiple operations after. Um it is a surgery which requires a lot of uh intellectual work. Uh These surgeons are always thinking on the spot. Um There are very few operations that they do, but, but the interesting bit about it is every, every congenital heart is always, it's always uh uh uh uh uh a nuance to it. There's always something different about the anatomy which makes it even more interesting, a bit of history. Um this is the Blalock Thomas to Shun um for the treatment of the Treg of follow. It used to be called the Blalock to Shun. But since then, we have recognized the efforts of even Thomas, um, who, uh was the lab assistant to Doctor Blalock, he wanted to pursue surgery, but due to financial restraints, he could not pursue it. You can see it on the top right hand corner. He was uh overlooking um, Doctor Blaylock's work, uh, simply because he, he actually designed the operation and he, he performed it on dogs. Um, but unfortunately due to the, the racial aspects back in the days, um, he was not able to, to touch, uh, any human hearts. Uh, this is Doctor Fontan who designed the Fontan circulation for patients with tricuspid atresia or, um, or, uh, uh left hyperplastic heart syndrome. Um, but essentially you can see that in congenital heart surgery, it's all about shunting about reconstruction, um, about trying to overcome the, um, the, the, uh, the nature's defects. So the old training pathway used to be from, uh, ST one or ST three to ST eight. But since then, it's now changed and, and entry is, entry points are ST one and ST four thoracic. Um, it's now divided in three phases and they have shortened the training to seven years instead of eight. the, uh, three phases, you sort of go through the, a little bit, of course, surgical training, general surgery training phase one following on, you declare what you're interested in and then you sort of go into that specialty for, for the rest of training, um recruitment wise. Um It is very competitive. Uh The competition ratios have gone up tremendously. Um When I applied, there was one in 20 now it's one in 45. Um So which means for every post, there are 45 applicants. Um Although it's competitive, it's not impossible. Um If I can do it, all of you can do it. Um The shortlisting criteria unfortunately is quite stringent and, and, and they used to take into account operative procedures, but nowadays, they have taken out it's become quite a academic um and it, it's constantly changing. Um But I think one of the key things is really you trying to find someone who can support mentor or someone who is familiar with the application process to guide you through it. Um It's something to think about if, if you do not get into ST one, training, ST four is always a, a possible option. Uh The competition ratio is less as one and five. Although you do need more experience um uh a as a reg uh to cover the T one to T three years. The Wessex Diary um website is where you would find the shortlisting criteria and, and recruitment um information. I wouldn't go into too much detail about the shortlisting criteria which has recently been released. Um it's always changing. I have highlighted in red boxes where I think most most people would, would be able to achieve um and should secure you a a spot in the interview. Uh But essentially, you know, for those of you who are currently medical students thinking about Korean cardiothoracic surgery is, is absolutely crucial to think about, about your portfolio at that, at your at at your stage of training. Um just because it will score you points in the longer run. Um But for those of you who are post graduate, you know, the the usual things are research publications, publications, audit and, and presentations and obviously teaching as well. Um So those are things that you might want to focus on. I'm happy to share some of these um slights obviously later on um for the ST four. again, it's quite similar, it's all about uh you know, presentations, publications, uh prizes research. But in addition, you do need to have um six months uh experience at ST three level and depending on how many years, post graduation you are, you might get some bonus uh scoring as well. These are some of the index procedures that we are expected to be able to do as we progress in training. It used to be a face to face interview, but these days that they have uh done it via uh uh teams just since COVID happened, um It's a 25 minute interview. Uh usually three clinical stations with a bit of uh uh uh ethical, ethical scenarios put into it as well. So in total about five stations and then, and then there will be all, usually be a one or two portfolio stations where they ask you to talk about all the research project that you have done because of my personal experience. Um I uh I have uh basically applied three times to get into training and I succeed on a third time. Um But essentially, it, it, for, if there's any consolation for some of you, I did not have uh much surgical rotation or experience when I was in foundation training. Um So it's, it's not um it's, it's useful but not essential to get into training. Um But what was really important was getting the right mentors and, and people to supervise you. Um and, and sort of helping you to get into training. I spent a year out uh as an F three in cardic surgery that really helped with my clinical experience. Um and then spent a year as a co surgical trainee as well doing a bit of general surgery before II got into um ST one. So some of the learning points um uh which I've uh gathered throughout my training is that years out of training uh should not be seen as wasted. Um In fact, if it's anything it's helped, it's helped me uh consolidate some of my learning and, and, and um surgical experience. Um It, it's crucial to find the right mentors and supervisors and, and from there, they sort of help you to network with others as well. And that's where you get your, your research projects and some of your audits and presentations um should try and see every day and every placement or rotation is a learning opportunity. Um For example, when I, when, when I had four months in hematology, little, did I realize that actually that would, that would help my career in Chios surgery, dealing with bleeding and uh and uh bleeding patients. So this is uh so, you know, just because it's not completely relevant does not mean that it will be useful in the future. Um Prizes, presentations, publications are not as difficult as you think you just need to find the right uh um uh society and right people to sort of point you in the right direction. Some of the pros cons and myths um of the specialty, the pros is obviously it is a very interesting specialty. We do a lot of um interesting surgeries. Um It requires very advanced technical skills. And if you are interested in academic and research, there's a lot of research potential. Um The cons is that some of the surgeries can take very long um in some aortic operations, it can take 1212 to 24 hours. Um autonomy comes later. Um Most of the time the operating independently or comes when you are sort of ST six t seven level. Um, and it is, it can be a very stressful specialty as we, we sort of deal with high, high stakes, high risk uh uh patients. Uh, some of the myths, uh which probably some of the consultants in their nineties have heard about and, and, you know, cardic surgery still exists that it, it, you know, it's not a dying specialty. We are still doing lots of cardic surgery these days. Despite the advent of, of um of cardiology interventions, um there are no consultant jobs. Well, there are, you know, you just need to, to find them, you need to be competitive yourself as well. And you know, all these, all these research and things do not stop even when you get into training. Um just a little bit about interview prep, um always prepare early and try and try and speak to registrars and consultants. They will help you with the interview and sort of um s steer you towards uh research and, and papers and, and updates that you need to know about uh top tips, try and get yourself exposed into the specialty as early as you can. For some of your medical students who are thinking about clastic surgery, get in touch with your local department and the surgeons, they will uh you know, link you up with some projects and then, and also get into theaters. Um this regard, negativity. Um I have been told time and time again after failing my applications to think about alternative pathways or alternative careers, um you know, if you find that this is something that you're interested in or passionate about, do go for it. Uh fundal um As I've mentioned, um S ep surgical care practitioners, they are, they are one of my early teachers. They help me a lot um in, in uh learning how to harvest veins, for example. Um You know, I know there's a lot of talk about physician associates and things like that that these days, but actually se PS they are far from taking operative opportunities from, from, from um from people who are willing to learn uh do not, you know, the it would be, it's not unusual to have to apply more than once um but do not be discouraged by it. Uh And also you can always think about SD four as a potential pathway into cardiothoracic training. Um bear in mind that, you know, this curriculum and shortlisting criteria always changes, but keep yourself up to date and, and link with the right people. These are some useful resources that, that you might want to look at. Uh There are some useful videos and, and um uh uh uh things that, that, that are interesting. Um S ETS is always a good opportunity. It's a National Society of Cardiothoracic Surgery. Um There is an annual meeting every year. It's a good uh place to submit abstracts and also link up with the cardiothoracic surgeons and trainees. Uh Thanks very much for listening and I'm happy to take questions. Uh feel free to drop me an email if, if you want to find out more about high classic training and, and the specialty in general. Lovely. Thank you so much, Jason was taking the time to concern about cardiothoracic surgery. Um All you guys have that email. So if you got any questions, fire it that way or post it into the, um, into the chat box. Uh, it's crazy to see how, how the rates keep climbing. The job prospects are probably dwindling and, um, I don't know where, where the future will go, but it still looks like such an incredibly exciting field. And, um, every time I see this lecture every year, it's like Jesus, I don't know how you guys are doing that. So huge. Congratulations on making it this far. Of course. And I'm sure I hope that you'll join us next year as well to do the same thing. Thanks for that. So, enjoy your day. Thank you.