Ensuring vascular surgical training is on the right track
ABSTRACT Approval of the primary certificate in vascular surgery eliminated the requirement for certification in general surgery before vascular surgery certification. New training paradigms for training in vascular surgery have emerged driven by the desire to offer greater flexibility of training and to shorten the length of training. Many of these changes are based upon "expert opinion," promise, and "logic" without objective evaluation of the residents or the training programs themselves. To be on the forefront of surgical education, vascular surgery will need to adopt methods of curriculum development firmly grounded in educational principles and use modern assessment tools for the evaluation of competence and performance. This report presents the evolution and challenges to the current vascular surgical training model and then argues for a more rigorous and scientific approach to training in vascular surgery. It presents an analysis of potential avenues for placing education and training in vascular surgery on the forefront of modern surgical education.
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ABSTRACT: Methods of learning may differ between generations and even the level of training or the training paradigm, or both. To optimize education, it is important to optimize training designs, and the perspective of those being trained can aid in this quest. The Association of Program Directors in Vascular Surgery leadership sent a survey to all vascular surgical trainees (integrated [0/5], independent current and new graduates [5 + 2]) addressing various aspects of the educational experience. Of 412 surveys sent, 163 (∼40%) responded: 46 integrated, 96 fellows, and 21 graduates. The survey was completed by 52% of the integrated residents, 59% of the independent residents, and 20% of the graduates. When choosing a program for training, the integrated residents are most concerned with program atmosphere and the independent residents with total clinical volume. Concerns after training were thoracic and thoracoabdominal aneurysm procedures and business aspects: 40% to 50% integrated, and 60% fellows/graduates. Integrated trainees found periprocedural discussion the best feedback (79%), with 9% favoring written test review. Surgical training and vascular laboratory and venous training were judged "just right" by 87% and ∼71%, whereas business aspects needed more emphasis (65%-70%). Regarding the 80-hour workweek, 82% felt it prevented fatigue, and 24% thought it was detrimental to patient care. Independent program trainees also found periprocedural discussion the best feedback (71%), with 12% favoring written test review. Surgical training and vascular laboratory/venous training were "just right" by 87% and 60% to 70%, respectively, whereas business aspects needed more emphasis (∼65%-70%). Regarding the 80-hour workweek, 62% felt it was detrimental to patient care, and 42% felt it prevented fatigue. A supportive environment and adequate clinical volume will attract trainees to a program. For "an urgent need to know," the integrated trainees are especially turning to online texts rather than traditional textbooks, which suggests an opportunity for a shift in educational focus. Point-of-care is the best time for education and feedback, suggesting a continued need for dedicated faculty. The business side of training is underserved and should be addressed.Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2011; 55(2):588-97; discussion 598. DOI:10.1016/j.jvs.2011.09.011 · 2.98 Impact Factor
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ABSTRACT: Opportunities are declining for residents to participate in complex open vascular surgical operations. Open simulation using fresh cadavers potentially can be used to familiarize residents with complex vascular exposures. We evaluated the use of fresh cadavers to assist resident comprehension of complex anatomic relationships in vascular surgery. Twenty-two postgraduate year (PGY) 3 (n = 12) and PGY 4 (n = 10) general surgery residents attended five structured 4-hour cadaver skills laboratories. Residents performed five conceptually difficult and infrequently encountered operative vascular exposures: the supraclavicular subclavian and vertebral arteries, supraceliac aorta, superior mesenteric artery, proximal and distal renal arteries, and common iliac artery bifurcations. Residents were tested (oral board examination style with percentage correct of a predetermined checklist) in their knowledge and understanding of the anatomic relationships before and after the cadaver laboratories. Participants' self-reported confidence in performing these complex vascular exposures was also measured before and after the course using the operative confidence score (1 = not confident; 5 = highly confident) for each exposure. Participation in the course resulted in increases in participant comprehension and self-reported operative confidence in the supraclavicular subclavian and vertebral arteries, supraceliac aorta, superior mesenteric artery, renal arteries, and iliac bifurcation exposures. Before vs after the course, the mean oral examination scores were 5% vs 87%, 26% vs 94%, 19% vs 86%, 30% vs 88%, and 29% vs 87%, respectively (all P < .001), and mean operative confidence scores were 1.1 vs 2.9, 1.3 vs 3.5, 1.2 vs 3.2, 1.2 vs 3, and 1.5 vs 3.9, respectively (all P < 0.001). Fresh cadaver laboratories can provide a learner-centered and safe environment for acquiring procedural understanding and operative confidence of complex vascular exposures. This may allow for the transformational change essential to becoming a competent vascular surgeon.Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 12/2011; 55(4):1187-94. DOI:10.1016/j.jvs.2011.09.098 · 2.98 Impact Factor
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ABSTRACT: To evaluate the qualitative impact of training in the endovascular era (post-2000) on vascular surgeons' comfort level and enjoyment with abdominal aortic aneurysm (AAA) repairs. A sample of vascular surgeons (n = 1754) were sent a survey pertaining to their fellowship training and practice of AAA repair. The influence of training- and practice-related variables on qualitative outcomes was assessed. A total of 382 (22%) surgeons completed the survey. Surgeons who performed more endovascular aneurysm repairs (EVARs) than open AAA repairs were more likely to enjoy EVAR (P < .001). Those completing fellowship after 2000 reported a higher level of procedure-related comfort with EVAR (P = .001) compared to those completing fellowship before 2000. Conversely, surgeons completing fellowship before 2000 reported a higher level of procedure-related comfort with open AAA repair (P = .001). The advent of EVAR has changed fellowship training of AAA repair and has translated into changes in both practice patterns and comfort level.Vascular and Endovascular Surgery 02/2012; 46(2):150-6. DOI:10.1177/1538574411432147 · 0.77 Impact Factor