Fellowship in Cardiovascular and Thoracic Surgery at Hofstra Northwell School of Medicine
Welcome to the Department of Cardiovascular and Thoracic Surgery at the Hofstra Northwell School of Medicine (now the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell). We are recognized as a national leader in the prevention and treatment of heart disease and thoracic diseases. Our department focuses on specialized and patient-focused care which is provided by talented and compassionate individuals in a team structure.
Our mission, like that of the entire Northwell Health, is to deliver the highest quality of clinical care for our community regardless of ability to pay, to educate future generations of healthcare professionals and to actively participate in the search for new advances in medicine through biomedical research.
We boast one of the most experienced cardiac surgical teams in the Queens, Nassau and Suffolk area. We are host to the only accredited cardiothoracic residency on Long Island and one of only five in the NY metropolitan area. As an academic affiliate of the Zucker School of Medicine, all of our cardiothoracic surgeons hold an academic rank in that prestigious institution.
Our focus on quality and progressive state-of-the-art surgical therapies has been consistent for many years. We have developed a team approach to the care of the cardiac and thoracic surgical patient that creates several multidisciplinary layers, promoting education, safety and compassionate care. We have worked diligently to be sure all members of the care team are imbued with the spirit of excellence, safety and pride in our mission.
Our surgeons and facilities have consistently achieved better than expected outcomes in coronary artery bypass surgery and valve surgery in the New York State Cardiac Surgery database. This remarkable achievement was achieved with the close cooperation of multiple teams of dedicated and highly competent individuals caring for an increasingly complex group of patients. It is emblematic of the steps we have taken to insure patient safety and satisfaction.
As you peruse our website, please use the resources here to increase your understanding of our program and of the diseases and procedures which define the specialty of Cardiothoracic Surgery. The proud team of professionals that comprise the Department of Cardiovascular and Thoracic Surgery look forward to training you to become a highly skilled, and competent cardiovascular and thoracic surgeon, while serving our community and colleagues with the highest level of clinical skill available anywhere delivered with precision, understanding and compassion.
Alan R. Hartman, MD
Chairman, Cardiovascular and Thoracic Surgery
The cardiothoracic faculty and staff at Northwell Health believe the best way to train cardiothoracic surgeons is through an integrated, hands-on approach with increasing levels of responsibility. This is why Northwell offers a two-year comprehensive, ACGME-accredited thoracic surgery residency program.
The program draws on the strength of the Northwell Health. The third largest, non-profit, secular healthcare system in the nation, Northwell Health has more than 5 million New Yorkers in its service areas of Long Island, Queens, Manhattan and Staten Island.
Residents have the opportunity to train at three of the health system’s 17 campus locations – North Shore University Hospital, Long Island Jewish Medical Center and Southside Hospital. These three centers serve as advanced diagnostic and treatment centers for cardiovascular and thoracic disease.
The program offers an integrated experience in clinical cardiothoracic surgery, including pediatric cardiothoracic surgery, general thoracic surgery and adult cardiac surgery. Clinical decision-making in preoperative and postoperative care is increased during the two-year training period. During the first 12 months of training, ten months are allocated to general thoracic surgery and two months are designated to pediatric cardiac surgery. The second (senior) year is designated as adult cardiac surgical training. The educational program is designed to achieve:
- Mastery of the core curriculum as developed by the Thoracic Surgery Directors Association
- Successful Preparation for standardized testing in thoracic surgery (Board examination and In-service training examinations)
- Appropriate preparation for the preoperative evaluation and postoperative management of patients undergoing adult and pediatric cardiothoracic surgical procedures
- An appropriate level of achievement in the technical performance of operative procedures included in the realm of cardiothoracic surgery and attainment of sufficient operative experience as surgeon to allow entry to the Thoracic Surgery Board examinations at the conclusion of the training period.
- Development of the Core Competencies as described by the ACGME
- Develop the clinical, analytical and technical skills required to perform cardiothoracic surgery independently
During the first twelve months of clinical rotations, the (junior) cardiothoracic resident is expected to concentrate his efforts on the development of core knowledge in general thoracic and cardiothoracic surgery. He/she will serve in the role of first assistant and primary surgeon in cardiothoracic surgical operative procedures under the supervision of an attending surgeon at all times. During the first ten months of training, the general thoracic rotation includes training in pacemaker and implantable cardioverter defibrillator therapy, thoracic oncology, pulmonary diagnostic evaluations and in GI endoscopy. During the second six months the junior resident should expect increased exposure to adult cardiac procedures. Two months are designated to training in congenital heart surgery.
Responsibility for operative procedures is assigned by the responsible attending surgeon and is graduated according to ability. The junior resident is administratively subordinate to the senior resident on the service and is expected to help in the preparation of M&M's, Tuesday and Thursday morning lectures, journal club, morning ward rounds, assistance in the instruction of general surgical residents, medical students and physician assistants rotating on the service, as well as take an equal share in coverage of the clinical service with the senior cardiothoracic resident.
The second calendar year of the residency is focused on adult cardiac surgery. During the first six months of the second year, the resident is exposed to cardiac catheterization and perfusion services and during the final six months is exposed to echocardiography. The senior resident is responsible for the presentation of mortality and morbidity conferences with his co-resident. The physician assistants help with gathering data for presentations. The senior resident in cardiothoracic surgery is administratively responsible for the assignment each day of personnel (surgical residents and physician's assistants) to the operating rooms. He/she is instructed to maximize his own educational experience to be certain that he/she has fulfilled the Board eligibility requirements as a trainee in terms of operative experience by the completion of his 24-month training. It is understood that the senior resident on the service may at any time choose to be present (either as assistant or operating surgeon) on any procedure, which will optimize his educational experience. The program director monitors the cases to insure that the residents receive a balanced and similar education.
The rotation schedule is adjusted to allow a greater exposure to general thoracic surgery for residents who wish to pursue the thoracic tract.
Residents at both the junior and senior level are involved preoperatively in preparation of both inpatients and outpatients. They are required to be present during office hours (clinic) at least once per week and participate in the evaluation of preoperative data, patient evaluation and planning. They are required to log this activity. Similarly, inpatient work ups are organized and directed by the cardiothoracic surgery resident. They are involved in the preoperative education of the patient and family and generate a formal consultation under the supervision of the attending surgeon. A formal plan of surgical intervention is discussed with the attending surgeon prior to the operative procedure. Decision making based on evidenced-based medicine and compassion are stressed at all levels. It is the duty of the cardiothoracic surgery resident to have an understanding of the patient's pathology and the plan of treatment. This includes collation and evaluation of all preoperative testing (with the assistance of the physician's assistant staff and general surgical house staff). It is understood that the attending surgeon is available to review the plan of therapy with the resident at any time.
The program requires each resident to maintain a concurrent log of operative and clinic activities. The web-based database is used for operative logging and each resident is asked to submit a case list at the completion of each quarter of training. Cases lists are reviewed with the program director quarterly and the resident is made aware of any deficiencies in operative experience so that they may be corrected in a timely fashion. Additionally, the cardiothoracic surgery office employs a full time data collection nurse whose job it is to maintain records for New York State and for hospital-wide Quality Assurance. These databases provide a backup source of information for residents since each case is logged with surgeon and assistant as well as patient identification, operative procedure, outcome and perioperative morbidity.
The volume of cardiothoracic procedures has increased over the last several years particularly in the area of general thoracic surgery. This has intensified the trainees' exposure to thoracoscopic pulmonary and mediastinal procedures, tracheal procedures, chest wall procedures, airway and upper GI endoscopy and multimodality thoracic oncologic approaches. Catheter based interventions are increasing relative to surgical referrals for ischemic cardiac disease such as thoracic endografting for aortic pathology (TEVAR) and percutaneous valve placement which are currently being performed at our facilities. This has resulted in an increase in the number of referrals for patients with cardiac disease.
The Zucker School of Medicine conforms rigorously to the working hour and resident supervision requirements of New York State. This means that there is adherence to both the Bell Commission Regulations and ACGME requirements, including a maximum average 80-hour work week and provision for adequate rest after extended hours. The average workday begins at 6:00 am and concludes at 6-7pm. Weekends days are abbreviated since operative procedures are not booked electively on weekends. They are scheduled for one day of rest for each seven-day period. Cardiothoracic surgery residents are allowed to take calls from home and return to the hospital only for emergencies and for operative procedures. They are required to leave the hospital the next day if the work hour limits are exceeded. Formal attending-level intensive care (intensivist) coverage was initiated in 1999 and covers 24 hours per day, seven days per week as of July 2001. This administrative change will further reduce the nighttime call responsibilities of the cardiothoracic surgery resident.
Each faculty member on a formalized evaluation document evaluates each resident quarterly. The resident is required to evaluate each faculty with whom he/she has had exposure and to separately evaluate the quality of his training experience on each rotation. During the quarterly meeting with the program director, the resident is allowed to review his evaluations and comments. He/she is advised of any deficiencies and encouraged in areas of strength at that time. A formal memorandum of the meeting is entered into his file by the program director. Residents are encouraged to be forth right in their evaluations of faculty and rotations. There is a formal policy for redress if the resident feels his comments have resulted in prejudicial treatment by the faculty.
The Department of Cardiovascular and Thoracic Surgery at the Hofstra North Shore-LIJ School of Medicine is among the leading cardiothoracic care programs in New York. We offer patients a full range of surgical options, including minimally invasive and beating heart techniques for patient requiting valve or coronary artery surgery, as well as advanced minimally invasive techniques for surgery of the aorta, lung, mediastinum and esophagus. These techniques have become the standard of care here because they fit in so well with our philosophy of achieving optimal surgical repairs while preserving patients' quality of life.
Our surgeons have access to the latest technologies and facilities. In fact, we are now offering transcatheter aortic valve replacement (TAVR) using a percutaneous device for patients with severe aortic stenosis who are at high or extreme risk for surgical aortic valve replacement. To ensure the best outcomes for TAVR patients, the health system has opened hybrid operating rooms that combine the functionality of a traditional catheterization lab with a cardiac operating room. This technology allows interventionalists and surgeons to collaborate on the most complex cardiac cases, and exemplifies our commitment to the latest advances in cardiac care.
In addition to offering groundbreaking technology, our surgical program provides patients with the advantage of an onsite multi-disciplinary team of cardiologists, electrophysiologists, interventional radiologists, vascular surgeons, dietitians, physical therapists and social workers. This team often expands to include immediate care from on-site physicians from every medical specialty required. Our multi-disciplinary approach and expertise has gained us the reputation of being the best prepared surgical practice to handle procedures that may be complex and/or complicated by underlying illness/age.
Our large volume, consisting of many complex and complicated procedures in all areas assures that patients are receiving the best care possible from some of the most experienced and expertly skilled surgeons in the world.
Our surgeons are committed to studying and evaluating new methods of surgical treatment as well as improving surgical outcomes through clinical and laboratory research. Our staff is equally concerned with helping patients and their families through the anxious days before and after surgery. We meet with patients before surgery to explain the process, answer questions and provide take home information. During the surgery an operating room nurse gives hourly updates so the family knows how the surgery is going. And after the surgery we assign a nurse case manager who works with the patient and family during the hospitalization and serves as the point of contact once the patient leaves the hospital.
Part of our commitment to delivering the best patient care is providing individuals with as much quality information regarding an illness and treatments is required to make them feel comfortable with their options and choices. We hope that the information contained on our web site meets your needs. If not, we ask that you feel free to contact us to request additional information or advice.
Applicants interested in the cardiovascular and thoracic surgery training program at Northwell Health should apply through the electronic residency application service (ERAS).
Essential application information includes:
- Common application form
- Curriculum vitae
- USMLE or COMLEX transcript
- Medical school transcript
- Personal statement
- Dean’s letter
- Three (3) letters of recommendation, no older than six (6) months
- ECFMG Status Report, if applicable
- A certified English translation if the documents are in a language other than English
Alan Hartman, MD
- Senior Vice President and Executive Director, Cardiothoracic Services,
Chair, Cardiovascular and Thoracic Surgery,
Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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Rick Anthony Esposito, MD
- Vice Chairman of Cardiovascular and Thoracic Surgery - Thoracic, North Shore University Hospital
- Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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Michael H. Hall, MD
- Chief of Division - Adult Cardiac Surgery of Cardiovascular and Thoracic Surgery, North Shore University Hospital
- Associate Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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L. Michael Graver, MD
- Chief of Division of Cardiovascular and Thoracic Surgery - Adult Cardiac Surgery, Long Island Jewish Medical Center
- Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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Lawrence Richard Glassman, MD
- Chief of Division of Cardiovascular and Thoracic Surgery - Thoracic, North Shore University Hospital
- Assistant Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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