Vascular Surgery Training Research Articles

Concerning Trends in Vascular Surgery Trainee Operative Experience in Venous Disease

Concerning Trends in Vascular Surgery Trainee Operative Experience in Venous Disease

Gender Differences in Perceptions and Attitudes Toward Vascular Surgery Among Prospective Preclinical Medical Students

Women account for approximately 15% of the vascular surgery workforce, yet represent 50% of all medical school matriculants. Despite a focus on increasing diversity among vascular surgeons, gender disparities in vascular surgery persist. In order to encourage increased representation of women entering vascular specialties, efforts have been made at the national level to create programs for mentorship and leadership development; however, efforts to increase awareness of vascular surgery at early stages of training have been limited. We aimed to characterize the attitudes and perceptions of prospective female vascular trainees in the preclinical phase of medical school. A panel hosted virtually by the Vascular and Endovascular Surgical Society National Vascular Surgery Interest Group (VSIG) was held to introduce the field of vascular surgery to prospective medical students with limited exposure to vascular surgery. Attendees to this event were asked to complete an anonymous survey prior to the start of the panel. Student t test and χ2 test were used to compare survey responses by gender. Out of the 114 attendees, there were 52 responses to the survey. Women made up 48.1% of respondents and were first (44.0%) and second year (56.0%) medical students. There were a similar number of Asian and White respondents of both genders; however, there were fewer women who identified as Black or Hispanic as compared to men (8.0% vs 14.8%; P < .001) (Table I). A greater number of men were interested in vascular surgery as compared to women (48.1% vs 36.0%; P < .001) at the time of the survey; however, women were more likely to be interested in other surgical specialties (ENT, orthopedics, cardiothoracic surgery, ophthalmology) (Table I). Female respondents were significantly less interested in the 5+2 vascular surgery training paradigm as compared to male respondents (P = .012) (Table II). A greater percentage of women reported that they did not have a VSIG at their home institution (32.0% vs 14.8%; P < .001) (Table I). Female respondents had similar interest in integrated vascular surgery programs as male counterparts, but were less interested in the 5+2 training paradigm. With the expansion of integrated programs, students may be encouraged to commit to a specialty earlier in training; however, female respondents were less likely to have a VSIG to facilitate early introductions to vascular surgery. These results highlight the need for early recruitment strategies toward women and an increased focus on establishing VSIGs at institutions.Table IDemographics and perceptions of available National Vascular Surgery Interest Group (VSIG)Female (n = 25)Male (n = 27)P valueYear<.001 MS111 (44.0)12 (44.4) MS214 (56.0)7 (25.9) MS30 (0)5 (18.5) MS40 (0)2 (7.4) Other0 (0)1 (3.7)Program<.001 MD23 (92.0)26 (96.3) DO1 (4.0)0 (0) IMG1 (4.0)1 (3.7)Geographic location<.001 International2 (8.0)4 (14.8) Midwest8 (32.0)10 (37.0) Northeast6 (24.0)9 (33.3) South2 (8.0)1 (3.7) West7 (28.0)3 (11.1)Race<.001 White12 (48.0)12 (44.4) Black1 (4.0)2 (7.4) Asian10 (40.0)11 (40.7) Hispanic1 (4.0)2 (7.4) Other1 (4.0)0 (0)Specialty choice<.001 Cardiothoracic surgery2 (8.0)1 (3.7) Cardiology1 (4.0)2 (7.4) Emergency medicine0 (0)1 (3.7) ENT2 (8.0)0 (0) General surgery4 (16.0)6 (22.2) Internal medicine1 (4.0)1 (3.7) Interventional radiology0 (0)1 (3.7) Ophthalmology1 (4.0)0 (0) Orthopedic surgery1 (4.0)0 (0) Pediatrics0 (0)1 (3.7) Vascular surgery9 (36.0)13 (48.1) Undecided4 (16.0)1 (3.7)Active VSIG at home institution19 (76.0)13 (61.9)0.301VSIG was first introduction to vascular surgery?<.001 Yes11 (44.0)12 (44.4) No6 (24.0)11 (40.7) No VSIG available8 (32.0)4 (14.8)VSIG provides adequate information to gain exposure to vascular surgery?<.001 Yes12 (48.0)14 (51.9) No1 (4.0)4 (14.8) Neutral5 (20.0)5 (18.5) No VSIG available7 (28.0)4 (14.8)Values are number (5). Open table in a new tab Table IIAttitudes and perceptions toward vascular surgery (Likert scale format 0-5)Female (n = 25)Male (n = 27)P valueFamiliarity with vascular surgery3.04 (1.02)3.37 (1.18).287Interest in vascular surgery4.04 (0.79)3.96 (0.71).712Interest in applying integrated vascular surgery program3.52 (0.96)3.52 (1.31).996Interest in applying 5+2 vascular surgery program3.00 (0.96)3.22 (1.05).012Comfort with reaching out to possible mentors3.84 (0.90)3.96 (1.09).661Understanding of pathways to becoming a vascular surgeon3.28 (1.24)3.44 (1.58).68Understanding of avenues to get involved in vascular surgery2.63 (1.01)3.15 (1.38).133Understanding of typical work week of vascular surgeon2.38 (1.10)2.67 (1.14).358Value are mean (SD). Open table in a new tab

Early findings and strategies for successful implementation of SIMPL workplace-based assessments within vascular surgery residency and fellowship programs

ObjectiveAs medical education systems increasingly move toward competency-based training, it is important to understand the tools available to assess competency and how these tools are utilized. The Society for Improving Medical Professional Learning (SIMPL) offers a smart phone-based assessment system that supports workplace-based assessment of residents’ and fellows’ operative autonomy, performance, and case complexity. The purpose of this study was to characterize implementation of the SIMPL app within vascular surgery integrated residency (0+5) and fellowship (5+2) training programs. MethodsSIMPL operative ratings recorded between 2018 and 2022 were collected from all participating vascular surgery training institutions (n = 9 institutions with 5+2 and 0+5 programs; n = 4 institutions with 5+2 program only). The characteristics of programs, trainees, faculty, and SIMPL operative assessments were evaluated using descriptive statistics. ResultsOperative assessments were completed for 2457 cases by 85 attendings and 86 trainees, totaling 4615 unique operative assessment ratings. Attendings included dictated feedback in 52% of assessments. Senior-level residents received more assessments than junior-level residents (postgraduate year [PGY]1-3, n = 439; PGY4-5, n = 551). Performance ratings demonstrated increases from junior to senior trainees for both resident and fellow cohorts with “performance-ready” or “exceptional performance” ratings increasing by nearly two-fold for PGY1 to PGY5 residents (28.1% vs 40.6%), and from first- to second-year fellows (PGY6, 46.7%; PGY7, 60.3%). Similar gains in autonomy were demonstrated as trainees progressed through training. Senior residents were more frequently granted autonomy with “supervision only” than junior residents (PGY1, 8.7%; PGY5, 21.6%). “Supervision only” autonomy ratings were granted to 21.8% of graduating fellows. Assessment data included a greater proportion of complex cases for senior compared with junior fellows (PGY6, 20.9% vs PGY7, 26.5%). Program Directors felt that faculty and trainee buy-in were the main barriers to implementation of the SIMPL assessment app. ConclusionsThis is the first description of the SIMPL app as an operative assessment tool within vascular surgery that has been successfully implemented in both residency and fellowship programs. The assessment data demonstrates expected progressive gains in trainees’ autonomy and performance, as well as increasing case complexity, across PGY years. Given the selection of SIMPL as the assessment platform for required American Board of Surgery and Vascular Surgery Board Entrustable Professional Activities assessments, understanding facilitators and barriers to implementation of workplace-based assessments using this app is imperative, particularly as we move toward competency-based medical education.

Training in vascular trauma surgery for non-vascular surgeons: Vascular trauma surgery skills course.

The experience of general and trauma surgeons in vascular trauma management has decreased with sub-specialization of surgery and working hours restrictions. We introduce avascular trauma surgery skills course established to train German military surgeons prior to their deployment to conflict areas. The intention and implementation of the vascular trauma course for non-vascular surgeons is described in detail. In hands-on courses, participants learn and train basic vascular surgical techniques on more realistic extremity, neck, and abdominal models with pulsatile vessels. Afundamental and an advanced course each provide military as well as civilian surgeons from different non-vascular specialties with asurgical skill set including direct vessel sutures, patch angioplasty, anastomosis, thrombectomy, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in order to render them capable of managing major vascular injuries. The experiences of this vascular trauma surgical skills course, initially established for military surgeons, can also be of use to all civilian general, visceral, and trauma surgeons occasionally facing traumatic or iatrogenic vascular injuries. Thus, the introduced vascular trauma course is valuable for all surgeons working in trauma centers.

Defining sources and ramifications of mistreatment among female vascular surgery trainees

ObjectiveMistreatment among vascular surgery trainees is a known risk factor for physician burnout. This study aims to characterize forms of and identify sources of mistreatment. MethodsThis is a cross-sectional study of United States vascular surgery trainees who voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between genders. Logistic regression was used for multivariable analysis. ResultsRepresenting all 125 vascular surgery training programs, 510 trainees (66.9% male) participated in the survey (83.6% response rate). Mistreatment was reported by 54.8% of trainees, with twice as many women reporting as men (82.3% vs 41.0%; P < .001). Women reported higher rates of being shouted at (44.1% vs 21.1%; P < .001); repeatedly reminded of errors (24.3% vs 16.1%; P = .04); ignored/treated hostilely (28.9% vs 10.5%; P < .001); subjected to crude/sexually demeaning remarks, stories, jokes (19.2% vs 2.1%; P < .001); evaluated by different standards (29.3% vs 2.1%; P < .001); and mistaken for a non-physician (75.2% vs 3.5%; P < .001). Among trainees reporting bullying, attendings were the most common source (68.5%). Patients and their families were the most common source of sexual harassment (66.7%), gender discrimination (90.4%), and racial discrimination (74.4%). Compared with men, women identified more patients and families as the source of bullying (50.0% vs 29.7%; P = .005), gender discrimination (97.2% vs 50.0%; P < .001), and sexual harassment (78.4% vs 27.3%; P = .003). Compared with men, women more frequently felt unprepared to respond to the behavior in the moment (10.4% vs 4.6%; P = .002), did not know how to report mistreatment at their institution (7.6% vs 3.2%; P = .04), and did not believe that their institution would take their mistreatment report seriously (9.0% vs 3.9%; P = .002). On multivariable analysis, female gender was an independent risk factor for both gender discrimination (odds ratio, 56.62; 95% confidence interval, 27.89-115) and sexual harassment (odds ratio, 26.2; 95% confidence interval, 3.34-14.8) when adjusting for children, training year, relationship status, and training program location. ConclusionsA majority of vascular surgery trainees experience mistreatment during training. Sources and forms of abuse are varied. Understanding the sources of mistreatment is critical to guide intervention strategies such as faculty remediation and/or sanctions; allyship training for staff, residents, and faculty; and institutional procedures for patient-initiated abuse.

Challenges and opportunities for evidence-based training in vascular surgery

Challenges and opportunities for evidence-based training in vascular surgery

Vascular Surgery In-Training Examination performance following implementation of the Vascular Surgical Council on Resident Education curriculum

ObjectiveThe Vascular Surgery Surgical Council on Resident Education (VSCORE) program is a standardized curriculum intended to prepare Vascular Surgery trainees for the annual Vascular Surgery In-Training Examination (VSITE). This study evaluated the performance of 0+5 and 5+2 Vascular Surgery trainees on the VSITE prior to and following implementation of the VSCORE curriculum. MethodsVSITE scores, measured as percentage of questions correct, were collected for Vascular Surgery trainees at a United States academic medical center between 2015 and 2022. The VSITE scores were compared for the periods prior to (2015-2021) and following (2022) implementation of the VSCORE curriculum. ResultsFifty-seven VSITE scores were evaluated, including 46 examinations completed prior to and 11 after the implementation of the VSCORE curriculum. The mean VSITE score across all training levels (post-graduate year [PGY] 1-7) increased significantly from 68.4% ± 1.5% prior to implementation of VSCORE curriculum to 76.5% ± 3.1% following implementation (P = .03). Two-way analysis of variance identified pre- and post-VSCORE implementation as a statistically significant categorical variable when residents were stratified into junior (PGY 1-2), senior (PGY 3-5), and fellow (PGY 6-7) training levels (P < .001). The mean change in score between consecutive years also increased following VSCORE implementation (14.1% ± 2.3%) compared with the pre-VSCORE era (5.7% ± 1.7%; P = .002) ConclusionsThe implementation of the VSCORE curriculum at an academic medical center improved VSITE scores across vascular surgery trainees at all levels.

The Impact of Endovascular Repair of Abdominal Aortic Aneurysms on Vascular Surgery Training in Open Aneurysm Repair

Since the introduction of endovascular abdominal aortic aneurysm (AAA) 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 future training of vascular surgeons that need to be appropriately addressed. Our objective is to analyze trends in open and endovascular AAA repair cases and to assess their implications on the quality of vascular surgery training. We analyzed the Accreditation Council for Graduate Medical Education (ACGME) case log database for total clinical experience in open and endovascular AAA repair for graduating vascular surgery fellows (VSF) finishing 5+2 programs between 2002-2019 and vascular surgery integrated residents (VSR) between 2013-2019. VSF case totals were calculated by combining average total cases of open and endovascular supra- and infra-renal 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. 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 two 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) (Figure 1). For VSR, while no significant trend was observed in the mean number of OAR cases (Coef. -0.3, P=0.2) due to limited time frame, the proportion of open cases was significantly lower compared to endovascular cases. Additionally, there were two 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). A significant reduction of average OAR cases and 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 expertise to perform such a high-risk procedure safely and independently.

An analysis of vascular surgery education publications reveals an educational shortage

BackgroundAs vascular surgery training continues to evolve with the growth of integrated vascular surgery residency (0+5) programs and the consolidation of fellowship programs, optimizing all aspects of the education for vascular surgery trainees, both fellows and 0+5 residents, has become increasingly important. In the present study, we aimed to determine the prevalence, quality, and content of vascular surgery education publications across journals. MethodsJournal websites (n = 26) and PubMed were queried to identify vascular surgery education publications from 2012 to 2021. The publications were organized into 11 content categories: (1) curriculum, (2) simulation, (3) trainee assessment, (4) program evaluation, (5) wellness/burnout, (6) diversity/inclusion, (7) mentorship/career, (8) case outcomes, (9) perceptions of training, (10) social media, and (11) other. Publication interactivity and quality were measured via PlumX data and Medical Education Research Study Quality Instrument scores. The data were analyzed via univariate analysis and linear regression. ResultsA total of 115 vascular surgery education publications (0.2% [interquartile range (IQR), 0.04%-0.5%] of total publications) were identified from the selected journals. The Journal of Vascular Surgery had the highest proportion (0.8%) of vascular surgery education publications, followed by the Journal of Surgical Education (0.7%) and Annals of Vascular Surgery (0.6%). Vascular surgery journals constituted most (79%) of the publications. Of the authors, 15% (IQR, 0%-25%) had a master's or doctorate degree in education. Senior authors were more often identified as male gender (77%), and more first authors (41%) were identified as female gender. An interactivity analysis showed that there were 10.3 citations (IQR, 12), 33.1 captures (IQR, 34), and 8.4 social media interactions (IQR 14) per publication. The educational quality had a median Medical Education Research Study Quality Instrument score of 11 (IQR, 9-12.5), with 49% of publications having a score greater than the median. Publications on training (44% curriculum and 20% simulation) were significantly more frequent than other topics (P < .001), with no change in the publication content over 10 years (P = .29). The volume of vascular surgery education publications did not change during the study period (P = .13) despite the ongoing changes in the educational environment. ConclusionsDespite the increasing importance placed on vascular surgery education by national vascular societies, publications on vascular surgery education have remained sparse among all journals. Also, the vascular surgery educational content has not changed during the past 10 years, with a primary focus on curriculum and simulation training. Further promotion of vascular surgery educational research is required to increase the quality, volume, and diversity of education publications.

Patterns In Complex Aortic Vascular Surgery Training

Recent literature suggests a decreasing experience with open aortic surgery among recent vascular surgery graduates. While trainees have a wide exposure to EVAR, experience with the management of thoracoabdominal aneurysms, and young surgeon comfort in early practice remains unknown. Thus, we sought to evaluate early practice patterns in the treatment of complex aortic surgery among recent U.S. vascular surgery graduates.

Fourth Year Medical Students’ Perceptions Of Vascular Surgery: Can We Improve The Pipeline?

Despite changes in vascular surgery training paradigms and attraction of competitive applicants, shortages of vascular surgeons are projected through 2050. We aimed to determine fourth-year medical students’ knowledge/perceptions of vascular surgery (VS).

Comparison of academic productivity and funding support between United States and international medical graduate vascular surgeons

ObjectiveThe demand for vascular surgeons in the United States stands to far exceed the current supply. International medical graduates (IMGs) are not only vital to meeting the country’s growing health care needs, but also help to advance clinical research and medical education in the field of vascular surgery. Nearly 17% of practicing vascular surgeons in the United States are IMGs, yet little is known about their relative contributions to academic vascular surgery. Our study aims to compare the academic profiles and funding support for IMG vascular surgeons to that of their US medical graduate (USMG) counterparts. MethodsA cross-sectional study was performed on all IMG and USMG academic vascular surgeons practicing in US-based hospitals with vascular surgery residency and/or fellowship programs. In addition to the baseline surgeon characteristics, academic profiles and research output were also collected. Furthermore, the National Institutes of Health (NIH) research reporting tool and open payments database were queried for any funding/payments to surgeons in both groups. Matching for year of vascular surgery training program graduation was performed where appropriate. ResultsA total of 908 academic vascular surgeons were included; 759 (83.6%) were USMGs and 149 (16.4%) were IMGs. The median year of graduation was comparable between the two groups, but USMGs had a significantly higher proportion of female surgeons (23.6% vs 10.7%; P = .0003). There were no significant differences in the academic profiles and leadership positions between the two groups. Although research productivity is similar between the two groups, IMG surgeons were more likely to have first or senior-authorship papers (47.1% vs 37.5%; P < .001). Additionally, faculty departments chaired/cheifed by a USMG were less likely to be staffed with IMG vascular surgeons (1.6 surgeons vs 3.1 surgeons; P < .0001). Following grant analysis, USMG surgeons received more NIH R01 grants (5.7% vs 1.3%; P = .026). R01-funded surgeons had significantly greater research output by number of publications (121.0 vs 47.5), citations (3872 vs 938), H-index (32.0 vs 17.5), and average journal impact factor (>10: 86.7% vs 33.3%) (all P < .001). ConclusionsThe efforts to further diversify vascular surgery are vital to better serving an increasingly diverse US population, amid growing disparities in health care. Although IMGs account for a minority of academic vascular surgeons, and contribute significantly to their published research, they had less NIH R01 funding, warranting further investigation.

Persistent racial discrimination among vascular surgery trainees threatens wellness.

Racial/ethnic discrimination is one form of mistreatment and a known risk factor for physician burnout. In the present study, we aimed to characterize the forms and identify the sources of racial/ethnic discrimination among vascular surgery trainees. We performed a cross-sectional study of U.S. vascular surgery trainees who had voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between race and ethnicity groups. We used χ2 tests and logistic regression for bivariate and multivariable analyses, respectively. Representing all 123 vascular surgery training programs, 510 trainees (66.9% men) participated in the survey (83.6% response rate). Most of the trainees had self-identified as White (53.1%), followed by Asian (24.4%), Hispanic/Latinx (7.6%), Black (4.2%), and other/prefer not to say (10.8%). No significant differences were found in the self-reported duty hour violations among the groups. Black (56.3%) and Asian (36.3%) trainees reported higher rates of racial/ethnic discrimination compared with the White, Hispanic/Latinx, and other/prefer not to say groups (P< .001). Patients and their families were reported as the most common source (74.7%). Other reported sources of discrimination included nurses or staff (60%), attendings (37.4%), co-residents (31.3%), and administration (16.9%). Regarding specific forms of racial discrimination, Black and Asian trainees reported the highest rates of different standards of evaluation (20% and 5.9%, respectively), being mistaken for a nonphysician (50.0% and 5.9%, respectively), slurs and/or hurtful comments (13.3% and 5.9%, respectively), social isolation (13.0% and 1.0%, respectively), and being mistaken for another trainee of the same race/ethnicity (60.0% and 33.7%, respectively). Only 62.5% of Black trainees reported their program/institution would take their mistreatment report seriously compared with the White (88.9%), Hispanic/Latinx (88.2%), Asian (83.2%), and other/prefer not to say (71.4%) trainees (P= .01). On multivariable analysis, female gender (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.44-4.33), Asian race (OR, 6.9; 95% CI, 3.53-13.3), Black race (OR, 13.6; 95% CI, 4.25-43.4), and training in the Southeastern United States (OR, 3.8; 95% CI, 1.17-12.80) were risk factors for racial/ethnic discrimination. The results from the survey revealed that racial/ethnic discrimination persists in surgical training programs, with Asian and Black trainees reporting higher rates than other racial and ethnic groups. Overall, patients and family members were the most common source of racial/ethnic discrimination. However, faculty, staff, and co-trainees also contributed to racial/ethnic discrimination. Further interventions that optimize diversity, equity, and inclusion strategies and policies to address all forms of racial/ethnic discrimination with faculty, staff, and patients within the hospital are critically needed.

Understanding radiation exposure and improving safety for vascular surgery trainees.

Despite having robust radiation safety education procedures and policies in place, we discovered that the trainees at our Accreditation Council for Graduate Medical Education-approved integrated vascular surgery residency and fellowship program were exceeding the annual radiation exposure limits. In the present report, we have described our quality improvement project to identify the root causes and implement policies to improve radiation safety education, oversite, and, ultimately, the exposure levels of our trainees. A committee of faculty, fellows, radiology nurses, and radiation safety officers from each of the programs affiliated hospitals convened to identify the potential root causes of the increased radiation exposure and potential modifiable actions. The radiation exposure reports for postgraduate year 4 to 7 trainees were evaluated before and after the interventions. Excessive radiation exposure was found to be more prevalent than anticipated, with multiple trainees surpassing the annual exposure limits. The committee classified the factors at play and interventions into four categories: policies and procedures, curriculum, environment, resources, and equipment. The multisite status of our program was a key factor associated with the increased radiation exposure. In addition, we found that excessive radiation levels were occurring primarily at a single hospital site. After the interventions, the monthly average levels at this site had decreased considerably from 936mrem to 272mrem. We found it alarming that the safety policies in place at vascular residency and fellowship programs were inadequate in securing the safety of their trainees. We found interventions such as inventorying and ensuring the availability of safety equipment, hands-on instruction to complement traditional didactics, lowering the default frame rates, and converting to real-time dosimetry to be effective measures for reducing radiation exposure.

Role of Simulated Training for Carotid Endarterectomy: A Systematic Review.

Vascular surgery trainees often do not get to perform carotid endarterectomy (CEA) directly on the patients as it requires meticulous surgical technique and has a high risk of procedure-related complications. Hence, the role of simulation in training future vascular surgeons becomes essential. This review aims to assess the types and utility of simulators available for CEA. In this systematic review, all the studies performed on CEA simulation were included. The purpose of this review was to assess different types of simulators and their usefulness for CEA. We identified 122 articles, of which 10 were eligible for review. A variety of simulators, ranging from animal models, virtual reality simulators and commercially designed models with high fidelity options were used. Technical competence was the major domain assessed in the majority of the studies (n=8), whereas four studies evaluated anatomical and procedural knowledge. Blinding was done in five studies for assessment purposes. The majority of studies (n=9) found the simulation to be an effective tool for achieving technical competence. This review shows the potential usefulness of simulation in acquiring technical skills and procedural acumen for CEA. The available literature is unfortunately too diverse to have a common recommendation.

Paradigm Shift in Vascular Surgery Training: Independent versus Integrated Match Outcomes

Currently, 2 predominant pathways exist for vascular surgery training: integrated and independent training pathways. We hypothesized that match rates would increase with time and be higher in the independent pathway than in the integrated pathway. The National Resident Matching Program provided data from the Vascular Surgery Match (VSM) (2008-2021). Match rates were defined as the percentage of applicants who matched. Chi-squared tests were used to evaluate temporal trends and interpathway differences. Over the study period, the annual number of training positions increased for both the independent (119 to 129, 8% increase) and integrated (9 to 79, 778% increase) training pathways. From 2008 to 2021, the annual match rate was stable in the independent pathway (97% to 96%, P>0.05). In the integrated pathway, the annual match rate increased from 29% to 44% (P<0.001). During each year, match rates in the independent pathway exceeded those in the integrated pathway (P<0.001). US allopathic graduates had higher match rates than non-US allopathic graduates in both the independent (92% vs. 82%, P<0.001) and the integrated pathway (70% vs. 17%, P<0.001). In the independent pathway, the percentage of applicants that matched at 1 of their top 3 choices decreased from 67% to 58% (P<0.001). Over the study period, more training positions went unmatched in the Independent (n=130, 8%) versus the Integrated (n=17, 3%) pathway (P<0.001). VSM match rates have increased for the integrated pathway and remains competitive especially for non-US allopathic graduates. More research is needed to understand applicant variables that modulate match rates.

General Surgery Trainee Cases Over Time: Postgraduate Year Matters.

Trainees and attending surgeons alike have concerns about resident and fellow operative volume/breadth, competency, and overall readiness for practice. This is an important topic within surgical graduate medical education. Our goal was to analyze the change in general surgery trainee operative experience over time by postgraduate year. Institutional operative records from two corresponding three-month time periods in 2009 and 2018 at the residency program's main hospital site were reviewed. Cases assisted on by general, vascular, or thoracic surgery trainees were included. The number of cases per level, combination of trainees in each case, and categories of cases were compared over time. There were 1940 cases in 2009 and 1967 cases in 2018 over the respective time periods. The distribution of trainees was different (P < .001), with a similar number of PGY-1 and fellow cases, a decrease in PGY-2 and PGY-5 cases, and an increase in PGY-3 and PGY-4 cases. The number of cases with two trainees, double scrubbed cases, increased from 19.6% to 26.8% (P < .001). In addition, there were differences in the resident years that double scrubbed cases together, an increase in robotic and endovascular surgery, and a decrease in open cases. This analysis of cases shows that resident operative volume over approximately a decade has been largely preserved, with some change in the distribution of cases based on trainee level, an increase in cases with more than one trainee, and a rise of minimally invasive surgery with a corresponding decrease in open cases.

The vascular surgery in-training examination predicts performance on qualifying examination.

Vascular surgery trainees participate in the vascular surgery in-training examination (VSITE) during each year of their training. Although the VSITE was developed as a low-stakes, formative examination, performance on that examination might correlate with the pass rates for the Vascular Surgery Board written qualifying examination (VQE) and oral certifying examination (VCE) and might, therefore, guide both trainees and program directors. The present study was designed to examine the ability of the VSITE to predict trainees' performance on the VQE and VCE. All first-time candidates of the Vascular Surgery Board VQE and VCE were analyzed from 2016 to 2020, including those from both the integrated and independent training pathways. VSITE scores from the final year of training were associated with the VQE scores and the probability of passing the VQE and VCE both. Linear and logistic regression models were used to determine the ability of VSITE results to predict the VQE scores and the probability of passing each board examination. VSITE scores available for the 559 candidates (69.3% male; 30.7% female) who had completed the VQE and 369 candidates (66.7% male; 33.3% female) who had completed both the VQE and the VCE. The linear regression model results for the final year of training showed that the VSITE scores explained 34% of the variance in the VQE scores (29% for the integrated and 37% for the independent trainees). Logistic regression demonstrated that the final year VSITE scores were a significant predictor of passing the VQE for both integrated and independent trainees (P< .001). A VSITE score of 500 during the final year of training predicted a VQE passing probability of >90% for each group of candidates. The probability of passing the VQE decreased to 73% for candidates from integrated programs, 61% for candidates from independent programs, and 64% for the whole cohort when the score was 400. The VSITE scores were a significant predictor of passing the VCE only for the candidates from independent programs (odds ratio, 1.01; 95% confidence interval, 1.00-1.02; P< .01), for whom a VSITE score of 400 correlated with an 82% probability of passing the VCE. VSITE performance is predictive of passing the VQE for trainees from both integrated and independent training paradigms. Vascular surgery trainees and training programs should optimize their preparation and educational efforts to maximize performance on the VSITE during their final year of training to improve the likelihood of passing the VQE. Further analysis of the predictive value of VSITE scores during the earlier years of training might allow the board certification examinations to be administered earlier in the final year of training.

Feasibility of video assessment of operative skills in FCPS vascular surgery.

To explore the feasibility of assessment of operative skills of FCPS vascular surgery trainees based on video recordings of the surgical procedures with a view to introduce it in the curriculum. This qualitative study was carried out from 9th April 2021 - 15th July 2021 at Shifa Tameer e Millat University, Islamabad, Pakistan. It is a qualitative study based on constructivist grounded theory. Semi structured interviews of 16 participants, including five vascular surgical trainees, six vascular surgical consultants/supervisors/examiners, and five medical educationists were conducted, recorded and transcribed. Open and axial coding method was employed to identify recurring themes. Six themes could be identified. (1) There was consensus among participants on deficiency in current assessment of surgical skills. (2) Most participants believed that this is a useful method, although four out of 16 participants believed that current methods were sufficient. (3) There was a unanimous opinion that its purpose should be initially formative assessment and later for summative assessment. (4) It was suggested that it is practical with logistic support; it can be made part of trainee's record to be reviewed later; maybe by independent observers. (5) Participants believed that the logistic issue in term of equipment and trained manpower will be a challenge in implementing this mode of assessment. Other barriers included medicolegal and ethical issue and acceptability by the stake holders. (6) Participants also suggested remedies for the barriers. Video review of surgical procedures can improve assessment of operative skills of trainees provided it is used as formative tool initially with a need to overcome logistics, medicolegal and cultural barriers.

Programmatic engagement in diversity, equity, and inclusion in U.S. vascular surgery training programs

ObjectiveGiven the diversity of populations that modern healthcare professionals treat, there has been an increasing call for academic medical centers to ensure that they themselves are diverse and inclusive. Historically, this has been measured by the composition of the workforce in terms of protected categories such as race/ethnicity, gender, and disability. However, these broad categories have only poorly reflected the actual ability of organizations to engage with a diverse workforce and patient population. The diversity and engagement survey (DES) is a specifically constructed and validated instrument designed to measure the integration of diversity, equity, and inclusion (DEI) within academic medical centers. The goal of the present study was to use the DES with vascular surgery program directors, to determine the predictors of low DEI in vascular surgery training programs. MethodsAn anonymous electronic survey was sent to all program directors and assistant program directors of vascular surgery training programs (residencies and fellowships) in the United States (n = 280). The survey consisted of 18 sections with 53 questions regarding details of the respondent, demographics, programmatic information, including information on faculty and trainee diversity, the resources available to enhance DEI within the program, institutional attitudes toward employees, and the DES itself. The total score from the DES section was used to the stratify institutions, which were classified as low DEI if in the bottom 25% percentile of the overall scores or as high DEI if scoring higher. Univariate analysis was used to determine whether any important differences were present in the demographics or survey responses between the institutions scoring as low vs high DEI. Multivariate logistic regression was also performed using the demographic variables and responses to the survey questions to determine their relationship to DEI status. ResultsThere were a total of 102 complete responses to the survey (36.4% response rate). The proportion of women was higher (66.67%) than the men (33.30%) in the low DEI cohort, although women were only 28.4% of the overall cohort. A statistically significant difference was found between the high and low DEI institutions in the proportion of those who had responded yes, no, or preferred not to disclose whether they had experienced discrimination or hurtful comments (P < .001) with 71% of the respondents in the low DEI institutions reporting this experience compared with only 11% in high DEI institutions. Multivariate analysis also demonstrated that non-male gender (odds ratio, 5.10; P = .034) and experiences of discrimination (odds ratio, 6.51; P = .024) were associated with low DEI institutions. ConclusionsNon-male program directors and those who had experienced discrimination at their institution were significantly more likely to find that their institution had low DEI.