Ensuring vascular surgical training is on the right track

Division of Vascular Surgery, OP11, VirtuOHSU Surgical Simulation Center, Oregon Health & Science University, Portland, Ore 97239, USA.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter (Impact Factor: 2.98). 11/2010; 53(2):517-25. DOI: 10.1016/j.jvs.2010.08.082
Source: PubMed

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: Since their introduction several years ago, Integrated (0+5) Vascular Surgery Residency Programs are being increasingly developed across the country. To date, however there is no defined "universal" curriculum for these programs and each program is responsible for creating its own curriculum. The aim of this study was to review the experiences of current 0+5 Program Directors (PD) to determine what factors contributed to the curricular development within their institution. Semi-structured interviews were conducted with 0+5 PDs to explore their experiences with program development, factors influencing the latter, and rationale for current curricula. The interview script was loosely structured to explore several factors including: time of incoming residents first exposure to the vascular surgical service, timing and rationale behind the timing of core surgical rotations throughout the 5 year program, educational value of non-surgical rotations, opportunities for leadership and scholarly activity, and influence the general surgery program and institutional climate had on curricular structure. All interviews were conducted by a single interviewer. All interviews were qualitatively analyzed using emergent theme analysis. 26 0+5 PDs participated in the study. 69% believed establishing professional identity early reduces resident attrition and recommend starting incoming trainees on vascular surgical services. 62% spread core surgical rotations over the 1(st) three years to optimize general surgical exposure and the majority of programs have eliminated specific rotations as they were not considered valuable to the goals of training. Factors considered most important by PDs in curricular development include: building upon existing institutional opportunities (96%), avoiding rotations considered unsuccessful by "experienced" programs (92%), and maintaining a good working relationship with general surgery (77 %). 58% of PDs voiced concern over the lack of standardization amongst the differing programs and the majority of PDs agree that some degree of programmatic standardization is critical for the continued success of the 0+5 training paradigm. Qualitative evaluation of PD experiences with the development of 0+5 vascular surgery residency programs reveals the key factors that commonly influence program design. Programs continue to evolve in both structure and content as PDs respond to these influences. Learning from the collective experience of PDs and some standardization of the curricula may help current and future programs avoid common pitfalls in curricular development.
    Annals of Vascular Surgery 03/2014; 28(7). DOI:10.1016/j.avsg.2014.02.028 · 1.03 Impact Factor
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    ABSTRACT: IntroductionDuplex ultrasound facilitates bedside diagnosis and hence timely patient care. Its uptake has been hampered by training and accreditation issues. We have developed an assessment tool for Duplex arterial stenosis measurement for both simulator and patient based training.MethodsA novel assessment tool: duplex ultrasound assessment of technical skills was developed. A modified duplex ultrasound assessment of technical skills was used for simulator training. Novice, intermediate experience and expert users of duplex ultrasound were invited to participate. Participants viewed an instructional video and were allowed ample time to familiarize with the equipment. Participants’ attempts were recorded and independently assessed by four experts using the modified duplex ultrasound assessment of technical skills. ‘Global’ assessment was also done on a four point Likert scale. Content, construct and concurrent validity as well as reliability were evaluated.ResultsContent and construct validity as well as reliability were demonstrated. The simulator had good satisfaction rating from participants: median 4; range 3-5. Receiver operator characteristic analysis has established a cut point of 22/ 34 and 25/ 40 were most appropriate for simulator and patient based assessment respectively. We have validated a novel assessment tool for duplex arterial stenosis detection. Further work is underway to establish transference validity of simulator training to improved skill in scanning patients.ConclusionsWe have developed and validated duplex ultrasound assessment of technical skills for simulator training.
    03/2014; 6(2):92-104.
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: Introduction As the first generation of integrated (0 + 5) vascular surgery (VS) residents enter the job market, this survey sought to understand how the surgical community perceives this training paradigm. Methods An anonymous online survey was e-mailed to surgery chairpersons (n = 193) and Society for Vascular Surgery (SVS) members (n = 2193) in the United States/Canada with 26% (n = 38) and 14% (n = 309) response rates, respectively. Respondents were asked about their practice background, residency program, hiring patterns, and perceptions of the 0 + 5 training. Results Response rates were 26% (n = 38) and 14% (n = 309) for surgery chairpersons and SVS members, respectively. SVS respondents were from academic (62%) and private (38%) practices and included staff surgeons (62%), program directors (15%), and division chiefs (22%). Only 33% had a 0 + 5 program, and 57% had a VS fellowship. Overall, 94% were likely to hire a new vascular surgeon in the next 5 years. In some categories, SVS respondents believed 0 + 5 residents would be less prepared than 5 + 2 residents. Only 32% thought that 0 + 5 residents have the same level of surgical maturity, and 36% thought that they have the same level of open operative skills as 5 + 2 trainees. Another 34% thought 0 + 5 residents will need additional fellowship training in open surgery. However, there was also a general perception from SVS respondents that 0 + 5 residents would be prepared for clinical practice (67%) and would have equal endovascular skills to 5 + 2 trainees (92%). The chairpersons had similar perceptions as SVS members. Both SVS members (88%) and chairpersons (86%) would consider interviewing a 0 + 5 graduate for faculty position; 83% and 72%, respectively, would consider hiring. Moreover, 93% of SVS respondents who currently have a 0 + 5 program and 86% of SVS respondents who do not would consider hiring a 0 + 5 graduate. Both SVS members (62%) and chairpersons (50%) believed the 0 + 5 paradigm is essential for the advancement of VS. Conclusions Overall perceptions of 0 + 5 graduates were positive and indicated their likely acceptance into the VS workforce. Although there were some reservations regarding the 0 + 5 graduates’ maturity level and open operative skills, the surgical community was willing to interview and hire these trainees for staff positions. Further follow-up will be required to evaluate their performance in clinical practice.
    Journal of Surgical Education 09/2014; 71(5). DOI:10.1016/j.jsurg.2014.02.005 · 1.39 Impact Factor