Cardiothoracic Surgery

Specialty Champions

2024-2025: Hannah Bibby & James Cartlidge

2025-2026: x

 

What is Cardiothoracic Surgery?

Cardiothoracic surgery is the specialty which involves performing operations on the heart, lungs and other organs within the chest cavity. Diseases in this area of the body include significant causes of morbidity and mortality such as ischaemic heart disease and lung cancer. Cardiothoracics involves the diagnosis and management of these conditions, as well as the performance of complex surgeries, monitoring of patients in ICU post-operatively, MDT involvement, and patient follow-up in clinic. The specialty also provides significant opportunities for sub-specialisation, research and teaching. It is a specialised field which is primarily found in larger, tertiary centres and as such can be particularly competitive.

 

What are the sub-specialties within Cardiothoracic Surgery?

Cardiothoracic surgeons will specialise into one of either cardiac (heart, aorta and other vasculature) or thoracic (lungs, chest wall and other thoracic organs) surgery specifically on progressing to the second phase of their training, typically around ST4 level. Within each of these branches, there is opportunity for further sub-specialisation based on specific areas of interest. During the final stage of training, national selection can be entered to allow for subspecialisation in the field of congenital cardiac surgery. Another significant area for subspecialisation is in cardiothoracic transplant surgery.

 

What are some of the common conditions and procedures performed in the specialty?

Cardiac

  • Ischaemic heart disease

  • Heart valve disease

  • Aorta vascular disease

  • Cardiac tumours

  • Cardiomyopathy

Thoracic

  • Lung malignancies

  • Chest wall deformities

  • Pleural disorders

  • Obstructive airways disease

  • Other major airways disease

Procedures

Cardiac

  • Coronary artery bypass graft

  • Valve repair / replacement

  • Aortic surgery

  • Ablation

Thoracic

  • Lung resection

  • Chest-wall deformity correction

  • Decortication

  • Thoracotomy

  • Video or robotic assisted thoracoscopic surgery

 

What are some of the pros and cons of the specialty?

Benefits

Your work will be hugely impactful on patients’ lives, there are numerous opportunities for sub-specialisation and career advancement, opportunities to use advanced and developing medical technology, lifelong learning and overall it’s just really interesting!!!

Drawbacks

The training pathway can be long and extremely competitive to get onto which could mean relocation, inevitably there will be long hours and maintaining a good work-life balance during training is tough. As with most surgical specialties, there will be emotional and physical demands due to the nature of the job.

 

What is the training pathway of the specialty?

Training is now typically completed as a run-through programme, beginning as a general cardiothoracic ST1 level trainee following foundations training. The image below outlines what the timeline usually looks like, though it is determined by completion of required competencies rather than a specific timeline.

https://www.iscp.ac.uk/media/1108/cardiothoracic-surgery-curriculum-aug-2021-approved-oct-20.pdf

 

What examinations need to be completed for the specialty?

MRCS Part A (MCQ) and Part B (OSCE) – typically completed in foundation years.

Intercollegiate Specialty Board Examination (ISB) – SBA and clinical exam, taken after completion of phase 2 of training.

All trainees with have to cover a syllabus rating their level based on knowledge, clinical and technical skills in a wide range of areas in order to complete training and record process in their portfolio. Full details of this and the training pathway can be found at: https://www.iscp.ac.uk/media/1108/cardiothoracic-surgery-curriculum-aug-2021-approved-oct-20.pdf

 

What conditions / presentations pertaining to this specialty are covered by the MLA content map?

As this is quite a niche specialty, there is minimal requirement to know details of cardiothoracic surgery but lots of areas in the content map cover common conditions for which surgery may be required and general points surrounding the overall care of surgical patients. These include:

  • Lung cancer

  • Cardiorespiratory arrest

  • Cardiorespiratory failure

  • Post-surgical care and complications

  • Acute coronary syndromes

  • Valve diseases

  • Ischaemic heart disease

  • Aortic dissection

  • Stridor

  • Myocardial infarction

  • Pneumothorax

Many of these conditions are covered in QUB lectures given during the ‘blood, cardiovascular and respiratory systems’ module in year 1 which should be available on Canvas, with information regarding surgical care available from the year 3 portal.

 

What OSCE skills are covered by this specialty?

The most important relevant skills are definitely to make sure you have you full cardiovascular and respiratory history and examinations perfected. Additionally, stations may involve the assessment and management of acutely unwell patients, typically using the ABCDE method. In some cases, these patients with be suffering from cardiorespiratory emergencies, e.g acute coronary syndrome, asthma/COPD exacerbation.

 

What are some learning resources which cover the conditions seen and procedures performed by this specialty?

Some old videos about cardiac and thoracic surgery available on the year 5 area of the QUB med portal - https://www.med.qub.ac.uk/Portal/year5/surgicalcare_videos.aspx

 Third-Party Learning Resources:

  • TeachMeAnatomy / TeachMeSurgery – for learning relevant anatomical structures and their physiology as well as core principles and procedures in the field (goes beyond necessary curriculum learning)

  • ZeroToFinals – notes and podcasts / videos relevant to many of the conditions included in the MLA content map

 

What professional organisations represent the specialty of Cardiothoracic Surgery?

The Society for Cardiothoracic Surgery

The representative body for cardiothoracic surgery in Great Britain and Ireland is the Society for Cardiothoracic Surgery (SCTS). The organisation was founded in 1934 and addresses the interests of patients, surgeons, allied professionals and students.

Their website (https://scts.org) hosts a wealth of helpful and interesting information, ranging from events to educational resources. They hold their Annual Meeting every March in different locations within the UK/Ireland.

There is a specific section dedicated within the website to medical students (https://scts.org/medical_students.aspx), showcasing mentorship initiatives, education events, useful resources and an electives repository.

They have set up a Student Education Committee ran by medical students, which caters events specifically towards students, with webinars and journal clubs. Keep up to date with them by following their Instagram: https://www.instagram.com/scts_studenteducation/

You can join the society for free as a medical student, sign up using this link: https://scts.org/join/default.aspx

The European Association for Cardio-Thoracic Surgery

The European Association for Cardio-Thoracic Surgery (EACTS) was founded in 1986. It is an organisation which supports the cardiothoracic community through education, cutting-edge learning opportunities, championing pioneering research through world-renowned journals and publications; with the ultimate aim of improving patient outcomes through best practices.

Their website (https://www.eacts.org) has lots of resources signposted, pertaining to education, publications, clinical practice guidelines and quality improvement. They host their annual meeting every October, in locations situated around Europe.

You can become a pre-trainee (medical student) member for just €20, click the following link to apply: https://www.eacts.org/our-community/become-a-member/

 

The Society of Thoracic Surgeons

This is the largest organisation dedicated to cardiothoracic surgery, founded in 1964. It is the professional body representing surgeons, researchers and allied healthcare professionals, who are dedicated to ensuring the best outcomes for heart, lung and oesophageal surgeries. It is based in the United States but has a global reach. It has lots of educational, research and registry analytic resources available. Their website is accessible through the following link: https://www.sts.org

 

What academic journals and literature are available concerning Cardiothoracic Surgery?

There are numerous journals with pertaining to the discipline of cardiothoracic surgery, the following are some of the main publications focussing solely on the specialty

 Some interesting studies which have been covered by the SCTS Student Education Committee, during their journal clubs include:

 SCTS has a list of randomised trials ongoing within the UK covering cardiac, thoracic and congenital surgery: https://scts.org/professionals/research/recently_published_trials.aspx

Other interesting resources concerning cardiothoracic surgery which you may wish to explore include:

 

What recruitment information is available concerning applying to the specialty?

Cardiothoracic Surgery is a nationally recruited, run-through specialty programme. All pertinent information relating to the application dates, document, matrix and post numbers may be on the NHS England Wessex Deanery Website: https://wessex.hee.nhs.uk/medical-dental-training-recruitment/core-and-specialty/cardiothoracic-surgery-st1-st4-national-recruitment/

 

What Cardiothoracic Surgery events take place during the year?

There are several annual events to keep a look out for, they include:

 

What QUB Student Selected Components may be relevant to the specialty?

QUB Student Selected Components, directly or indirectly related projects to cardiothoracic surgery:

 Year 1

  • What’s to come for the Broken Hearted?

  • Tumour Immunology and Immunotherapeutics

Year 2

  • Cardiac Anaesthesia and Intensive Care

  • Challenges and Opportunities in Treating Secondary Cancer

  • Managing Univentricular Hearts

Year 3

  • Cardiology Imaging

  • Clinical Investigation of Cardiovascular Physiology

  • Intensive Care Medicine

  • Interstitial Lung Disease

  • Oncology: The Patient Journey

  • Radical Treatment of Early-Stage Lung Cancer

 

What intercalation opportunities are available that may give a better insight into the research element of the specialty?

You may wish undertake an intercalated degree in a programme related to cardiothoracic surgery, some of which include:

  • Cardiovascular Science iBSc (University College London)

  • Cardiovascular Medicine iBSC (King’s College London)

  • Cardiovascular Sciences BSc (Imperial College London)

  • Translational Cardiovascular Medicine MSc (University of Bristol)

  • Clinical Anatomy MSc (University of Edinburgh or Bristol)

 

Other resources / opportunities for students interested in the specialty