Jobs Review: Cardiothoracic Surgery

Hi, my name is Rahul. I am an academic F2 based in Sheffield. I did my cardiothoracic surgery rotation at the Northern General Hospital, a large tertiary centre; it was my only hospital job as an SHO. In this blog post, I aim to give an overview of what a typical week would involve.

What will we cover?

So what kind of things does a job on Cardiothoracic involve?

    • Daily ward rounds –  you see elective and acute admissions who require cardiac or thoracic input. Before starting the ward round, we had a handover from the night team. They would inform us of jobs that were outstanding or sick patients who needed attention overnight. Every day including weekends, there I a consultant-led ward round. During ward rounds, I would look up results on the computer and document in the notes, much like any other hospital job. What surprised me was the length of the ward round compared to my other surgical job, which was general surgery. Looking back, this was probably because cardiothoracic is a very niche speciality, and even senior registrars and junior consults would have to seek advice from seniors regularly. 
    • Jobs – once the ward round was complete, I would create a list and prioritise the jobs. Titrating or adjusting medications was one of the essential things I had to do for these patients. Requesting scans is something I frequently had to do. Often patients would require repeat imaging to track post-surgical progress or complications. Often I would have to make referrals to other teams, one of the main ones being to cardiology.
    • Procedures – One thing that was unique to this job was familiarising yourself with the management of thoracic drains and understanding pacing systems. I had the opportunity of inserting and removing chest drains and treated patients with persistent pneumothoraces with talc or blood pleurodesis.  I also learned how to apply VAC dressings. These skills will no doubt come in handy in my future clinical practice.
    • Theatre days  – As I want to pursue a career in surgery, a good part of this job was the timetabled theatre days. On these days, I had complete choice of which surgery and which consultant/registrar I would like to assist, which allowed me to see a wide variety of cases. 
    • Out of hours working – I was on the specific cardiothoracic SHO rota. Out of hours fluctuated from being very quiet, where I was able to prep TTOs for the patients going home the next day, to very manic, where every post-op patient went into fast AF at once. It is very well supported out of hours, and there is always a registrar around. You can go to trauma calls with the registrars, which was a good experience for me as the hospital was a trauma centre.  I had a lot of nights in this job compared to other rotations. However, they were only ever stretches of 2 nights.

Pros of the job

    • Well supported job in a nice speciality where you can learn a lot 
    • If you are willing to get involved and show initiative, there are a lot of procedures that senior members will allow you to do. 
    • You have protected timetabled theatre time.

Cons of the job

    • Because it is such a niche speciality, I often found I did not have much autonomy. 
    • While it is not an overly busy job, you work quite a lot of hours and a lot of out of hours working. This may not apply to all cardiothoracic jobs in different hospitals. 

Final Word

Cardiothoracic surgery is very complex and can sometimes seem overwhelming for someone in their foundation years. However, it presents an opportunity to practice niche clinical skills and manage medical emergencies that you will commonly see throughout the rest of your career.

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