Operative Competency and Autonomy Achieved by Senior Vascular Surgery Integrated Residents and Fellows.

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Integrated vascular surgery residency and traditional fellowship training paradigms offer two unique pathways to independent vascular surgery practice and board eligibility. Although operative case requirements are equivalent in each, it is unknown whether operative competence achieved by graduates is comparable between paradigms. We sought to examine operative performance and autonomy achieved between vascular integrated residents (VIR) and vascular surgery fellows (VSF) in their final year of training. Operative assessments were collected between 2018-2022 from a national cohort of vascular surgery training programs using the Society for Improving Medical Professional Learning (SIMPL) OR assessment application. Statistical analysis of intraoperative autonomy, performance, and case complexity was stratified by training paradigm. Generalized linear mixed models were conducted to compare assessments of autonomy and performance between VIR and VSF in their graduating year, controlling for case complexity and procedure type (open or endovascular). To account for the statistical dependency within the nested data, the random effects of trainee, faculty, program, and procedure were included. Separate analyses were conducted for faculty assessments and trainee self-assessments. Data were analyzed using R software. Twenty-five training programs (n=12 residency, 13 fellowship) collected 4,927 assessments (n=2,232 assessments by faculty; 2,695 self-assessments by trainees) from 106 trainees and 94 faculty. There were no differences in faculty assessments or trainee self-assessments of operative performance (faculty: B = 0.06, P = 0.56; trainee: B = -0.15, P = 0.19) or autonomy (faculty: B = 0.06, P = 0.61; trainee: B = 0.03, P = 0.83) between VIR and VSF during the final year of training, even when corrected for case complexity and procedure type. Using the model, the predicted performance and autonomy ratings for VIR and VSF were estimated across PGY and various case complexities for open and endovascular procedures, respectively. During the final year of vascular surgery training, VIR and VSF trainees achieve similar operative performance and autonomy for both endovascular and open procedures. Despite inherent differences in the training paradigms, equivalent operative competence and autonomy are achieved by graduation, suggesting similar preparedness for independent practice.