Thoracic Surgery

Frequently Asked Questions by MS1s and MS2s

Thoracic Surgery is a relatively new and highly competitive surgical subspecialty with an integrated or fast-track application option whereby medical students can apply directly into a Cardiothoracic training program through the Match. A very strong performance on Step I of the USMLE is essential to be competitive. Programs are most interested in students who have demonstrated a strong interest and commitment to the field through clinical exposure and research. Work with and develop a relationship with Thoracic Surgeons. Review the websites of professional organizations.  See below.

Thoracic Surgery is a very competitive specialty and while research experience is not required it would certainly strengthen your application. Most importantly do a research project that you find highly interesting and are eager to engage with. Your preclinical years are a great time to get started with a research project. It is generally preferable to have completed one or two comprehensive projects where you had significant involvement rather than multiple projects where you were only minimally involved.

Talk to your mentors and Dr. McEchron as he can help guide you to find a good “fit” depending on your interests. Work with your peers, Residents and Fellows as well as Thoracic Surgery faculty and express your interest in getting involved.

A strong academic foundation and strong performance on Step I is your most important priority. If you can successfully add volunteer work or other extracurricular activities and maintain a healthy balance with your academics then it is highly recommended. Volunteering will make you more well-rounded and better informed to make a career decision while gaining valuable experience and serving the local community.

Cardiothoracic Surgery is known to be rigorous and competitive.  Due to this being a relatively new program option, the National Resident Matching Program (NRMP) has not published statistical trends for thoracic surgery yet.

Frequently Asked Questions by MS3s and MS4s

Most students start thinking about letters toward the end of 3rd year and beginning of 4th year. We recommend doing your Surgery Sub-I and away rotations early in Blocks 1-5 of your 4th year to facilitate developing professional relationships and obtaining letters of recommendation along the way. Your Career Advisor and Specialty Advisor can provide you a more specific recommendation of the number and type of letters based upon your individual circumstances and competitiveness.

You should have your CV updated and your personal statement available for reference. If you are asking for a LOR during your Sub-I or away rotation, consider asking for it about three weeks into the rotation from a faculty member who you have worked very well with. Even better if you have developed that relationship with the Department Chair or Program Director. When asking for a Letter of Recommendation it is ideal to do it in person. It is appropriate to ask specifically if they would be willing to write you a “strong letter of recommendation”. Please thank you letter writers for their effort.

You are allowed to submit up to four letters in ERAS. We recommend including letters from faculty that know you well from your Sub-I and away rotations and from faculty that support other aspects of your application. This could include your SP mentor, MPH or Certificate of Distinction programs you are a part of and from a research mentor you have worked closely with.

Yes, depending on specialty, all LOR do not have to be from the field you are applying to residency in. It is recommended that most of your letters come from Thoracic Surgery attendings with whom you worked with during your rotations. A good combination of letters might be: Department Chair, two attendings, and one research mentor (if you worked closely together and have a good working relationship). That said, only ask people who are willing to write you a strong recommendation!

A Department Chair Letter may be required for some Thoracic Surgery programs. Please check the individual program websites for more specific expectations.

In addition to your 4th year Surgery Sub-I rotation, away rotations in Thoracic Surgery are strongly recommended. Some of the benefits of doing an away rotation include networking, increasing the number of interview invitations you’re likely to receive, and figuring out what you’re looking for in a residency program. Thoracic Surgery is a very small community and many Department Chairs and Program Directors know each other and having an endorsement from faculty from your away rotations can make a very positive impact on your application. We recommend working closely with your Career Advisor and Specialty Advisor to help with this decision.

Information specific for Thoracic Surgery

 There are three pathways to becoming a Cardiothoracic surgeon in the US:


1. Independent Programs (also known as the Traditional Pathway — 5 years of general surgery (or vascular surgery), plus 2-3 years of cardiothoracic surgery residency).  Medical Students would apply to general surgery (or vascular surgery) residency, applying to cardiothoracic surgery in their 4th year of residency to a cardiothoracic fellowship program.


2. Integrated Pathway (also known as I-6 — 6 years of cardiothoracic surgery residency).  Medical students apply directly to an integrated cardiothoracic surgery residency program.  Upon completion, graduates are eligible to sit for the American Board of Thoracic Surgery certification, but not the General Surgery board.


3. Joint Thoracic/General Surgery Track (also known as the Fast-track Pathway — 4 years of general surgery, plus 3 years of cardiothoracic surgery residency), all completed at one institution.  Medical students apply to one of the participating general surgery residency programs that offer a fast-track pathway. Residents interested in fast-track programs apply after their second year of general surgery residency, although at many institutions the application process is informal. For a given institution’s fast-track program, only general surgery residents at that same institution are eligible. Residents who complete this track are eligible for board certification by both the American Board of Surgery and the American Board of Thoracic Surgery.


Both Cardiac Surgeons and Thoracic Surgeons complete the same training, but typically choose to specialize in one area or another.  In 2007 a “track” system was created for all training paradigms –trainees select between cardiothoracic track or thoracic track.  The board certification is the same, but residents must declare one track or the other, and meet specific operative numbers from that track during residency. 

Additional Resources

Click here to visit the American Association for Thoracic Surgery (AATS) website

Click here to visit the Society of Thoracic Surgeons Student and Resident Resources Page