Vascular Surgery Training Research Articles

Implementation of an academic half day in a vascular surgery residency program improves trainee and faculty satisfaction with surgical indications conference

BackgroundThe Accreditation Council for Graduate Medical Education mandates scheduled didactics for residency programs but allows flexibility in implementation. Work-hour restrictions, patient care duties, and operative schedules create barriers to attendance for surgical trainees. We explored vascular surgery trainees and faculty perceptions on trainees operative preparation and participation, and overall fund of knowledge after implementing an academic half day conference (AHD) schedule. MethodsThe vascular surgery conference at a single academic institution was changed from three 1-hour conferences weekly, to a single protected, 3-hour conference once weekly. Faculty and trainees were surveyed before and 5 months after implementing the new AHD schedule. ResultsOverall satisfaction improved after initiating the AHD (4 of 4 trainees, 3 of 4 faculty). All trainees (n = 4) and faculty (n = 4) believed the AHD conference format was worthwhile. Most trainees believed the AHD format improved their Vascular Surgery in Service Training Exam preparation (3 of 4), fund of knowledge (4 of 4), and operative preparation (3 of 4). More trainees than faculty tended to feel that the AHD interfered with operative participation (3 of 4 trainees vs 1 of 4 faculty). Neither group agreed that the conference was optimally scheduled. ConclusionThis single-institution, pilot study suggests a positive association in the attitudes of most vascular surgery trainees and faculty regarding preparation for the Vascular Surgery In-Training Exam and overall fund of knowledge after implementing a protected AHD schedule. Further research is needed to understand the impact of the AHD conference on operative experience and training exam scores.

Vascular Surgery Training - Horses for Courses.

Vascular Surgery Training - Horses for Courses.

An evaluation of the availability, accessibility, and quality of online content of vascular surgery training program websites for residency and fellowship applicants

BackgroundVascular surgery residency and fellowship applicants commonly seek information about programs from the Internet. Lack of an effective web presence curtails the ability of programs to attract applicants, and in turn applicants may be unable to ascertain which programs are the best fit for their career aspirations. This study was designed to evaluate the presence, accessibility, comprehensiveness, and quality of vascular surgery training websites (VSTW). MethodsA list of accredited vascular surgery training programs (integrated residencies and fellowships) was obtained from four databases for vascular surgery education: the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, Fellowship and Residency Electronic Interactive Database, and Society for Vascular Surgery. Programs participating in the 2016 National Resident Matching Program were eligible for study inclusion. Accessibility of VSTW was determined by surveying the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, and Fellowship and Residency Electronic Interactive Database for the total number of programs listed and for the presence or absence of website links. VSTW were analyzed for the availability of recruitment and education content items. The quality of VSTW was determined as a composite of four dimensions: content, design, organization, and user friendliness. Percent agreements and kappa statistics were calculated for inter-rater reliability. ResultsEighty-nine of the 94 fellowship (95%) and 45 of the 48 integrated residencies (94%) programs participating in the 2016 Match had a VSTW. For program recruitment, evaluators found an average of 12 of 32 content items (35.0%) for fellowship programs and an average of 12 of 32 (37%) for integrated residencies. Only 47.1% of fellowship programs (53% integrated residencies) specified the number of positions available for the 2016 Match, 20% (13% integrated residencies) indicated alumni career placement, 34% (38% integrated residencies) supplied interview dates, and merely 17% (18% integrated residencies) detailed the selection process. For program education, fellowship websites provided an average of 5.1 of 15 content items (34.0%), and integrated residency websites provided 5 of 14 items (34%). Of the fellowship programs, 66% (84.4% integrated residencies) provided a rotation schedule, 65% (56% integrated residencies) detailed operative experiences, 38% (38% integrated residencies) posted conference schedules, and just 16% (28.9% integrated residencies) included simulation training. ConclusionsThe web presence of vascular surgery training programs lacks sufficient accessibility, content, organization, design, and user friendliness to allow applicants to access information that informs them sufficiently. There are opportunities to more effectively use VSTW for the benefit of training programs and prospective applicants.

Give My Poor Heart Ease.

We came to The University of Virginia (UVA) within a year of each other nearly four decades ago: one (DN) to join the UVA basketball team during four of the best years of UVA basketball, and to earn 2 degrees, first in English and then in Sports Psychology; and the other (CT) to begin 7 years of training in general, vascular, thoracic, and cardiac surgery, which culminated with a faculty appointment in the UVA Department of Surgery, with part of the charge being to organize most of the Department's educational programs. Realizing that the education and training of medical students and surgical residents would require knowledge, skills, and understanding above and beyond the usual training of a resident in surgery, I (CT) started an informal, though enriching, attempt to find those on the grounds of the University who might share ideas and insights that could enhance the educational programs in the Department. This process embodied the vision of the founders of the University to create an "academical village."

Decline of Open Abdominal Aortic Aneurysm Repair among Vascular Surgery Training Programs in the United States

Decline of Open Abdominal Aortic Aneurysm Repair among Vascular Surgery Training Programs in the United States

Vascular Surgery Training Websites: An Evaluation of the Availability, Accessibility, and Quality of Online Content for Residency and Fellowship Applicants: Much Work Needs to be Done!

Vascular Surgery Training Websites: An Evaluation of the Availability, Accessibility, and Quality of Online Content for Residency and Fellowship Applicants: Much Work Needs to be Done!

A national resident survey about the current state of venous education in vascular surgery training programs.

The objective of this study was to characterize U.S. vascular surgery trainees' perceptions, case numbers, and attitudes toward venous disease education, as well as their intent to incorporate it into future practice. These data will provide us with a current snapshot of postgraduate venous education from a resident's perspective. Institutional Review Board approval was obtained. A 13-question survey was created and distributed to all vascular surgery residents in the United States by SurveyMonkey. Formal electronic distribution remained deidentified as the surveys were e-mailed to residents from the Association of Program Directors in Vascular Surgery. Of 464 vascular surgery trainees queried, 104 (22%) responded to the survey. The majority of responders (80%) were between 25 and 34years of age, 60% were male, and 72% were white; 91% reported that they were in an academic training program, and 57% were enrolled in an integrated vascular surgery residency program. Postgraduate years (PGYs) of training among respondents were well represented: PGY 1, 14%; PGY 2, 8%; PGY 3, 14%; PGY 4, 12%; PGY 5, 9%; PGY 6, 18%; and PGY 7, 25%. Vascular resident training experience with venous disease revealed the following: 63% performed<10 inferior vena cava stents, 64% performed<10 vein stripping/ligation procedures, and 50% performed<10 iliac stents; 92% of responders reported having performed<10 venous bypasses during their training. Experience with endothermal ablations was slightly better, with 74% of responders reporting having performed up to 20 cases. Case volumes for endothermal ablation, vein stripping/ligation, inferior vena cava stenting, and iliac stenting increased progressively by clinical training year among integrated vascular residents (P ≤ .02) but were relatively stable for classic 5+ 2 vascular fellows (P ≥ .67). Integrated residents reported having received more didactic venous education than the 5+ 2 vascular surgery fellows (P= .01). There were no differences in overall reported venous procedure volumes between groups (P ≥ .28). The majority of trainees (82%) acknowledged that treating venous disease is part of a standard vascular surgery practice, and many (75%) indicated a desire to have increased venous training. Despite this, 59% of responders reported plans to dedicate<25% of their future vascular surgery practice to venous disease. In this national survey-based study of vascular surgery trainees, we demonstrate a perceived weakness in venous disease case volumes and didactic education in residency. This training deficit is apparent in both integrated (0+ 5) and traditional (5+ 2) training pathways. Our data suggest that expansion of the venous disease curriculum with clear training standards is warranted and that trainees would welcome such a change.

A Proficiency Based Stepwise Endovascular Curricular Training (PROSPECT) Program Enhances Operative Performance in Real Life: A Randomised Controlled Trial

ObjectivesHealthcare evolution requires optimisation of surgical training to provide safe patient care. Operating room performance after completion of proficiency based training in vascular surgery has not been investigated. DesignA randomised controlled trial evaluated the impact of a Proficiency based Stepwise Endovascular Curricular Training program (PROSPECT) on the acquisition of endovascular skills and the transferability of these skills to real life interventions. MaterialsAll subjects performed two endovascular interventions treating patients with symptomatic iliac and/or superficial femoral artery stenosis under supervision. Primary outcomes were technical performances (Global Rating Scale [GRS]; Examiner Checklist), operative metrics, and patient outcomes, adjusted for case difficulty and trainee experience. Secondary outcomes included knowledge and technical performance after 6 weeks and 3 months. MethodsThirty-two general surgical trainees were randomised into three groups. Besides traditional training, the first group (n = 11) received e-learning and simulation training (PROSPECT), the second group (n = 10) only had access to e-learning, while controls (n = 11) did not receive supplementary training. ResultsTwenty-nine trainees (3 dropouts) performed 58 procedures. Trainees who completed PROSPECT showed superior technical performance (GRS 39.36 ± 2.05; Checklist 63.51 ± 3.18) in real life with significantly fewer supervisor takeovers compared with trainees receiving e-learning alone (GRS 28.42 ± 2.15; p = .001; Checklist 53.63 ± 3.34; p = .027) or traditional education (GRS 23.09 ± 2.18; p = .001; Checklist 38.72 ± 3.38; p = .001). Supervisors felt more confident in allowing PROSPECT trained physicians to perform basic (p = .006) and complex (p = .003) procedures. No differences were detected in procedural parameters (such as fluoroscopy time, DAP, procedure time, etc.) or complications. Proficiency levels were maintained up to 3 months. ConclusionsA structured, stepwise, proficiency based endovascular curriculum including e-learning and simulation based training should be integrated early into training programs to enhance trainee performance.

Trends in open abdominal exposure among vascular surgery trainees

BackgroundThis retrospective study evaluates the trends in open abdominal surgery cases among integrated vascular surgery residents compared with their 5 + 2 counterparts. MethodsThe Accreditation Council for Graduate Medical Education (ACGME) case logs between 2007 and 2016 were collected from a pool of 9861 residents and fellows from 371 institutions. Trainees were grouped into three categories: general surgery residency (GSR), integrated vascular surgery residency (IVSR), and vascular surgery fellowship in the United States. Inclusion criteria were specific to open abdominal cases of or including the anatomy adjacent to the aorta performed by the surgeon chief. ResultsThe 5 + 2 graduates have obtained significantly more open vascular surgery training experience than their IVSR graduate counterparts (P < .01). GSR chief residents performed significantly more open abdomen cases than IVSR chief residents (P < .01). IVSR chiefs performed significantly more open vascular procedures than GSR chiefs (P < .01). On the completion of vascular surgery fellowship, 5 + 2 graduates had significantly more open abdominal aortic aneurysm (AAA) exposure during training than IVSR graduates did (P < .01); however, IVSR trainees had performed significantly more open AAA procedures than their GSR counterparts (P < .01). ConclusionsUp to 2016, graduates of the 5 + 2 vascular training pathway had significantly higher open abdominal exposure than those of the IVSR track. However, graduates of the IVSR track had significantly higher open AAA exposure than GSR graduates.

Young female vascular surgeons more likely to enter academia

ObjectiveIn the last decade, there has been a dramatic increase in the number of women entering vascular surgery. Our goal was to evaluate the differences in career paths based on gender and to determine some of the factors that influence career decisions among young vascular surgeons. MethodsA 17-item web-based survey focusing on current employment status, reasons for choosing academic vs nonacademic positions, and career satisfaction was distributed to 900 members of the Society for Vascular Surgery who completed vascular surgery training in the past 10 years. ResultsA total of 199 individuals responded to the survey (22.1%). The cohort included 49 (24.6%) women and 149 (74.9%) men. The majority of the respondents were non-Hispanic white (66.3%). Sixty-four percent of all respondents were younger than 40 years. Overall, 72.9% of women had applied to academic positions after their training compared with 58.8% of men. Women were more likely to apply for and to work in an academic setting (P = .0266 and P = .0198, respectively) and cited mentorship more frequently (P = .0474) as the reason for choosing an academic practice. Women respondents were less likely to have a spouse or children (P = .0269 and P < .001, respectively). More than 87.4% of all respondents were very satisfied or somewhat satisfied with their careers. However, men were more likely to be very satisfied compared with women (P = .0345). ConclusionsCareer satisfaction remains high among young vascular surgeons. In this cohort of vascular surgery graduates, we found that women were more likely to pursue academic positions than men, with mentorship, ability to teach, and complexity of cases commonly cited as reasons for this career choice. However, whether young women stay in academia and what factors affect academic retention will need further evaluation.

Risk Factor Modification Behaviors of Practicing Vascular Surgeons

National smoking rates have declined; however, it remains the primary modifiable risk factor for nearly all vascular disease. While vascular surgeons have the availability to treat patients via medical or surgical/endovascular means, involvement in risk factor modification may be lacking. This study seeks to understand vascular surgeons' involvement in tobacco cessation and risk factor modification and to determine if practice variables had any effect on provision of these services to vascular surgery patients. Anonymous electronic surveys examining tobacco cessation and risk factor modification were sent to the Vascular & Endovascular Surgery Society members (n=633). Influence of time from training, practice type (dichotomized into academic and nonacademic vascular surgeons), hospital size, region, and workload was assessed, and data were analyzed by univariate contingency tables. A total of 149 (24%) surveys were completed. While the majority of respondents ask patient's smoking status (97%), assess willingness to quit (84%), and advise patients to quit (95%), only 34% prescribe medications to assist in cessation, 7% see patients in tobacco cessation follow-up, and 3% verify cessation with cotinine levels or carbon monoxide monitoring. Surgeons who prescribed medications for cessation are more likely to assess patient's willingness to quit, prescribe/advise nicotine replacement, or prescribe initial statin or other lipid-lowering medications. There was no difference in perceived education received during training in risk factor modification, but only 26% of respondents thought they were well trained. Comparing academic to private practice vascular surgeons, there was no difference in cessation techniques used; however, academic surgeons were less likely to perform endovascular procedures for claudication in patients who continued to smoke (29% vs. 46%, P=0.03) and more likely to prescribe an initial antihyperlipid medication (65% vs. 39%, P=0.0018). Tobacco dependence remains a critical issue for vascular surgery patients; however, there is wide variation in cessation techniques used. The majority of vascular surgeons are not well versed in cessation techniques and risk factor modification, and thus, efforts should be made to provide this education in vascular surgery training programs.

IP167. Recent Trends in Publications of U.S. and European Directors for Vascular Surgery Training

IP167. Recent Trends in Publications of U.S. and European Directors for Vascular Surgery Training

Effects of Mentorship on Graduating Vascular Surgery Trainees

Mentorship within surgery, particularly vascular surgery, has not been extensively evaluated. This study sought to examine mentorship experiences in graduating vascular trainees (VTs). An anonymous electronic survey examining current mentor relationships, ideal characteristics, academic productivity, and operative comfort level was emailed to all US graduating 2015 (n=141) and 2016 (n=144) VTs during their last year of training. A parallel survey was emailed to program/associate program directors (PDs) of all US vascular training programs (n=169). Surveys were completed by 65 (38%) PDs and 62 (22%) VTs. Forty-three (69%) VTs identified a mentor with no difference in frequency of having a mentor noted among gender, type of training (fellowship/residency), or geographical region. The majority (41/43, 95%) recognized a vascular surgeon as their mentor; the mentor was assigned to 10 of 43 (23%) trainees and was their PD to 9 of 43 (21%). Ideal mentor characteristics, identified by VTs using 4-point Likert scales, were approachability, supportiveness, and accessibility (3.94, 3.76, and 3.74, respectively), while those of a good mentee were enthusiasm, ethical work, and commitment (3.79, 3.69, and 3.45, respectively). Trainees scored accessibility, approachability, compassion, and same gender significantly higher than PDs as characteristics of ideal mentors (P<0.05). The majority of PDs thought mentorship increased access to research opportunities, professional networking, and job opportunities, but not operative skill (90%, 95%, 65%, and 18%, respectively). There was no difference between trainees with mentors and those without in terms of reported academic productivity or operative comfort level. Vascular fellows reported higher comfort than residents in open abdominal aortic aneurysm repair (3.32 vs. 2.73, P=0.006), juxtarenal aneurysm repair (2.8 vs. 2.1, P=0.02), and aorto-mesenteric bypass (2.57 vs. 1.93, P=0.03), and neither group was comfortable performing carotid stenting or fenestrated endovascular aneurysm repairs. There is no difference in academic productivity or case comfort level between surgical trainees with mentors and those without. Possible benefits identified by PDs and trainees include professional networking and increased research and job opportunities. Mentors should be approachable, accessible, supportive, and ethical, while mentees should be enthusiastic, ethical, committed, and approachable. Vascular fellows feel more comfortable with open vascular operations than residents, and nether group feels comfortable with complex endovascular cases. More research is warranted.

Comparison of the integrated vascular surgery resident operative experience and the traditional vascular surgery fellowship

ObjectiveAfter almost 10 years since its approval, residents in integrated vascular surgery training programs now outnumber traditional vascular fellows. We examined the Accreditation Council for Graduate Medical Education (ACGME) case log data to assess whether there is a difference in operative experience between the graduating integrated residents and vascular fellows. MethodsWe analyzed the total clinical experience of vascular surgery trainees during the academic years between 2012 and 2014 for the 30 graduated integrated vascular surgery residents (VSRs) and the 243 graduated vascular surgery fellows (VSFs). Data were compared on the basis of reported categories defined by the ACGME operation reporting system. VSR case totals were calculated by combining “surgeon chief,” “surgeon junior,” and “secondary procedures” categories. VSF “surgeon fellow” and “secondary procedures” case totals were combined with all vascular cases done in general surgery residency (using averages of general surgery resident ACGME case log data from the same years) to reflect their total vascular experience. ResultsThe average total vascular experience reported by VSRs was 1446.0 compared with 1421.8 for VSFs (P = .2086). VSRs performed 694.7 major vascular procedures on average compared with 616.3 major cases for VSFs (P = .0106). Highlighted comparisons include the following: open aortic aneurysm cases, VSRs 20.6 and VSFs 22.2 (P = .320); endovascular aortic aneurysm cases, VSRs 80.0 and VSFs 80.6 (P = .945); cerebrovascular cases, VSRs 78.8 and VSFs 85.0 (P = .1132); and peripheral obstructive cases, VSRs 343.6 and VSFs 293.4 (P = .0032). ConclusionsIntegrated VSRs and traditional VSFs graduate with comparable overall vascular surgery clinical experience. VSRs reported, on average, a significantly higher number of major vascular procedures during their tenure as trainees as well as a significantly increased number of cases in six of the other ACGME categories.

Evaluating the venous experience in vascular surgery training.

There is an increasing recognition and treatment of venous disease in the United States; results of the Society for Vascular Surgery 2014 membership survey showed that venous disease represents 18.8% of a vascular surgeon's current practice. Despite this, there are no operative objectives or case requirements specific to venous disease for vascular surgery trainees. The objective of this study was to examine the current venous surgical training experience of graduating vascular surgery trainees. Following Institutional Review Board waiver and Association of Program Directors in Vascular Surgery and Residency Review Committee approval, results of the 2014 Association of Program Directors in Vascular Surgery Educational Needs Assessment Survey pertinent to venous training as well as the Vascular Surgery In-Training Examination (VSITE) venous scores were summarized. Using the Residency Review Committee case log database, venous case logs of 0/5 resident and 5/2 fellow vascular surgery graduates from 2012 to 2015 differentiated by Current Procedural Technology code were summarized. Venous case logs of 0/5 vascular surgery residents were compared with those of 5/2 fellows using a Student t-test, with results considered statistically significant at P< .05. Of the recent vascular surgery graduates, 15% thought they encountered training gaps in venous procedures; 54% thought this was due to a gap in vascular surgery training, whereas 43% thought this was due to evolution in technology. Venous VSITE scores were similar between 0/5 residents and 5/2 fellows (69% vs 76% correct answers, respectively), as were overall VSITE scores (70% vs 74% correct answers, respectively). The 0/5 residents completed between 11 and 264 cases and 5/2 fellows completed between 1 and 188 cases during their training. The 0/5 residents' venous cases were 8.1% of overall cases and the 5/2 fellows' cases were 4.3% of overall cases during their training. Current vascular surgery trainee experience is highly variable and not consistent with future vascular surgery clinical practice. Vascular surgery trainee fund of knowledge does not appear affected. Program directors should consider developing a better-defined venous curriculum that includes venous case minimums in defined categories.

A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training

Practical skills training in vascular surgery is facing challenges because of an increased number of endovascular procedures and fewer open procedures, as well as a move away from the traditional principle of "learning by doing." This change has established simulation as a cornerstone in providing trainees with the necessary skills and competences. However, the development of simulation based programs often evolves based on available resources and equipment, reflecting convenience rather than a systematic educational plan. The objective of the present study was to perform a national needs assessment to identify the technical procedures that should be integrated in a simulation based curriculum. A national needs assessment using a Delphi process was initiated by engaging 33 predefined key persons in vascular surgery. Round 1 was a brainstorming phase to identify technical procedures that vascular surgeons should learn. Round 2 was a survey that used a needs assessment formula to explore the frequency of procedures, the number of surgeons performing each procedure, risk and/or discomfort, and feasibility for simulation based training. Round 3 involved elimination and ranking of procedures. The response rate for round 1 was 70%, with 36 procedures identified. Round 2 had a 76% response rate and resulted in a preliminary prioritised list after exploring the need for simulation based training. Round 3 had an 85% response rate; 17 procedures were eliminated, resulting in a final prioritised list of 19 technical procedures. A national needs assessment using a standardised Delphi method identified a list of procedures that are highly suitable and may provide the basis for future simulation based training programs for vascular surgeons in training.

The undergraduate teaching of vascular surgery in Greek medical schools: theory and clinical practice.

The objective of this survey was to document and analyze the teaching methods of vascular surgery (VS) in the undergraduate curricula of the seven Greek medical schools. The type of VS subject (core, selective, integrated in other subject), the type of clinical practice, and the specialty of the VS tutors were recorded from the curriculum of each medical school, as documented online. The information was cross-checked with the academic tutors of each Medical School via phone contact and verified by ten medical students of Medical School. VS is taught mainly as part of general surgery (GS) in four medical schools, as part of another academic subject in two MS but as a core subject in only one Medical School. Five out of seven curricula offer VS as selective subject while three of them focusing on the hemodynamic principles of Angiology and VS. The specialty of instructors was VS in every Greek Medical School. Despite the great need for diagnosis and treatment of vascular diseases we recorded a limited VS training among the undergraduate Greek curricula. This heterogeneity does not ensure high-quality education in VS. Furthermore, emphasis on clinical skill acquisition should be further encouraged.

Role of Simulation in Endovascular Aneurysm Repair (EVAR) Training: A Preliminary Study

Endovascular aneurysm repair (EVAR) requires a high-level of technical-competency to avoid device-related complications. Virtual reality simulation-based training (SBT) may offer an alternative method of psychomotor skill acquisition; however, its role in EVAR training is undefined. This study aimed to: a) benchmark competency levels using EVAR SBT, and b) investigate the impact of supervised SBT on trainee performance. EVAR procedure-related metrics were benchmarked by six experienced consultants using a Simbionix Angiomentor EVAR simulator. Sixteen vascular surgical trainees performing a comparable EVAR before and after structured SBT (>4 teaching sessions) were assessed utilising a modified Likert-scale score. These were benchmarked for comparison against the standard set by the consultant body. Median procedural-time for consultants was 43.5min (IQR 7.5). A significant improvement in trainee procedural-time following SBT was observed (median procedural time 77min [IQR 20.75] vs. 56min [IQR: 7.00], p<.0001). The mean (SD) trainee Likert score pre- and post-SBT improved (16.6 [SD 1.455] vs. 28.63 [SD 2.986], p<.0001). Fewer endoleaks were observed (p=.0063) and trainees chose an appropriately sized device more often after SBT. This study suggests that EVAR-SBT should be considered as an adjunct to standard psychomotor skill teaching techniques for EVAR within the vascular surgery training curricula.

Progressive shortfall in open aneurysm experience for vascular surgery trainees with the impact of fenestrated and branched endovascular technology

BackgroundIn 2014, we published a series of articles in the Journal of Vascular Surgery that detailed the decrease in volume of open aneurysm repair (OAR) completed for abdominal aortic aneurysm (AAA) by vascular surgery trainees. At that time, only data points from 2000 through 2011 were available, and reliable predictions could only be made through 2015. Lack of data on endovascular aneurysm repair (EVAR) using fenestrated (FEVAR) and branched (BrEVAR) endografts also affected our findings. Despite these limitations, our predictions for OAR completed by vascular trainees were accurate for 2012 to 2014. This report uses updated data points through 2014 in conjunction with data on FEVAR and BrEVAR obtained from industry to predict trends in OAR and how it will affect vascular surgery training through 2020. MethodsAn S-curve modified logistic function was used to model the effect of introducing new technologies (EVAR, FEVAR, BrEVAR) on the standard management of AAA with OAR starting in the year 2000, similar to the technique that we have previously described. Weighted samples and data from the United States Census Bureau were used in conjunction with volume estimates derived from the National Inpatient Sample, State Inpatient Databases, and industry sources to determine trends in OAR and EVAR. The number of cases completed at teaching hospitals was calculated using the National Inpatient Sample, and Accreditation Council for Graduate Medical Education case logs were used to forecast the number of cases completed by vascular surgery trainees through 2020. Sensitivity analysis and trend analysis were completed. ResultsApproximately 45,000 AAA repairs are completed annually in the United States, but only 15% of these are now completed using OAR compared with >50% just a decade ago. Further, with the accelerating adoption of FEVAR and BrEVAR, and expanding indications for standard EVAR, our model predicts that <3000 OARs will be completed annually by 2020. Because only a subset of these cases are completed at teaching institutions, our model predicts that a vascular surgery trainee in a fellowship program will complete only one to two OARs, whereas trainees in a 0+5 program may complete two to three OARs. ConclusionsOur initial prediction in the 2014 report was that vascular trainees would complete approximately five OARs by 2020. After incorporating new data on BrEVAR, FEVAR, and the accelerating pace of EVAR use between 2012 and 2014, it now appears that vascular trainees will complete one to three OARs during their training.

Impact of an Interactive Vascular Surgery Web-Based Educational Curriculum on Surgical Trainee Knowledge and Interest

The surgical council on resident education developed an online competency-based self-study curriculum for general surgery residency trainees. Vascular surgery trainees are yet to have a similarly validated and readily accessible self-study curriculum. We sought to determine the effect of an interactive online vascular surgery curriculum on trainee knowledge and interest in vascular surgery. Over 15 months, 53 trainees (36 medical students and 16 surgical residents) performing a vascular surgery rotation were enrolled in a prospective, randomized, 2-cohort study. Before starting a 4-week rotation, trainee baseline demographics were collected, and a pretest was administered to evaluate baseline vascular surgery knowledge. During the same study period, 31 trainees (GROUP 1) were randomized to an interactive online curriculum with weekly reading assignments, and 21 trainees (GROUP 2) did not have access to the online curriculum. At the conclusion, all trainees received a posttest and survey to evaluate any change in vascular surgery knowledge and interest. Although 26.8% of trainees predicted that online computer modules would be a beneficial learning tool, most of trainees indicated textbook reading and case discussions are preferred. Analysis of GROUPS 1 and 2 revealed no significant differences in the average trainee age, training level, sex, or number of surgical cases observed during the rotation. Improvement in vascular surgery knowledge in GROUP 1 was significantly higher compared to GROUP 2 (average increase in posttest scores of 16.1% vs 6.6%, p = 0.009). New interest in vascular surgery was increased by 22.2% in GROUP 1, but was decreased by 40% in GROUP 2 (p < 0.001). Basic vascular surgery principles can be efficiently introduced through an interactive online curriculum. This type of self-study can improve trainee knowledge, and foster interest in vascular surgery. As in other specialties, a standardized and validated online vascular surgery curriculum should be developed for emerging trainees.