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Kim Y, Cui CL, Williams ZF, Long CA. Impact of Integrated Vascular Surgery Residency on General Surgery Resident and Vascular Fellow Operative Volume: A National Analysis. Vasc Endovascular Surg 2024; 58:302-307. [PMID: 37918823 DOI: 10.1177/15385744231213299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND The impact of integrated vascular surgery (VS) residency (0 + 5) programs on general surgery (GS) resident and VS fellow (5 + 2) operative volume has not been investigated on a national scale. METHODS Accreditation Council for Graduate Medical Education (ACGME) case logs were reviewed for GS resident, VS resident, and VS fellow operative volume from 2001-2021. Integrated VS resident data was available from 2012-2021, corresponding with the introduction of the 0 + 5 paradigm. Trends in operative volume were evaluated via linear regression analysis. RESULTS The national cohort of chief GS resident graduates increased from 1005 to 1357 per year. Total operative volume also increased from 932 to 1039 cases (+7.4 cases/yr, R2 = .80, P < .0001) among GS residents. Major vascular cases decreased among GS residents from 138 to 101 cases (-2.4 cases/yr, R2 = .58, P < .0001) with a decrease in proportion of chief-level vascular cases from 30.4% to 11.9% (-1.0%/yr, R2 = .92, P < .0001). Palliative procedures (amputations and hemodialysis access) comprised a significant proportion of GS cases (median 44.7%). Concurrently, integrated VS graduates increased from 11 to 37 per year, with an increase in major vascular case volume from 506 to 658 cases (+18.4 cases/yr, R2 = .63, P = .01). Total VS fellow major case volume also increased from 369 to 444 cases (+3.5 cases/yr, R2 = .73, P < .0001). CONCLUSIONS The introduction of the 0 + 5 intgrated VS residency paradigm has correlated with a significant decrease in GS operative experience in major vascular procedures on a national level. Traditional VS fellow case volume does not appear to be impacted by 0 + 5 integrated residents. Further analysis with program-level data may help to explain the causative relationship of these findings.
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Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
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Cui CL, Loanzon RS, Southerland KW, Coleman DM, Waldrop HW, Williams ZF, Long CA, Kim Y. A national analysis of vascular surgery resident operative experience in peripheral artery disease. J Vasc Surg 2023; 78:1541-1547. [PMID: 37558145 DOI: 10.1016/j.jvs.2023.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Endovascular and hybrid interventions have played an increasingly prominent role in the treatment of peripheral arterial disease (PAD) in the past decade. This shift has prompted concerns about the adequacy of open surgical training for current surgical residents. Moreover, the recent Best Surgical Therapy in Patients With Critical Limb Ischemia trial has further emphasized the importance of open surgical techniques in the treatment of peripheral arterial disease. The purpose of this study was to examine national temporal trends in peripheral operative volume among integrated vascular surgery residents. METHODS Data was obtained from the Accreditation Council for Graduate Medical Education national data reports for integrated vascular surgery residents. Case volumes for surgeon chief or surgeon junior cases were collected from academic years 2012 to 2013 and 2021 to 2022. Trends in case-mix and volume were evaluated using linear regression analysis. RESULTS The mean total vascular operative volume increased from 851.2 to 914.3 cases among graduating chief residents, with an annual growth of 8.5 ± 1.7 cases/year (R2 = 0.77; P < .0001). Major vascular case volume also increased at a rate of 5.7 ± 1.2 cases/year (R2 = 0.74; P < .001). Among operative categories, peripheral cases were the most frequent (n = 232.2 [26.6%]) and demonstrated the greatest annual growth (+8.0 ± 0.8 cases/year, R2 = 0.93; P < .001). No changes were seen in volume of open peripheral cases, including suprainguinal bypass (+0.1 ± 0.2 cases/year; R2 = 0.08; P = .40) or femoropopliteal bypass procedures (-0.1 ± 0.2 cases/year; R2 = 0.17; P = .20). Infrapopliteal bypass (+0.4 ± 0.1 cases/year; R2 = 0.48; P = .006), iliac/femoral endarterectomy (+1.3 ± 0.2 cases/year; R2 = 0.82; P < .001), and leg thromboembolectomy (+0.4 ± 0.1 cases/year; R2 = 0.64; P < .001) all demonstrated annual growth. For endovascular peripheral cases, aortoiliac revascularization (+3.4 ± 0.3 cases/year; R2 = 0.94; P < .001), femoropopliteal revascularization (+5.4 ± 0.2 cases/year; R2 = 0.98; P < .001), and tibioperoneal revascularization (+2.0 ± 0.2 cases/year; R2 = 0.92; P < .001) all increased in volume. Lower extremity amputations, including above-knee amputation (+0.6 ± 0.2 cases/year; R2 = 0.65; P < .001) and below-knee amputation (+0.9 ± 0.2 cases/year; R2 = 0.72; P < .001) also demonstrated an increase in volume. CONCLUSIONS Current graduating residents have higher open and endovascular case volumes for peripheral artery disease on a national level, despite the increasing popularity of endovascular techniques. Further studies are needed to identify how these trends may impact current vascular surgery milestones. These trends may also influence the rising interest in competency-based training programs.
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Affiliation(s)
- Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Medical Center, Durham, NC
| | - Roberto S Loanzon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Medical Center, Durham, NC
| | - Kevin W Southerland
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Medical Center, Durham, NC
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Medical Center, Durham, NC
| | - Heather W Waldrop
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Medical Center, Durham, NC
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Medical Center, Durham, NC
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Medical Center, Durham, NC
| | - Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Medical Center, Durham, NC.
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The Impact of Endovascular Repair of Abdominal Aortic Aneurysms on Vascular Surgery Training in Open Aneurysm Repair. Ann Vasc Surg 2023; 92:1-8. [PMID: 36754163 DOI: 10.1016/j.avsg.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Since the introduction of endovascular aneurysm repair (EVAR) in 1992, the number of open AAA repair (OAR) cases continue to decline. The consequence of reduced OAR cases raises valid concerns related to patient safety and the future training of vascular surgeons that need to be appropriately addressed. Our objective is to analyze trends in OAR and EVAR cases and to assess their implications on the quality of vascular surgery training. METHODS We analyzed the Accreditation Council for Graduate Medical Education (ACGME) case log database for total clinical experience in OAR and EVAR for graduating vascular surgery fellows (VSFs) finishing 5 + 2 programs between 2002 and 2019 and vascular surgery integrated residents (VSRs) between 2013 and 2019. VSF case totals were calculated by combining average total cases of open and endovascular supra- and infrarenal AAA repair during fellowship years combined with total cases performed during their general surgery residency. VSR case totals included only the cases performed during the 5-year residency period. Isolated Iliac and thoracic aortic aneurysms were excluded from our analysis. RESULTS The average number of OAR cases per trainee has decreased by 60% (from 36.9 to 14.7) with a rate of 1.4 cases per year (P < 0.001) for VSF. Meanwhile, EVAR average cases have increased by 102% (from 22 to 44.4). However, there were 2 different trends exhibited with EVAR over the study period. Between 2002 and 2007, EVAR cases tended to increase by 5.9 cases per year (P < 0.001). Whereas, between 2007 and 2019, there was a slightly decreased trend in EVAR cases by 0.3 cases per year (P = 0.01). For VSR, while no significant trend was observed in the mean number of OAR cases (Coef. -0.3, P = 0.2) due to the limited time frame, the proportion of open cases was significantly lower compared to endovascular cases. Additionally, there were 2 different trends exhibited with EVAR over the study period. Between 2013 and 2015, EVAR cases tended to increase by 1.7 cases per year (P = 0.1). Whereas, between 2015 and 2019, there was a slightly decreased trend in EVAR cases by 0.2 cases per year (P = 0.007). CONCLUSIONS A significant reduction in average OAR cases and an increase in EVAR cases were observed over the study period. Vascular surgery training programs may need to introduce further training programs in open surgical repair to ensure vascular surgery trainees have the required technical skills and expertize to perform such a high-risk procedure safely and independently.
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Treil L, Neumann N, Chanes N, Lejay A, Bourcier T, Bismuth J, Lee JT, Sheahan M, Rouby AF, Chakfé N, Eidt J, Georg Y, Mitchell EL, Rigberg D, Shames M, Thaveau F, Sheahan C. Objective Evaluation of Clock Face Suture Using the Objective Structured Assessment of Technical Skill (OSATS) Checklist. EJVES Vasc Forum 2022; 57:5-11. [DOI: 10.1016/j.ejvsvf.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
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Stienen MN, Bartek J, Czabanka MA, Freyschlag CF, Kolias A, Krieg SM, Moojen W, Renovanz M, Sampron N, Adib SD, Schubert GA, Demetriades AK, Ringel F, Regli L, Schaller K, Meling TR. Neurosurgical procedures performed during residency in Europe—preliminary numbers and time trends. Acta Neurochir (Wien) 2019; 161:843-853. [PMID: 30927157 DOI: 10.1007/s00701-019-03888-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/20/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
- Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Jiri Bartek
- Department of Clinical Neuroscience and Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Marcus A Czabanka
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | | | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Wouter Moojen
- HAGA Teaching Hospital and Medical Center Haaglanden, The Hague & Leiden University Medical Center, Leiden, Netherlands
| | - Mirjam Renovanz
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Nicolas Sampron
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - Sasan D Adib
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | | | | | - Florian Ringel
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Karl Schaller
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Torstein R Meling
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Irfan W, Sheahan C, Mitchell EL, Sheahan MG. The pathway to a national vascular skills examination and the role of simulation-based training in an increasingly complex specialty. Semin Vasc Surg 2019; 32:48-67. [DOI: 10.1053/j.semvascsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Simulation in Vascular Surgery. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Al-Jundi W, Firdouse M, Morrow D, Wyatt M, Wheatcroft M. Vascular Surgery Fellowships: Comparison of Two Programmes in Canada and the UK. EJVES Short Rep 2018; 41:28-31. [PMID: 30582025 PMCID: PMC6300430 DOI: 10.1016/j.ejvssr.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Wissam Al-Jundi
- Norwich Vascular Centre, Norfolk and Norwich University Hospital, Norwich, UK
| | - Mohammed Firdouse
- Department of Vascular Surgery, St Michael Hospital, Toronto, ON, Canada
| | - Darren Morrow
- Norwich Vascular Centre, Norfolk and Norwich University Hospital, Norwich, UK
| | - Michael Wyatt
- Northern Vascular Centre, Freeman Hospital, Newcastle, UK
| | - Mark Wheatcroft
- Department of Vascular Surgery, St Michael Hospital, Toronto, ON, Canada
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Pei KY, Zhang Y, Sarac T, Davis KA. Comparison of Outcomes in Below-Knee Amputation between Vascular and General Surgeons. Ann Vasc Surg 2018; 50:259-268. [PMID: 29501591 DOI: 10.1016/j.avsg.2017.11.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is evidence to suggest outcomes may be related to surgeon experience or skill level. Lower extremity amputations are performed by both general surgeons (GSs) and vascular surgeons (VSs); however, the effect of specialty on postoperative outcome in below-knee amputation is not known. This retrospective study compares outcomes in below-knee amputations (BKA) between VS and GS. METHODS Patients who underwent below-knee amputations between 2005 and 2014 were identified from the American College of Surgeons National Surgical Quality Improvement Project database. Data collected included patient demographics, comorbid conditions, and indication for procedures. Univariate and multivariate unconditional logistic regression models and linear regression models were employed to evaluate the associations between various outcomes and indications for surgery, emergency and teaching status, and surgical specialty. RESULTS Amputations performed by GSs experienced an increased risk of developing pneumonia (odds ratio [OR] = 1.49, 95% confidence interval [CI]: 1.19-1.86), pulmonary embolism (OR = 2.10, 95% CI: 1.10-4.01), and sepsis (OR = 1.29, 95% CI: 1.05-1.59). When stratified by indications for BKA, similar outcomes were noted between GS and VS if indication for surgery was diabetes or peripheral vascular disease; however, there was increased risk of pneumonia (OR = 1.86, 95% CI: 1.26-2.74), sepsis (OR = 1.96, 95% CI: 1.39-2.75), and death (OR = 1.47, 95% CI: 1.04-2.07, P = 0.027) when GS performed BKA for infectious indications. Overall complications were higher when GS performed BKA emergently (OR = 1.17, 95% CI: 1.01-1.36). CONCLUSION There are less postoperative complications when VSs performed BKA for infectious indications, during emergencies, and at nonteaching hospitals. Clinicians should consider vascular consultation for these specific scenarios.
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Affiliation(s)
- Kevin Y Pei
- Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT.
| | - Yawei Zhang
- Section of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Timur Sarac
- Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Kimberly A Davis
- Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT
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Suckow BD, Goodney PP, Columbo JA, Kang R, Stone DH, Sedrakyan A, Cronenwett JL, Fillinger MF. National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients. J Vasc Surg 2017; 67:1690-1697.e1. [PMID: 29290495 DOI: 10.1016/j.jvs.2017.09.046] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 09/24/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Open repair effectively prevents rupture for patients with abdominal aortic aneurysm (AAA) and is commonly studied as a metric reflecting hospital and surgeon expertise in cardiovascular care. However, given recent advances in endovascular aneurysm repair (EVAR), such as branched-fenestrated EVAR, it is unknown how commonly open surgical repair is still used in everyday practice. METHODS We analyzed trends in open AAA repair, EVAR, and branched-fenestrated EVAR for AAA in Medicare beneficiaries from 2003 to 2013. We used Medicare Part B claims to ascertain counts of these repair types annually during the study period. We assessed regional and national trends in characteristics of the patients and procedure volume. RESULTS Between 2003 and 2013, the total number of AAA repairs performed in fee-for-service Medicare patients declined by 26% from 31,582 to 23,421 (P < .001), after a peak number of 32,540 was performed in 2005 (28% decline since 2005). The number of open AAA repairs steadily declined by a total of 76%, from 20,533 in 2003 to 4916 in 2013 (P < .001). Whereas the number of EVARs increased from 11,049 in 2003 to 19,247 in 2011 (P < .001), it has since declined a total of 15% to only 16,362 repairs in 2013 (P < .001). After its introduction in 2011, the number of branched-fenestrated EVAR cases continuously rose from 335 procedures in 2011 to 2143 procedures in 2013 (P < .001). By 2013, virtually all hospital referral regions in the United States had rates of open AAA repair that would have been in the lowest quintile of volume in 2003. CONCLUSIONS The number of open AAA repairs fell by nearly 80% during the last decade, whereas traditional EVAR declined slightly and branched-fenestrated EVAR rapidly disseminated into national practice. These results suggest that open AAA repair is now performed too infrequently to be used as a metric in the assessment of hospital and surgeon quality in cardiovascular care. Furthermore, surgical training paradigms will need to reflect the changing dynamics necessary to ensure that surgeons and interventionists can safely perform these high-risk surgical procedures.
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Affiliation(s)
- Bjoern D Suckow
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; VA Outcomes Group, White River Junction, Vt; Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH
| | - Jesse A Columbo
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; VA Outcomes Group, White River Junction, Vt
| | | | - David H Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Art Sedrakyan
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH
| | - Jack L Cronenwett
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mark F Fillinger
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Piazza M, Nayak N, Ali Z, Heuer G, Sanborn M, Stein S, Schuster J, Grady MS, Malhotra NR. Trends in Resident Operative Teaching Opportunities for Treatment of Intracranial Aneurysms. World Neurosurg 2017; 103:194-200. [DOI: 10.1016/j.wneu.2017.03.124] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 11/16/2022]
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Yan H, Maximus S, Kim JJ, Smith B, Kim D, Koopmann M, DeVirgilio C. General Surgery Resident Vascular Operative Experience in the Era of Endovascular Surgery and Vascular Fellowships. Am Surg 2015. [DOI: 10.1177/000313481508101036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Advances in endovascular surgery have resulted in a decline in major open arterial reconstructions nationwide. Our objective is to investigate the effect of endovascular surgery on general surgery resident experience with open vascular surgery. Between 2004 and 2014, 112 residents graduated from two academic institutions in Southern California. Residents were separated into those who graduated in 2004 to 2008 (period 1) and in 2009 to 2014 (period 2). Case volumes of vascular procedures were compared using two-sample t test. A total of 43 residents were in period 1 and 59 residents were in period 2. In aggregate, there was no significant difference in open cases recorded between the two periods (84 vs 87, P = 0.194). Subgroup analysis showed period 2 recorded significantly fewer cases of open aneurysm repair (5 vs 3, P < 0.001), cerebrovascular (14 vs 10, P = 0.007), and peripheral obstructive procedures (16 vs 13, P = 0.017). Dialysis access procedures constituted the largest group of procedures and remained similar between the two periods (35 vs 42, P = 0.582). General surgery residents experienced a significant decline in several index open major arterial reconstruction cases. This decline was offset by maintenance of dialysis access procedures. If the trend continues, future general surgeons will not be proficient in open vascular procedures.
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Affiliation(s)
- Huan Yan
- Department of Surgery, Harbor-University of California Los Angeles Medical Center
| | - Steven Maximus
- Department of Anesthesia and Surgery, University of California at Irvine; and the Los Angeles Biomedical Research Institute at Harbor-University of California
| | - Jerry J. Kim
- Department of Surgery, Harbor-University of California Los Angeles Medical Center
| | - Brian Smith
- Department of Anesthesia and Surgery, University of California at Irvine; and the Los Angeles Biomedical Research Institute at Harbor-University of California
| | - Dennis Kim
- Department of Surgery, Harbor-University of California Los Angeles Medical Center
| | - Matthew Koopmann
- Department of Surgery, Harbor-University of California Los Angeles Medical Center
| | - Christian DeVirgilio
- Department of Surgery, Harbor-University of California Los Angeles Medical Center
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Batista P, Abai B, Salvatore D, DiMuzio P. The first assessment of operative logs for traditional vascular fellowship track versus integrated vascular training programs. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.05.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fonseca AL, Reddy V, Longo WE, Gusberg RJ. Are graduating surgical residents confident in performing open vascular surgery? Results of a national survey. JOURNAL OF SURGICAL EDUCATION 2015; 72:577-584. [PMID: 25678048 DOI: 10.1016/j.jsurg.2014.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/24/2014] [Accepted: 12/09/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION General surgical training has changed significantly over the past decade with work-hour restrictions, increasing use of minimally invasive techniques, and increasing specialization, leading to decreased resident exposure to open operative techniques. Furthermore, the presence of vascular surgery fellows and the advent of dedicated vascular surgery residencies have had the potential to diminish further the vascular surgery experience of general surgery residents. Given these changes, this study was undertaken to assess the confidence of graduating general surgery residents in performing certain key open vascular maneuvers, approaches that might be required in a general surgery practice, and to determine factors associated with variations in reported confidence. METHODS A survey was developed and sent to graduating chief surgical residents nationally. We queried them regarding demographics and program characteristics and asked them to rate their confidence (rated 1-5 on a Likert scale) in performing a vascular anastomosis and 4 specific vascular control maneuvers. We then compared those who indicated confidence with those who did not. RESULTS We received 653 responses from fifth-year (postgraduate year 5) surgical residents: 69% men, 67.5% from university programs, and 51% from programs affiliated with a Veterans Affairs hospital; additionally, 22% were from small programs, 34% from medium programs, and 44% from large programs. Although 70% of respondents indicated confidence performing a vascular anastomosis, less than 25% indicated confidence performing each of the 4 specified vascular maneuvers. Age, program size, future fellowship plans, surgical volume, estimated percentage of cases performed laparoscopically, and geographic location were all associated with variations in reported confidence. CONCLUSIONS Graduating general surgical residents indicated a significant lack of confidence in performing specific open vascular surgical maneuvers. This decreased confidence varied regionally and was associated with both demographic and program-specific factors.
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Affiliation(s)
- Annabelle L Fonseca
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Vikram Reddy
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Walter E Longo
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Richard J Gusberg
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Enomoto LM, Hill DC, Dillon PW, Han DC, Hollenbeak CS. Surgical specialty and outcomes for carotid endarterectomy: evidence from the National Surgical Quality Improvement Program. J Surg Res 2013; 188:339-48. [PMID: 24480081 DOI: 10.1016/j.jss.2013.11.1119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 11/22/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) has been performed since the 1950s and remains one of the most common surgical procedures in the United States. The procedure is performed by cardiothoracic, general, neurologic, and vascular surgeons. This study uses data from the National Surgical Quality Improvement Program (NSQIP) to examine the outcomes after CEA when performed by general or vascular surgeons. MATERIALS AND METHODS Data included 34,493 CEAs from years 2005 to 2010 recorded in the NSQIP database. Primary outcomes measured were length of stay, 30-d mortality, surgical site infection, cerebrovascular accident, myocardial infarction, and blood transfusion requirement. Secondary outcomes measured were the remaining intraoperative outcomes from the NSQIP database. RESULTS After controlling for patient and surgical characteristics, patients treated by general surgeons did not have a significantly different LOS or 30-d mortality than those treated by vascular surgeons. Patients of general surgeons had nearly twice the risk of acquiring a surgical site infection (odds ratio [OR] = 1.94; P = 0.012), >1.5 times the risk of cerebrovascular accident (OR = 1.56; P = 0.008), and >1.8 times the risk of blood transfusion (OR = 1.85; P = 0.017) than those of vascular surgeons. Patients of general surgeons had less than half the risk of having a myocardial infarction (OR = 0.34; P = 0.031) than those of vascular surgeons. CONCLUSIONS Surgical specialty is associated with a wide range of postoperative outcomes after CEA. Additional research is needed to explore practice and cultural differences across surgical specialty that may lead to outcome differences.
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Affiliation(s)
- Laura M Enomoto
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Darren C Hill
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Peter W Dillon
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - David C Han
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Christopher S Hollenbeak
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Valentine RJ, Rhodes RS, Jones A, Biester TW. Evolving Patterns of Vascular Surgery Care in the United States: A Report from the American Board of Surgery. J Am Coll Surg 2013; 216:886-893.e1. [DOI: 10.1016/j.jamcollsurg.2013.01.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 11/30/2022]
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17
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Robinson WP, Schanzer A, Cutler BS, Baril DT, Larkin AC, Eslami MH, Arous EJ, Messina LM. A randomized comparison of a 3-week and 6-week vascular surgery simulation course on junior surgical residents' performance of an end-to-side anastomosis. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.06.105] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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18
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Karthikesalingam A, Buxton P, Marron C, Oshin OA, Scurr JRH, Wall M. Deficiencies Persist in the Experience of UK Vascular Trainees. Vasc Endovascular Surg 2012; 46:358-63. [DOI: 10.1177/1538574412450075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aims.To evaluate the training experience of the current United Kingdom (UK) vascular trainees. Methods. A Web-based questionnaire was administered to 217 members of the Rouleaux Club, which represents UK vascular and endovascular trainees, between May and June 2011. Results. A total of 153 trainees (71% response rate) completed the survey; 52% were in posts that do not offer endovascular training, 88% performed <10 peripheral angiograms, and 67% performed part or all of <10 endovascular aneurysm repairs in the last year. Half had no access to formal ultrasound training; 85% believe that vascular access will play a role in their future practice, but 49% performed no vascular access procedures in the past year. No experience of endovenous laser, radiofrequency ablation, or foam sclerotherapy was reported by 33%, 49%, and 46%, respectively. Conclusions. Trainee experience is insufficient for a modern specialist practice. Separate specialty training in the United Kingdom must address these deficiencies.
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Mitchell EL, Sevdalis N, Arora S, Azarbal AF, Liem TK, Landry GJ, Moneta GL. A fresh cadaver laboratory to conceptualize troublesome anatomic relationships in vascular surgery. J Vasc Surg 2012; 55:1187-94. [DOI: 10.1016/j.jvs.2011.09.098] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 08/31/2011] [Accepted: 09/03/2011] [Indexed: 01/22/2023]
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20
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Ullery BW, Nathan DP, Jackson BM, Wang GJ, Fairman RM, Woo EY. Qualitative Impact of the Endovascular Era on Vascular Surgeons’ Comfort Level and Enjoyment With Open and Endovascular AAA Repairs. Vasc Endovascular Surg 2012; 46:150-6. [DOI: 10.1177/1538574411432147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: 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. Methods: 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. Results: 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). Conclusion: The advent of EVAR has changed fellowship training of AAA repair and has translated into changes in both practice patterns and comfort level.
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Affiliation(s)
- Brant W. Ullery
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA, USA
| | - Derek P. Nathan
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin M. Jackson
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA, USA
| | - Grace J. Wang
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald M. Fairman
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Y. Woo
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA, USA
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21
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Konstantinou EA, Brady JM, Soultati A, Mitsos A, Mamoura K, Mariolis TS, Christina DD, Fotis T. Intraoperative use of cell saver on patients undergoing open abdominal aortic aneurysm surgical repair: a Greek hospital experience. J Perianesth Nurs 2011; 26:225-30. [PMID: 21803270 DOI: 10.1016/j.jopan.2011.04.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 02/22/2011] [Accepted: 04/12/2011] [Indexed: 10/17/2022]
Abstract
Perioperative use of a cell saver device can serve as a cost-beneficial alternative to the transfusion method, especially in countries where the cost of a single unit of blood is high. The purpose of this study, conducted in a Greek hospital, was to calculate the cost benefit of using a cell saver device to salvage intraoperative blood during open surgical abdominal aortic aneurysm repair or open aortofemoral bypass for occlusive disease. This retrospective study measured the amounts of salvaged blood and reinfused blood encountered during the procedure and then calculated the cost benefit of cell saver use. With the cost of a unit of blood purchased in Greece about €450 ($585), the blood units salvaged and reinfused were calculated at a mean cost benefit of €754 ($980) per case.
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22
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Marrocco CJ, Bush RL. Explantation of abdominal aortic endografts: the need for complex aortic repair training. J Endovasc Ther 2010; 17:703-4. [PMID: 21142476 DOI: 10.1583/10-3186c1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christopher J Marrocco
- Division of Vascular Surgery, Scott & White Hospital, Texas A & M College of Medicine, Temple, Texas 76508, USA
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23
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Bismuth J, Donovan MA, O'Malley MK, El Sayed HF, Naoum JJ, Peden EK, Davies MG, Lumsden AB. Incorporating simulation in vascular surgery education. J Vasc Surg 2010; 52:1072-80. [DOI: 10.1016/j.jvs.2010.05.093] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 05/19/2010] [Accepted: 05/22/2010] [Indexed: 01/02/2023]
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24
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Nordon IM, Hinchliffe RJ. An independent specialty is the only way to guarantee the future of vascular surgery: the trainees' perspective. Vascular 2010; 18:194-6. [PMID: 20643028 DOI: 10.2310/6670.2010.00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ian M Nordon
- St George's Vascular Institute, St George's Hospital, London, UK
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25
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Franz RW. General Versus Vascular Surgeon: Impact of a Vascular Fellowship on Clinical Practice, Surgical Case Load, and Lifestyle. Ann Vasc Surg 2010; 24:196-204. [DOI: 10.1016/j.avsg.2008.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 10/31/2008] [Accepted: 11/06/2008] [Indexed: 11/16/2022]
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26
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Burkhardt GE, Rasmussen TE, Propper BW, Lopez PL, Gifford SM, Clouse WD. A national survey of evolving management patterns for vascular injury. JOURNAL OF SURGICAL EDUCATION 2009; 66:239-247. [PMID: 20005495 DOI: 10.1016/j.jsurg.2009.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 09/14/2009] [Accepted: 09/16/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND The modern era has witnessed an increase in endovascular techniques used by physicians to treat vascular injury and age-related disease. As a consequence, the number of open vascular operations available for general surgical education has decreased dramatically. This changing paradigm threatens competence in vascular injury management achieved during surgical residency. The objective of this study is to sample perceptions on vascular injury treatment in the United States to highlight the need for planning for this important tenet of surgical education. METHODS An electronic survey was extended to board-certified surgeons through 3 professional societies, the Peripheral Vascular Surgery Society (PVSS), the Eastern Association for the Surgery of Trauma (EAST), and the American College of Surgeons (ACS). RESULTS A total of 520 respondents were self-categorized as trauma (59%; n = 307), vascular (17%; n = 90), or general (19%; n = 99) surgeons. Respondents reported that general surgeons currently manage less than 10% of vascular injuries at their respective institutions. A 2.5-fold increase in endovascular treatment of vascular injury during the past decade was reported with interventional radiologists now involved in the management of up to 25% of injuries. Few general or trauma surgeons surveyed possessed a catheter-based skill set, although 38% of trauma surgeons expressed great interest in endovascular training. Additionally, a cadre of vascular surgeons (67%) affirmed a commitment to teaching vascular injury management. CONCLUSIONS The results of this study confirm a diminished role for non-fellowship-trained surgeons in managing vascular injury. Despite an increased acceptance of endovascular techniques to manage trauma, general and trauma surgeons do not possess the skill set. Collaboration between surgical communities will be especially important to maintain high standards in vascular injury management.
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Affiliation(s)
- Gabriel E Burkhardt
- San Antonio Military Medicine Consortium, Wilford Hall USAF Medical Center, 2200 Bergquist Drive, Lackland Air Force Base, Texas 78236, USA
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Karmy-Jones R, Kouchoukos NT. Endovascular credentialing and assembling the endovascular team. J Card Surg 2009; 24:334-42. [PMID: 19438793 DOI: 10.1111/j.1540-8191.2009.00839.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Riyad Karmy-Jones
- Department of Thoracic and Vascular Surgery, Southwest Washington Medical Center, Vancouver, Washington, USA
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Hingorani AP, Ascher E, Marks N, Shiferson A, Patel N, Gopal K, Jacob T. Self-assessment of the Training of Vascular Fellows: Survey Results of 219 Vascular Fellows From 2004 Through 2007. Vasc Endovascular Surg 2009; 43:185-9. [DOI: 10.1177/1538574408327791] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. In an attempt to identify the concerns of vascular fellows regarding their training in vascular surgery, we conducted a survey consisting of 22 questions at an annual national meeting from 2004 to 2007. Methods. The fellows were asked to assess various aspects of their training as excellent, satisfactory, or mixed. Results. 76% were satisfied with their endovascular experience during their fellowship while 82% were satisfied with their experience with open cases. The distribution of non-learning cases was felt to be excellent, satisfactory, or required some or much improvement in: 45%, 44%, 8%, and 2% respectively. However, only 61% felt that their vascular laboratory experience was excellent or satisfactory. Only 36% actually performed the vascular duplex exam, and only 49% felt that they would feel comfortable in managing a vascular laboratory. Conclusions. The results of this Survey suggest that several significant issues are reflected in the minds of vascular trainees.
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Affiliation(s)
- Anil P Hingorani
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY,
| | - Enrico Ascher
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY
| | - Natalie Marks
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY
| | | | - Nirav Patel
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY
| | - Kapil Gopal
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY
| | - Theresa Jacob
- Division of Vascular Services, Maimonides Medical Center, Brooklyn, NY
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Hingorani AP, Ascher E, Marks N, Shiferson A, Puggioni A, Tran V, Patel N, Jacob T. 219 vascular fellows' perception of the future of vascular surgery. Ann Vasc Surg 2008; 23:453-7. [PMID: 18973989 DOI: 10.1016/j.avsg.2008.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 08/23/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
Abstract
In an attempt to identify the fellows' concerns about the future of the field of vascular surgery, we conducted a survey consisting of 22 questions at an annual national meeting in March from 2004 to 2007. In order to obtain accurate data, all surveys were kept anonymous. The fellows were asked (1) what type of practice they anticipated they would be in, (2) what the new training paradigm for fellows should be, (3) to assess their expectation of the needed manpower with respect to the demand for vascular surgeons, (4) what were major threats to the future of vascular surgery, (5) whether they had heard of and were in favor of the American Board of Vascular Surgery (ABVS), (6) who should be able to obtain vascular privileges, and (7) about their interest in an association for vascular surgical trainees. Of 273 attendees, 219 (80%) completed the survey. Males made up 87% of those surveyed, and 60% were between the ages of 31 and 35 years. Second-year fellows made up 82% of those surveyed. Those expecting to join a private, academic, or mixed practice made up 35%, 28%, and 20% of the respondents, respectively, with 71% anticipating entering a 100% vascular practice. Forty percent felt that 5 years of general surgery with 2 years of vascular surgery should be the training paradigm, while 45% suggested 3 and 3 years, respectively. A majority, 79%, felt that future demand would exceed the available manpower, while 17% suggested that manpower would meet demand. The major challenges to the future of vascular surgery were felt to be competition from cardiology (82%) or radiology (30%) and lack of an independent board (29%). Seventeen percent were not aware of the ABVS, and only 2% were against it; 71% suggested that vascular privileges be restricted to board-certified vascular surgeons. Seventy-six percent were interested in forming an association for vascular trainees to address the issues of the future job market (67%), endovascular training during fellowship (56%), increasing focus on the vascular fellows at national meetings (49%), and representation for the fellows on the national councils (37%). This survey suggests that several significant issues exist in the minds of vascular trainees that have not been addressed and may present opportunities for further dialogue.
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Affiliation(s)
- Anil P Hingorani
- Division of Vascular Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
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