Vision of the vascular surgeon as the vascular specialist of the future

A modern appraisal of current vascular surgery education

OBJECTIVE

Although general program requirements and curriculum content outlines are provided by the Accreditation Council for Graduate Medical Education, Association for Program Directors in Vascular Surgery, and Vascular Surgery Board of the American Board of Surgery, there is no single format for delivery of this content. The delivery of these defined educational components is, thus, likely to differ from site to site. The curriculum committee of the Association of Program Directors in Vascular Surgery was tasked with formalizing the content of the Vascular Surgery Surgical Council on Resident Education curriculum modules, and, therefore, we sought to appraise the current status of vascular educational programs in U.S. training programs before its implementation.

METHODS

Program directors (PDs) of 112 U.S. vascular surgery residency and fellowship training programs were contacted via email and asked to participate in an anonymous electronic survey. This survey evaluated the educational components of individual programs, including vascular specific conferences, use of other training modalities, and determination of who was involved in the creation of these programs.

RESULTS

Of the 112 PDs offered the survey, 80 (71%) responded. Most (42 of 80; 53%) have both an integrated vascular residency and a fellowship with the remaining being solely fellowship (31 of 80; 39%) or integrated residencies (7 of 80; 9%). The majority (79 of 81; 98%) of programs hold at least one vascular conference per week, with 75% (60 of 81) holding more than one each week. The total time spent in conference averaged 2.6 hours/wk, and the most common educational components of the weekly conferences were review of upcoming (48 of 79, 61%) or recently completed surgical cases (30 of 79; 38%), lectures on vascular disease processes (40 of 79; 51%), and review of book chapters from vascular surgery textbooks (27 of 78; 35%). PDs are responsible for creating the schedule at 50% (39 of 78) of the programs with most remaining programs relying on trainees (18 of 78; 23%) and assistant PDs (17 of 78; 22%). Vascular trainees present the majority of material at most programs' conferences (64 of 77; 83%). The majority of PDs feel that trainees should independently study 4 hours or more per week (51 of 79; 65%), but only 25% (20 of 79) believe that trainees actually spend this amount of time studying (P = .0001). Only 13 of 80 (16%) programs currently use a preformatted standardized vascular curriculum, but 64 of 80 (80%) believe that there is a need for the creation of this product and 72 of 80 (90%) would most likely use it.

CONCLUSIONS

There is a significant variation in vascular surgery educational programs with considerable dependence on trainees to create the curriculum. The majority of PDs in vascular surgery support the creation of a standardized vascular curriculum and would use it if made.

Complication rates of diagnostic angiography performed by vascular surgeons

The objective of this study was to compare the complication rates of diagnostic angiography performed by vascular surgeons to those previously published by interventional radiologists. From May 1999 through August 2000, 3 board-certified vascular surgeons performed 224 endovascular procedures in a modern endovascular suite. Of these 224 procedures, 144 were diagnostic angiographies. A retrospective chart review was conducted to identify periprocedural complications of these angiographies. The patients were classified into 3 groups according to the indication for angiography, and the major and overall complication rates were tabulated. The complication rates for the initial 25 and subsequent 119 arteriographies were compared to evaluate the presence of a learning curve. Thirty-eight percent of angiographies were performed to define aneurysmal anatomy (type I), 51% to define peripheral arterial stenosis or occlusion (type II), and 12% to assess symptomatic carotid artery disease or mesenteric ischemia (type III). The major complication rates for these 3 types were 0%, 2.7%, and 5.9%, respectively, and showed no statistical difference (Fischer's exact test) compared to published rates of 0.7%, 2.9%, and 9.1%. Major complications included an external iliac artery dissection, a cerebral air embolus, and a deep venous thrombosis. The overall major complication rate was 2.1%, which compares to published rates of 1.9-2.9%. The major complication rates for the initial 25 and final 119 were 8% and 0.8%, respectively. Vascular surgeons can perform diagnostic angiography with acceptable complication rates. The complication rate is reduced with angiographic experience.

Regional vascular surgical units: a practical means of providing specialist services

BACKGROUND

A comprehensive regional emergency and elective vascular surgical service was established in Limerick Regional General Hospital between 1994 and 1996 following the appointment of three surgeons with vascular training.

AIM

To compare vascular surgical activity before and after the establishment of a regional vascular service.

METHODS

This study used local and national computerised databases, clinic letters, theatre registers and radiology records to compare vascular surgical activity before (1992) and after (1997) this service was established.

RESULTS

Total outpatient activity increased almost six-fold and total number of inpatient vascular procedures (including radiological) increased from 146 to 432, but the venous proportion declined from 70% to 36%. The number of major arterial procedures increased from 37 to 165 in 1997 including 10 carotid endarterectomies, 24 aortic reconstructions and 54 lower limb reconstructions representing rates of 3/100,000, 8/100,000 and 17/100,000 population respectively.

CONCLUSION

As substantial changes in disease patterns are unlikely, these data indicate that patients previously diverted elsewhere for therapy are now cared for within the health board region and that further increases in workload may be expected. We suggest that these data mandate the reallocation of resources to fund appropriately staffed and audited regional vascular units.