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Specialty Training Requirements in
Cardiac Surgery

2013

EDITORIAL REVISION – MAY 2015
VERSION 1.2

These training requirements apply to those who begin training on or after July 1^st, 2013.

MINIMUM TRAINING REQUIREMENTS

Acceptance to write the Royal College Certification Examination in Cardiac Surgery requires successful completion of one of the three following pathways:

PATHWAY 1

Six (6) years of approved residency training made up of rotations equivalent to 78 4-week blocks. This period must include:

1. Twenty-six (26) blocks of foundational training in surgery:
   1. Three (3) blocks of Cardiac Surgery
   2. Three (3) blocks of critical care medicine
   3. One (1) block of anesthesia
   4. Two (2) blocks of general surgery
   5. One (1) block on a trauma service
   6. Six (6) blocks of Cardiology which must include one (1) block of each of the following:
      1. Coronary care unit
      2. Ward cardiology
      3. Adult cardiac electrophysiology
      4. Interventional cardiology
      5. Adult echocardiography
      6. Cardiac imaging
   7. One (1) block of emergency medicine
   8. Four (4) blocks of vascular surgery and/or thoracic surgery
   9. Five (5) blocks of selectives chosen from among the following:
      1. Cardiac Surgery
      2. General surgery
      3. Pathology
      4. Plastic surgery
      5. Ambulatory cardiology
      6. Cardiology consultation
      7. Coronary care unit
      8. Cardiac imaging
      9. Echocardiography
      10. Critical care medicine
      11. Geriatrics
      12. Infectious diseases
      13. Nephrology
      14. Neurology
      15. Other training in as approved by the program director to a maximum of 2 blocks
2. Twenty (20) blocks of approved residency training in adult Cardiac Surgery, thirteen (13) blocks of which must be at a senior resident level and must include:
   1. Six (6) blocks as chief resident in Cardiac Surgery
3. Thirteen (13) blocks of Thoracic Surgery and Vascular Surgery, which must include
   1. A minimum of three (3) blocks at senior resident level in Thoracic Surgery
   2. A minimum of six (6) blocks at senior resident level in Vascular Surgery
4. Six (6) blocks of approved senior residency training on a dedicated congenital cardiac surgery service, which must include:
   1. Minimum of three (3) blocks on a pediatric cardiac surgery service
5. Thirteen (13) blocks of academic/clinical enrichment, as approved by the Residency Training Committee. This year is flexible both in terms of its content and its location within the six (6) years of residency training. For those individuals entering a Clinician Investigator Program, the academic enrichment period could serve as the initial phase of a two (2) or three (3) year program leading to qualifications for a Masters Degree or PhD. For other residents, the year, or part of it, might be spent in clinical situations to obtain further training in Vascular Surgery or one of the subspecialty areas within Cardiac Surgery.

Notes regarding Pathway 1:

1. The order of rotations during the two foundational years is at the discretion of the program director and according to local availability.
2. The sequence of the requirements listed above does not imply that they must be met in the same order.
3. Senior residency is defined as a period during which the resident is regularly entrusted with the responsibility for pre-operative, operative, and post-operative care. This must include the most difficult problems in adult Cardiac Surgery. This period of training usually occurs at the PGY4-6 level. No other resident, with the exception of the chief resident, shall intervene between the senior resident and the attending staff surgeon.
4. Chief resident is defined as a trainee in the final year of training with responsibilities that are at minimum, that of a senior resident. During this time the trainee must be responsible for resident call designation and may self-assign to surgical cases.

OR

PATHWAY 2

Eligible for Royal College Certification in General Surgery (see requirements for General Surgery) plus:

1. Six (6) blocks of approved residency training on a dedicated congenital cardiac surgery service with a minimum of three (3) blocks on a pediatric cardiac surgery service
2. Six (6) blocks of approved Cardiac Surgery residency training if not completed under the aegis of an accredited Cardiac Surgery program during the course of training for General Surgery
3. Six (6) blocks of approved senior residency training with a minimum of three (3) in Thoracic Surgery and a minimum of three (3) in Vascular Surgery if not completed under the aegis of an accredited Thoracic or Vascular Surgery program during the course of training for General Surgery
4. Thirteen (13) blocks of academic enrichment as under Pathway 1 if not completed during General Surgery training
5. Thirteen (13) blocks of senior residency in Cardiac Surgery

OR

PATHWAY 3

Eligible for Royal College Certification in Thoracic Surgery (see requirements for Thoracic Surgery) plus:

1. Six (6) blocks of approved residency training on a dedicated congenital cardiac surgery service with a minimum of three (3) blocks on a pediatric cardiac surgery service
2. Six (6) blocks of approved Cardiac Surgery residency training if not completed under the aegis of an accredited Cardiac Surgery program during the course of training for General Surgery and/or Thoracic Surgery
3. Six (6) blocks of approved senior residency training with a minimum of three (3) in Vascular Surgery if not completed during the course of training for General Surgery
4. Thirteen (13) blocks of senior residency in Cardiac Surgery

Note regarding Pathways 2 and 3:

All accredited Canadian Cardiac Surgery training programs are required to demonstrate adequate resources for the six (6) year pathway. The alternative entry pathway is detailed to give more advanced candidates a general idea of the range of additional training that may be required. Partial training in a Royal College approved program may also be recognized at the discretion of the Credentials Committee. It is very important to understand that the specific additional training required by a candidate, under any alternate pathway, cannot be assumed by either potential trainees or program directors. For each candidate, request for assessment of prior postgraduate training and for determination of additional training requirements must be submitted to the Office of Specialty Education - Credentials of the Royal College. It is prudent to seek approval prior to entering any alternative pathway.

NOTES ON ALL PATHWAYS:

Royal College certification in Cardiac Surgery requires all of the following:

1. Successful completion of the Royal College Surgical Foundations curriculum;
2. Successful completion of the Royal College Surgical Foundations Examination;
3. Successful completion of STR requirements in Cardiac Surgery;
4. Successful completion of the certification examination in Cardiac Surgery; and
5. Successful completion of a scholarly project suitable for submission to a peer-reviewed journal as evidenced by a letter from the program director.

The program outlined above is to be regarded as the minimum training requirements. Additional training may be required by the program director to ensure that clinical competence has been achieved.

• REVISED – Specialty Standards Review Committee – June 2013
• EDITORIAL REVISION – January 2014
• EDITORIAL REVISION – May 2015

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