The first assessment of operative logs for traditional vascular fellowship track versus integrated vascular training programs

Abstract

As vascular surgery training paradigms evolve, one measure of success is operative experience. This study assessed the initial operative experience of those graduating from new integrated programs (0+5) vs those from the traditional programs (5+2). National operative case log data supplied by the Accreditation Council for Graduate Medical Education was compiled for vascular surgical residents graduating between 2010 and 2013. Mean case numbers for the 0+5 residents were compared with those for the 5+2 residents (experience from their general surgery residency plus vascular fellowship) for total vascular operations, open vascular operations, endovascular procedures, and total operative experience. The 5+2 trainees performed significantly more procedures than the 0+5 trainees (mean, 1605 vs 1015); however, they performed 12% less vascular procedures (mean, 758 vs 851). No significant differences in total number of open vascular operations (mean, 404 vs 411) or specific open operations for cerebral vascular disease, aneurysm, peripheral obstruction, and access were found. The increase in vascular procedures logged by 0+5 trainees was realized by a 24% increase in endovascular procedures, mainly involving diagnostic arteriography, caval filter placement, and balloon angioplasty. No significant differences were seen in endovascular aneurysm repair (mean, 63 vs 60) and stent placement (mean, 59 vs 60). This report summarizes the first data available for the 0+5 trainee operative experience. Compared with the traditional 5+2 trainees, the 0+5 trainees have (1) equivalent open vascular training and (2) overall superior endovascular training, although this was accounted via an increase in minor procedures. The overall operative experience remains greater for the 5+2 trainees secondary to 2 extra years of training. Further longitudinal studies will be needed to fully characterize the effect of the new 0+5 training paradigm.