Vascular Surgery Training Programs Research Articles

Women Representation in Academic Vascular Surgery: Leadership, Education, and Research

There has been an increase in the proportion of registered women vascular surgeons in the past 5 years. It is unclear whether these changes have been reflected within leadership positions within vascular surgery. The purpose of our study was to quantify and highlight women representation within academic vascular surgery, specifically among editorial boards, the Society for Vascular Surgery (SVS), and in training program directors. Data on program directors and department or division leadership was determined by visiting the individual websites of all active vascular surgery residencies (n = 63) and fellowships (n = 116). Data on committee involvement was obtained from the SVS website (https://vascular.org/about/councils-and-committees). Demographics on editorial boards was determined from the top three vascular surgery-specific journals with the highest impact factors: Journal of Vascular Surgery, Journal of Vascular and Endovascular Surgery, and Annals of Vascular Surgery. Gender was assumed from the use of pronouns in surgeon biographies. The proportion of women vascular surgeons in the above leadership positions was compared with the demographics of the 2019 active physician's data available through the Association of American Medical Colleges using χ2 tests. Our analysis revealed significant disparities between men and women in vascular surgery leadership. Among active vascular surgeons, women account for 14.6% (575/3941) of the total workforce. Among the three highest impact vascular surgery journals, women comprised only 8.6% (25/291) of the editorial board, which was significantly lower than the proportion of active women vascular surgeons (P = .006). In contrast, 45.16% (14/31) of the SVS committee leadership positions were held by women (14/31), which was significantly higher than the proportion of active women surgeons (P < .001). Within vascular surgery training programs, women account for 14.52% (9/62 positions) of program directors in the integrated residency programs and 12.07% (14/116 positions) of program directors in fellowship programs (P = 1.0 and P = .487, respectively). Among division chiefs in the same academic institutions, women comprised only 4.81% (5/104 positions; P = .007) (Fig). Our results suggest that women are well-represented among SVS committee leadership but underrepresented among journal editorial boards and division leadership. Of note, our analysis may over-represent women in leadership as some individuals held multiple positions both within their institution and nationally. Leadership positions should evolve with the changing demographics of vascular surgeons, and additional research is needed to understand attitudes and barriers to a more balanced representation. In addition, gender was assumed based off pronoun usage, and self-reported data is needed to capture gender identity more accurately.

The State of Vascular Surgery Virtual Away Rotations in the Time of a Pandemic

The ensuing restrictions from the coronavirus disease 2019 pandemic have significantly hindered in-person fourth-year medical student away rotations. Adapting to this, vascular surgery training programs introduced virtual away rotations (VAR) for fourth-year medical students, in preparation for the residency match. This study aimed to characterize the current curricula of vascular surgery VAR.

The Changing Demographics of Surgical Trainees in General and Vascular Surgery: National Trends over the Past Decade

Recent initiatives have targeted the issue of gender and ethnic/racial disparities in general surgery and vascular surgery. However, the prevalence of these disparities in general and vascular surgical training programs is unknown. A retrospective analysis was conducted using data from three separate sources, including the US Graduate Medical Education annual report, Electronic Residency Application Service database, and National Resident Matching Program annual report. Demographic information regarding gender distribution and ethnic/racial identity was collected from 328 general surgery residency programs, 59 vascular surgery residency programs, and 100 vascular surgery fellowship programs across the US. The primary outcomes of this study were to evaluate national trends in gender and ethnic diversity in general surgery and vascular surgery training programs, including both traditional fellowship and integrated residency paradigms. From 2011-2020, general surgery residency programs showed a positive trend towards both female applicants (from 31.9%-41.5%) and trainees (from 36.2%-43.1%) (p < 0.0001 each). The proportion of minority trainees decreased, primarily among Black (from 7.2%-5.4%) and Asian trainees (from 21.5%-19.2%) (p < 0.0001 each). Concurrently, the number of vascular integrated residency programs grew from 27 to 59, resulting in a fivefold increase in trainees (from 64-335). Despite this growth, there was no change in the proportion of women applicants or trainees for both vascular integrated residency (24.9% applicants; 36.2% trainees) and fellowship programs (27.4% applicants; 25.9% trainees) over the study period (p = 0.11, 0.89, 0.43, and 0.13 respectively). Moreover, there was no significant change in proportion of minority trainees in both vascular integrated residency and fellowship programs. While general surgery programs have expanded in proportion of both female applicants and trainees, racial diversity has decreased. Gender and racial diversity in vascular training has not changed. Future initiatives in general and vascular surgery should focus on recruitment and promotion of proficient women and minority trainees.

Factors influencing medical student choices in the integrated vascular surgery match: Implications for future post-pandemic residency matches

ObjectiveIntegrated vascular surgery residency is among the most competitive specialties, but little is known about the applicant perspective. The coronavirus disease 2019 outbreak impacted the 2021 integrated vascular surgery residency match because of travel restrictions. We sought to better understand pre-pandemic applicant recruitment strategies, logistics of away rotations, and the residency interview process to identify areas for improvement in the application process. MethodsAn anonymous survey was sent to matched students in 2020, inquiring about motivations for pursuing vascular surgery (VS), logistic of away rotations and interviews, and factors influencing students' rank lists. ResultsSeventy of the 73 matched students completed the survey (95.9% response rate). The median age was 27 (range, 25-41); 32.9% were female, 91.4% were U.S. medical students, and 77.1% were from institutions with a VS training program. Factors most strongly influencing the decision to choose VS as a career were interest in open vascular procedures, endovascular procedures, perceived job satisfaction, emerging technologies, and influence of a mentor. The prospect of the job market, future salary, and competitiveness of the application process had the least impact. Of the matched students, 82.9% completed an away rotation (median, 2; range, 1-4), with 51.7% of students paying a total cost of more than $2500. Fifty percent of students matched either at their home institution or where they had performed an away rotation. Students reported application submissions to a median of 50 programs (range, 1-70) and interviewed at 17 (range, 1-28), with 40% of students paying a total of more than $4000 for interview costs. The most significant factors affecting students' rank lists included program culture, open aortic surgical volume, geography, and complex endovascular procedure volume. Tours of facilities, resident salary, and male/female distribution had the least importance. ConclusionsSuccessfully matched applicants in 2020 prioritized operative case volume and program collegiality when ranking programs. Despite their high cost, away rotations played an important role in the Match, suggesting that time spent at potential institutions allowed ideal assessment of factors for students. The high average number of away rotations and in-person interviews performed in 2019-2020 was limited for the 2021 Match due to coronavirus disease 2019 restrictions. Programs will have to continue developing creative alternatives or additions to away rotations and the application processes to assure continued success in future post-pandemic Match cycles.

Examining the Development of Operative Autonomy in Vascular Surgery Training and When Trainees and Program Directors Agree and Disagree

Lack of autonomy in the operating room (OR) during general surgery residency is a major contributing factor to low confidence operating independently after graduation. Although attempts to address decreased autonomy and development of entrustment in the OR are being made in general surgery programs, this issue has not been examined thoroughly in vascular surgery. We sought to determine barriers and opportunities for developing operative autonomy during vascular surgery training by surveying program directors (PDs) and trainees (integrated residents and fellows) in U.S. vascular surgery training programs. An anonymous electronic survey was sent via email to all PDs (n = 155) and trainees (n = 516) in United States vascular surgery training programs. Demographics, academic characteristics, and responses regarding factors impacting the development of entrustment were collected. Thirty-five PDs and 100 trainees completed the survey (22.5% and 19.4% response rate, respectively). Sixty percent of trainees were integrated residents and 40% were fellows. Twenty percent of PDs and 33% of trainees were female, and 5% of all PDs and trainees were from underrepresented minorities. The single most positive factor affecting the development of autonomy according to trainees and PDs is familiarity of the faculty with the trainee. Both PDs and trainees thought the trainee's preparation for the case positively affected development of autonomy; however, more PDs believed that involvement with preoperative preparation in particular (marking the patient, consenting the patient, filling out a history and physical, prepping and draping the patient) was important (P < 0.05). PDs believed that duty-hour limitations negatively affected the trainee's ability to develop autonomy in the OR, whereas more trainees believed that hospital or OR efficiency policies played a negative role (P < 0.05). Finally, compared with trainees, PDs believed that the appropriate amount of time for safe struggle before the attending should take over the case was when OR efficiency was compromised or at any moment the trainee is unsure of themselves (P < 0.05); trainees believed that the attending should take over the case after the limit of their skill set or troubleshooting ability was reached (P < 0.05). Familiarity of the attending physician with the trainee is an important positive factor for development of entrustment and autonomy in vascular surgery trainees. Duty-hour limitations and belief of the need for hospital efficiency may negatively impact operative independence of trainees. An open discussion about balancing OR efficiency and trainees' safe struggle is essential to address the growth of independent operative skills in vascular surgery trainees.

A Framework for Understanding the Association Between Training Paradigm and Trainee Preparedness for Independent Surgical Practice

The sociopolitical and cultural context of graduate surgical education has changed considerably over the past 2 decades. Although new structures of graduate surgical training programs have been developed in response and the comparative value of formats are continually debated, it remains unclear how different time-based structural paradigms are preparing trainees for independent practice after program completion. To investigate the factors associated with trainees' and program directors' perception of trainee preparedness for independent surgical practice. This qualitative study used an instrumental case study approach and obtained information through semistructured interviews, which were analyzed using open-and-focused coding. Participants were recent graduates and program directors of vascular surgery training programs in the United States. The 2 training paradigms analyzed were the integrated vascular surgery residency program (0 + 5, with 0 indicating that the general surgery training experiences are fully integrated into the 5 years of overall training and 5 indicating the total number of years of training) and the traditional vascular surgery fellowship program (5 + 2, with 5 indicating the number of years of general surgery training and 2 indicating the number of years of vascular surgery training). All graduates completed their training in 2018. All interviews were conducted between July 1, 2018, and September 30, 2018. A conceptual framework to inform current and ongoing efforts to optimize graduate surgical training programs across specialties. A total of 22 semistructured interviews were completed, involving 7 graduates of 5 + 2 programs, 9 graduates of 0 + 5 programs, and 6 vascular surgery program directors. Of the 22 participants, 15 were men (68%). Participants described 4 interconnected domains that were associated with trainees' perceived preparedness for practice: structural, individual, relational, and organizational. Structural factors included the overall and vascular surgery-specific time spent in training, whereas individual factors included innate technical skills, confidence, maturity, and motivation. Faculty-trainee relationships (or relational factors) were deemed important for building trust and granting of autonomy. Organizational factors included features of the local organization, including patient population, case volume, and case mix. Findings suggest that restructuring training paradigms alone is insufficient to address the issue of trainees' perceived preparedness for practice. A framework was created from the results for evaluating and improving residency and fellowship programs as well as for developing graduate surgical training paradigms that incorporate all 4 domains associated with preparedness.

The State of Vascular Surgery Interest Groups in North America

Vascular surgery interest groups (VSIGs) raise awareness and attract medical students to the specialty. There has been a plateauing of applicants interested in integrated programs. The goal of this survey was to assess the activities of VSIGs and identify factors associated with matriculation into vascular surgery residency. A survey was administered to members of the association of program directors in vascular surgery. It inquired about the presence of a VSIG at the corresponding medical schools. The program directors at institutions lacking VSIGs were asked about possible hurdles in establishing one. The rest of the survey focused on the different activities of the VSIG. The VSIGs were divided into low enrollment if less than 10% of the students in that group pursue vascular surgery training and high enrollment if greater than 10% of the students pursue vascular surgery. Chi-squared test was used for comparison. There were 65/123 programs that responded (53% response rate). The responses came most commonly from programs in the Northeast (36.9%). Only 37% (n=24) had a VSIG at their institutions. Lack of time (65.2%) and lack of a student champion (60.9%) were the most common hurdles encountered by the program directors who considered establishing a VSIG. Comparing the 2 groups of VSIGs, there was no difference in terms of the training paradigm, experience of program director, or geographical location. The VSIGs had comparable duration of activity, number of students, and meeting frequency. There was no difference in clinical exposure outside the curriculum between the 2 groups with observation on the wards and in clinic being most common. Endovascular simulation was significantly (P=0.01) more common in low enrollment (83.3%) compared with high enrollment (33.3%) VSIG. There was a trend in the high enrollment group for more vascular anastomosis training (75% vs. 66.7%) that did not reach statistical significance (P=0.65). There was no difference between the 2 groups in career development opportunities and education activities. Most VSIGs (75%) operated with a budget of less than $1,000 based on divisional or departmental funding (low enrollment=66.7% versus high enrollment=41.7%, P=0.22). Only one-third of the vascular surgery training programs have an associated VSIG. Vascular surgery training programs should promote VSIG formation with equal emphasis on endovascular and open surgery, thus providing medical students an early exposure to the specialty.

Simulation-Based Course Improves Resident Comfort, Knowledge, and Ability to Manage Surgical Intensive Care Unit Patients

BackgroundSimulation-based education can augment residents' skills and knowledge. We assessed the effectiveness of a simulation-based course for surgery interns designed to improve their comfort, knowledge, and ability to manage common surgical critical care (SCC) conditions. Materials and methodsFor 2 y, all first year residents (n = 31) in general surgery, urology, interventional radiology, and the integrated plastics, vascular, and cardiothoracic surgery training programs at our institution participated in a simulation-based course emphasizing evidence-based management of SCC conditions. Precourse and postcourse surveys and multiple-choice tests, as well as summative simulation tests, assessed interns' comfort, knowledge, and ability to manage SCC conditions. Changes in these measures were assessed with Wilcoxon matched-pairs signed rank tests. Factors associated with summative performance were determined by linear regression. ResultsThe course consisted of four simulation-based teaching sessions in year 1 and six in year 2. The course taught seven of the 18 core SCC conditions in the Surgical Council on Resident Education general surgery curriculum in year 1 and 10 in year 2. Interns' self-reported comfort, knowledge, and ability to manage each condition taught in the course increased (P < 0.02). Their knowledge of each condition, as assessed by written tests, also increased (P < 0.02). Their summative simulation test performance correlated with the number of course sessions attended (P < 0.03) and status as general surgery residents (P < 0.01). ConclusionsA simulation-based SCC training course for surgery interns that emphasizes evidence-based management of SCC conditions improves interns' comfort, knowledge, and ability to manage these conditions.

Contemporary Analysis of Senior Level Case Volume Variation between Traditional Vascular Surgery Fellows and Integrated Vascular Surgery Chief Residents

The present study compares the senior level operative experience of graduates from the traditional vascular surgery fellowship (5+2) and integrated vascular surgery training programs (0+5) using contemporary operative case log data. The Accreditation Council for Graduate Medical Education integrated vascular surgery, vascular surgery fellowship, and general surgery case logs for trainees graduating between 2013 and 2018 were queried for vascular surgery procedures. "Senior" cases were categorized as cases logged as "surgeon fellow" by 5+2 trainees or "surgeon chief" (post graduate year-4,5) by 0+5 trainees. Overall case volume was defined as the combined volume of cases logged as "surgeon junior," "surgeon chief," "surgeon fellow," "teach assist," "first assist," or "secondary procedure." To reflect total vascular experience, all vascular cases done during general surgery residency were combined with cases performed during vascular surgery fellowship. Mean case volumes were compared for all operations/procedures. The 5+2 trainees had higher mean volume of open repair of suprarenal aortic aneurysms (2.4 vs. 1.4, P=0.0026) and open repair of thoracic aortic aneurysms (0.5 vs. 0.3, P=0.004) at the fellow level compared to 0+5 surgeon chief cases. Additionally, 5+2 trainees performed more endovascular repair of abdominal aortoiliac aneurysm (44.7 vs. 28.4, P<0.0001), endovascular repair of iliac artery aneurysm (1.9 vs. 1.2, P=0.0003), and endovascular repair of thoracic aortic aneurysm (14.9 vs. 8.4, P<0.0001). The 5+2 fellows performed more vein bypasses than 0+5 chief residents (femoral-popliteal 9.8 vs. 6.4, P=0.002; infrapopliteal 13.9 vs. 8.8, P=0.0490), extra-anatomic bypasses (axillofemoral 4.2 vs. 2.9, P=0.0004; femoral-femoral 5.6 vs. 3.1, P=0.034), carotid endarterectomies (47.3 vs. 29.3, P<0.0001), carotid artery stenting (9.6 vs. 4.5, P=0.0001), celiac/SMA endarterectomy or bypass (3.7 vs. 1.9, P<0.0001), renal artery balloon angioplasty/stenting (5.0 vs. 2.5, P=0.0006), thoracic outlet decompression (5.4 vs. 1.9, P<0.0001), traumatic repairs [thoracic vessels (0.5 vs. 0.1, P<0.0001), neck vessels (0.7 vs. 0.3, P=0.0004), abdominal vessels (3.0 vs. 1.7, P=0.0005), and peripheral vessels (6.6 vs. 3.1, P=0.034)], as well as a higher mean volume of arteriovenous (AV) fistulas (30.7 vs. 15.7, P<0.0001), AV grafts (10.7 vs. 5.1, P<0.0001), and revision of AV access (16.1 vs. 8.0, P=0.0003). Although both pathways graduate trainees with a similar overall surgical experience, 5+2 trainees log significantly more "Senior" cases. Further studies investigating potential variation in operative autonomy between both pathways are necessary.

An Evaluation of the Availability and Accessibility of Online Content of Integrated Vascular Surgery, Interventional Radiology, and Thoracic Surgery Training Program Websites for Residency Applicants

Residency websites are an important recruitment resource, introducing applicants to programs across the country and allowing for comparison. Recruitment is highly competitive between vascular surgery (VS), CT, and interventional radiology (IR) with the ratio of applicants to positions being highest in CT, then IR, and last VS, as reported by the Electronic Residency Application Service. Thus, we sought to evaluate the accessibility and availability of online content for those integrated residency programs. A list of accredited VS, IR, and CT residencies was obtained from Accreditation Council for Graduate Medical Education. Program websites were evaluated by independent reviewers for content items pertaining to program recruitment and education (scored absent or present). Statistical analysis was performed in R. Of Accreditation Council for Graduate Medical Education-accredited programs, 74 (87%) of 85 IR, 56 (92%) of 61 VS, and 27 (100%) of 27 CT had functional websites. IR websites contained 19.4 ± 9.54 (mean ± SD) content items (interquartile range [IQR], 14.8-25.1), VS websites contained 24.2 ± 10.7 (mean ± SD) content items (IQR, 19-31.5), and CT websites contained 26.6 ± 7.15 (mean ± SD) content items (IQR, 21.8-31.5). CT and VS websites contained significantly more content items than IR websites (P = .0004 and P = .0026, respectively). Two content items highly influential to applicant program decision are operative experience and faculty mentorship, reported at 50% and 14.9% for IR, 32.1% and 10.7% for VS, and 18.5% and 11.1% for CT. Key deficits were work hours, debt management, and curriculum for IR; resident profiles, sample contract, and departmental research interests for VS; and operative experience, PD contact, and message for CT. IR deficits in work hours and CT deficits in operative experience both represent information highly valued by applicants. All had deficits in evaluation criteria and faculty mentorship. Detailed information on availability of specific content items can be seen in the Table. This study has uncovered key differences in availability of online content for residencies recruiting from the same pool of applicants. CT has the most information, then VS, with IR reporting the least content. To attract valuable candidates, programs should aim to increase the availability of online content for potential applicants.TableAvailability of content on US integrated interventional radiology (IR), integrated vascular surgery (VS), and integrated thoracic surgery training program websitesIR, No. (%) of programs (n = 74)VS, No. (%) of programs (n = 56)Thoracic surgery, No. (%) of programs (n = 27)Program recruitment Program description69 (93.2)56 (100.0)26 (96.3) Faculty listing73 (98.6)53 (94.6)27 (100.0) Faculty education (training history)68 (91.9)52 (92.9)25 (92.6) Admin/coordinator contact63 (85.1)53 (94.6)22 (81.5) Application requirements50 (67.6)42 (75.0)22 (81.5) ERAS link47 (63.5)35 (62.5)16 (59.3) Benefits51 (68.9)39 (69.6)19 (70.4) No. of incoming positions available45 (60.8)44 (78.6)20 (74.1) Salary48 (64.9)34 (60.7)17 (63.0) Current residents47 (63.5)40 (71.4)20 (74.1) Faculty publications40 (54.1)24 (42.9)19 (70.4) Wellbeing strategies37 (50.0)26 (46.4)17 (63.0) Interview dates29 (39.2)32 (57.1)13 (48.1) Alumni listing17 (23.0)20 (35.7)7 (25.9) Alumni career placement17 (23.0)15 (26.8)6 (22.2) Selection process13 (17.6)4 (7.1)2 (7.4) Debt management8 (10.8)22 (39.3)11 (40.7) Work hours6 (8.1)12 (21.4)12 (44.4)Program education Rotation schedule45 (60.8)47 (83.9)19 (70.4) Research interests (department)49 (66.2)22 (39.3)16 (59.3) Didactic instruction42 (56.8)39 (69.6)17 (63.0) Research requirements39 (52.7)41 (73.2)19 (70.4) Operative experience37 (50.0)18 (32.1)5 (18.5) Journal club25 (33.8)34 (60.7)11 (40.7) Meetings attended23 (31.1)26 (46.4)11 (40.7) Elective rotation20 (27.0)25 (44.6)12 (44.4) Curriculum12 (16.2)21 (37.5)10 (37.0) National organization link8 (10.8)4 (7.1)7 (25.9) Evaluation criteria5 (6.8)9 (16.1)6 (22.2) Simulation training3 (4.1)19 (33.9)9 (33.3)ERAS, Electronic Residency Application Service. Open table in a new tab

Trends in Open Vascular Surgical Exposure Among Graduates of Canadian Vascular Surgery Training Programs

Trends in Open Vascular Surgical Exposure Among Graduates of Canadian Vascular Surgery Training Programs

The Prevalence and Utility of Vascular Surgery Training Programs' and Vascular Societies’ Social Media Presence

There is a paucity of information describing the adoption of social media by the vascular surgery community and social media's effectiveness. We evaluated current trends in social media use by all accredited vascular surgery training programs (VSTPs) in the United States and National and Regional Vascular Societies (NVS) in comparison to hospital/institutions and general surgery programs (GSPs). Four major social media platforms (Twitter, Facebook, Instagram, and YouTube) were individually searched for VSTPs, affiliated hospital/institution, affiliated GSP, and NVS profiles (31 societies). Social media presence was evaluated for quantitative and qualitative variables (likes/followers/posts and content) on each platform. Statistical analysis was performed utilizing a two-sample t-test, exact McNemar's and Fischer's exact test, as appropriate, with alpha set at 0.05. Social media accounts were found for 31% of VSTP. VSTP with both fellowship and integrated positions had a greater social media presence than integrated only (45% vs. 10%, P=0.042) and fellowship only (45% vs. 26%, P=0.044) programs. For integrated programs, an increase in residency positions filled in the 2019 match was associated with the use of social media (P=0.002). VSTP social media presence was largest on Twitter (24%) with 232 total posts and 0.32 posts/day. 52% of NVS had a social media platform, with the highest prevalence on Facebook (42%) and highest utilization on Twitter (1422 posts, 0.47 posts/day). Hashtags were used for postings by 78% of VSTP and 100% of NVS. VSTP had a lower overall social media presence than their institutions and GSP (31% vs. 96% and 65%, P<0.001). Twitter was used by VSTP significantly less than the institutions and GSP (24% vs. 87% and 57%, P<0.001). Facebook and Instagram were used less by VSTP than institutions or GSP (10% vs. 93% and 26% P<0.001, 4% vs. 76% and 24% P<0.001 respectively). YouTube channels were the least used platform in VSTP compared with institutions (3% vs. 92%, P<0.001), but comparable to GSP (3% vs. 10%, P=0.062). Regarding content, VSTP accounts were used for comments on academic activity of residents/physicians, faculty research, patient education, and commendations. There is relative underuse of social media by VSTP in comparison to their associated institutions and general surgery programs. VSTP may modify their approach to recruitment by utilizing the follower base of institutions, surgery programs, and NVS or by leveraging established institutional marketing programs. Adoption of social media may provide vascular surgery increased exposure for trainee and patient recruitment and specialty brand recognition.

Vascular surgery's identity

Vascular surgery's identity

Digital Footprint of Vascular Surgery Training Programs in the United States and Canada

The digital footprint of vascular residency and fellowship programs may have an impact on an applicant's likelihood of selecting a given program. This may include content and accessibility of a particular program's website as well as its social media presence. The goal of this study is to evaluate the online presence of all accredited vascular surgery training programs in the United States and Canada. A list of accredited vascular surgery training programs in the United States was obtained from the Accreditation Council for Graduate Medical Education and the Society for Vascular Surgery websites. Canadian program websites were sourced from the Canadian Society for Vascular Surgery website. Each program website was individually queried. A systematic Google search of each program was carried out to determine website accessibility. Thirty-one individual content and quality metrics were used to appraise the websites. Three major social media platforms (Twitter, Facebook, and Instagram) were individually searched for program profiles. A total of 105 independent vascular surgery fellowship programs in the 5+2 paradigm and 55 integrated vascular surgery residency programs in the 0+5 paradigm were identified in the United States. An additional 10 Canadian programs were also identified, including 10 integrated residency programs and 4 independent fellowships. Ninety-nine percent of integrated residency and fellowship programs were accessible through Google search. Program description was also almost universally available. Significant differences between US and Canadian programs were observed including the mention of salary information (43% vs. 10%, P=0.039), clinic responsibilities (38% vs. 90%, P=0.001), teaching responsibilities (34% vs. 100%, P<0.0001), program director contact information (47% vs. 80%, P=0.045), mention of journal club (52% vs. 100%, P=0.003), research requirements (50% vs. 90%, P=0.014), and past and current research (30% vs. 70%, P=0.009 and 37% vs. 80%, P=0.008, respectively). Additionally, there were significant differences in mention of institutions from which trainees came from (48% vs. 10%, P=0.021), mention of hybrid operating room (42% vs. 100%, P=0.0003), advertised medical student rotations (25% vs. 90%, P<0.0001), and finally social media presence (13% vs. 70%, P<0.0001). The overall digital footprint of the majority of training programs in the United States was small, unlike their Canadian counterparts. Although the vast majority of websites for vascular surgery training programs were accessible via simple internet searches, they lacked information that could have been important to applicants. Additionally, the significant underuse of social media platforms by American vascular surgery programs indicated a potential missed opportunity to target the millennials who make up most of the applicant pool to these programs.

Gender disparities in academic vascular surgeons

ObjectivePrevious studies have identified significant gender discrepancies in grant funding, leadership positions, and publication impact in surgical subspecialties. We investigated whether these discrepancies were also present in academic vascular surgery. MethodsAcademic websites from institutions with vascular surgery training programs were queried to identify academic faculty, and leadership positions were noted. H-index, number of citations, and total number of publications were obtained from Scopus and PubMed. Grant funding amounts and awards data were obtained from the National Institutes of Health (NIH) and Society for Vascular Surgery websites. Industry funding amount was obtained from the Centers for Medicare and Medicaid Services website. Nonsurgical physicians and support staff were excluded from this analysis. ResultsWe identified 177 female faculty (18.6%) and 774 male faculty (81.4%). A total of 41 (23.2%) female surgeons held leadership positions within their institutions compared with 254 (32.9%) male surgeons (P = .009). Female surgeons held the rank of assistant professor 50.3% of the time in contrast to 33.9% of men (P < .001). The rank of associate professor was held at similar rates, 25.4% vs 20.7% (P = .187), respectively. Fewer women than men held the full professor rank, 10.7% compared with 26.2% (P < .001). Similarly, women held leadership positions less often than men, including division chief (6.8% vs 13.7%; P < .012) and vice chair of surgery (0% vs 2.2%; P < .047), but held more positions as vice dean of surgery (0.6% vs 0%; P < .037) and chief executive officer (0.6% vs 0%; P < .037). Scientific contributions based on the number of each surgeon's publications were found to be statistically different between men and women. Women had an average of 42.3 publications compared with 64.8 for men (P < .001). Female vascular surgeons were cited an average of 655.2 times, less than half the average citations of their male counterparts with 1387 citations (P < .001). The average H-index was 9.5 for female vascular surgeons compared with 13.7 for male vascular surgeons (P < .001). Correcting for years since initial board certification, women had a higher H-index per year in practice (1.32 vs 1.02; P = .005). Female vascular surgeons were more likely to have received NIH grants than their male colleagues (9.6% vs 4.0%; P = .017). Although substantial, the average value of NIH grants awarded was not statistically significant between men and women, with men on average receiving $915,590.74 ($199,119.00-$2,910,600.00) and women receiving $707,205.35 ($61,612.00-$4,857,220.00; P = .416). There was no difference in the distribution of Society for Vascular Surgery seed grants to women and men since 2007. Industry payments made publicly available according to the Sunshine Act for the year 2018 were also compared, and female vascular surgeons received an average of $2155.28 compared with their male counterparts, who received almost four times as much at $8452.43 (P < .001). ConclusionsAlthough there is certainly improved representation of women in vascular surgery compared with several decades ago, a discrepancy still persists. Women tend to have more grants than men and receive less in industry payments, but they hold fewer leadership positions, do not publish as frequently, and are cited less than their male counterparts. Further investigation should be aimed at identifying the causes of gender disparity and systemic barriers to gender equity in academic vascular surgery.

Development of a pulsatile cadaver-based simulation for training of open abdominal vascular surgery skills

ObjectiveDeveloping competence in open aortic surgery is increasingly challenging in vascular surgery training programs. Although static cadaver models provide an opportunity for dissection and exposure, the lack of pulsatility limits further education in managing blood vessels. We developed an affordable pulsatile cadaver simulation model to improve training in open abdominal aortic surgery with the primary objective of determining whether it incorporated the fidelity required to teach critical surgical techniques. MethodsThe University of Minnesota Bequest program supported a pilot project to develop a fresh pulsatile cadaver. A written pretest on exposure of the aorta in various locations was given to all trainees. The external iliac artery was exposed, cannulated, then perfused in a pulsatile fashion using normal saline and a pump. Trainees were then evaluated and timed on location of the aorta, retractor placement, dissection, and creation of an aortic anastomosis. ResultsTwenty-six pulsatile cadaver procedures were performed with five fellows over 13 months. All procedures were performed under the supervision of the same faculty member. Total cost over the study period was $8800. Four abdominal aortic aneurysms were found (15%). With bilateral iliac artery ligation, adequate pulsatility was created for blind supraceliac aortic dissection. Abdominal wall and organ relationships were ideal for teaching proper retractor placement and techniques for vascular dissection, endarterectomy, and anastomosis. Although 100% of fellows documented written understanding of the steps for procedures on the pretest, no fellow successfully placed a supraceliac aortic clamp, properly positioned retractors for proper open AAA exposure, or placed all proximal aortic back wall sutures transmurally on the initial assessment. After training for a variable number of cases, all were able to place a supraceliac clamp blindly within 4 minutes from skin incision. Retractor placement and suturing technique improved significantly for all trainees during the study period. ConclusionsThe implementation of a pulsatile cadaver-based simulation model for abdominal vascular surgery has the potential to be both affordable and provide necessary haptics and fidelity for training fellows in critical abdominal vascular techniques.

Gender disparity and sexual harassment in vascular surgery practices

BackgroundSexual harassment is defined as unwelcome behaviors or obscene remarks that affect an individual’s work performance or create an intimidating, hostile, or offensive environment. It is known to be more pervasive in male-dominated workplaces and flourishes in a climate of tolerance and culture of silence. We sought to examine its prevalence in faculty of vascular surgery training programs, to identify factors associated with occurrence, to determine reporting barriers, and to identify any gender bias that exists. MethodsAn anonymous survey consisting of questions on gender bias and sexual harassment was e-mailed to vascular surgery faculty members at 52 training sites in the United States. The survey asked about type, perpetrators, and locations; why and how the practice occurs; reporting mechanisms and barriers to reporting; and demographic information. Descriptive and univariate analyses were performed. ResultsOf 346 invitations sent, 149 recipients (43%) completed the survey. Of respondents, 48 of 149 (32%) thought harassment occurred more commonly in surgical specialties with historical male dominance, citing ignoring of behavior and hierarchy/power dynamics as the most common reasons for its occurrence; 61 of 149 (41%) reported having experienced workplace harassment, with unwanted sexually explicit comments or questions and jokes, being called a sexist slur or nickname, or being paid unwanted flirtation as the most common behaviors. Harassment was high in both men and women, although women had a higher likelihood of being harassed (67% of women respondents vs 34% of men respondents; P = .001) and on average had experienced 2.6 (of 11) types of harassment. The majority of harassment came from hospital staff, although women were more likely to receive harassment from other faculty. Despite that 84% of respondents acknowledged known institutional reporting mechanisms, only 7.2% of the harassing behaviors were reported. The most common reasons for not reporting included feeling that the behavior was “harmless” (67%) or “nothing positive would come of it” (28%). Of the respondents, 30% feared repercussions or felt uncomfortable identifying as a target of sexual harassment, and only 59% would feel comfortable discussing the harassment with departmental or divisional leadership. In examining workplace gender disparity, female surgeon responses differed significantly from male surgeon responses in regard to perceptions of gender differences. ConclusionsA significant number of faculty of vascular surgery training programs have experienced workplace sexual harassment. Whereas most are aware of institutional reporting mechanisms, very few events are reported and <60% of respondents feel comfortable reporting to departmental or divisional leadership. Female vascular surgeons believe gender influences hiring, promotion, compensation, and assumptions of life goals. Further work is necessary to identify methods of reducing workplace sexual harassment and to optimize gender disparity in vascular surgery practice.

Critical Comparison of the Quality and Content of Integrated Vascular Surgery, Thoracic Surgery, and Interventional Radiology Residency Training Program Websites

Objective: With the move to virtual interviewing, residency websites are an important recruitment resource, introducing applicants to programs across the country and allowing for comparison. Recruitment is highly competitive from a common potential pool between vascular surgery, thoracic surgery and interventional radiology with the ratio of applicants to positions being highest in interventional radiology, followed by thoracic surgery and lastly vascular surgery, as reported by the National Resident Matching Program. The aim of this study is to evaluate the accessibility and availability of online content for those integrated residency programs. Methods: A list of accredited vascular surgery, thoracic surgery, and interventional radiology residencies was obtained from the ACGME. Program websites were evaluated by trained independent reviewers (n=2) for content items pertaining to program recruitment and education (scored absent or present). Statistical analysis was performed in R software. Results: Of ACGME accredited programs, 56 of 61 (92%) vascular surgery, 27 of 27 (100%) thoracic surgery, and 74 of 85 (87%) interventional radiology programs had functional websites (P=0.122). Vascular surgery websites contained a median of 26 content items (IQR: 20, 32), thoracic surgery websites contained a median of 27 content items (IQR: 21, 32), and interventional radiology websites contained a median of 23 content items (IQR: 18, 27). Two content items considered highly influential to applicant program decision are procedural experience and faculty mentorship, were reported at 32% and 11% for vascular surgery, 19% and 11% for thoracic surgery, and 50% and 15% for interventional radiology (P=0.008 and P=0.751, respectively). Key deficits were work hours, debt management and curriculum for interventional radiology; resident profiles, sample contracts, and research interests in vascular surgery; operative experiences, program director contact and message for thoracic surgery. Interventional radiology deficits were work hours and thoracic surgery deficits were procedural experience. Both IR and CT websites lacked information in evaluation criteria and faculty mentorship. Conclusions: This study has uncovered key differences in availability of online content for residencies recruiting from the same pool of applicants. Thoracic surgery has the most information, followed by vascular surgery, with interventional radiology reporting the least content. In the era of virtual interviewing from the same potential pool of applicants, programs should review and revise their web presence with the aim to increase the availability of online content in order to attract valuable candidates.

A Roadmap for Noninvasive Vascular Laboratory Education

Since 2014, the Registered Physician in Vascular Interpretation (RPVI) designation has been required for a vascular surgery board certification candidate to register for the vascular surgery certifying exam. Although the importance of the noninvasive vascular laboratory (NIVL) is recognized, vascular laboratory education within vascular surgery fellowship programs is heterogeneous and much less regulated compared with clinical education. Evidence suggests that many vascular surgery trainees may not have received ideal training to obtain RPVI certification or direct an NIVL. The NIVL curriculum at The Ohio State University Wexner Medical Center has been used since 2005 and combines didactics, supervised reading, videos, hands-on experience with vascular sonographers, and one on one time with the vascular laboratory medical director. This curriculum is outlined in this article and can be used as a guide for creating NIVL curricula for vascular surgery and other training programs.

The decline of open abdominal aortic aneurysm surgery among individual training programs and vascular surgery trainees

ObjectiveIn the past decade, treatment of abdominal aortic aneurysm (AAA) has dramatically shifted from open repair to an endovascular approach. The decreasing number of open AAA repairs (OAR) has raised concerns regarding future vascular surgeons' competence to perform this complex and high-risk procedure. Prior work has documented decreasing open aortic volume among surgical residents. However, these studies report average national case volume with a limited understanding of the variation in OAR exposure among training programs and trainees. We sought to evaluate the current open AAA repair trends among individual accredited vascular surgery training programs and vascular surgery residents to better evaluate trainees' exposure to OAR. MethodsWe identified elderly Medicare beneficiaries undergoing OAR and endovascular aneurysm repair (EVAR) between 2010 and 2014. Accredited vascular surgery training program hospitals were identified. OAR and EVAR volume was aggregated at the program level and the number of senior vascular surgery trainees per year at each program was captured. The training program all-payer total AAA repair volume was calculated based on the national proportion of patients undergoing AAA covered by Medicare in the Vascular Quality Initiative. Temporal trends in program and vascular surgery trainee OAR and EVAR volume were calculated. ResultsA total of 119,408 (77%) EVAR and 35,042 (23%) were identified in the Medicare database between 2010 and 2014. Of these, 21% were performed among the 111 training programs, including 22,227 (73%) EVAR and 8416 (27%) OAR. The total OAR volume among training programs decreased by 38% during the study period, from a median of 29.1 to 18.2 OAR. In 2014, 25% of programs performed fewer than 10 OARs annually. Among senior vascular surgery trainees, the median number of OAR decreased from 10.0 in 2010 to 6.4 in 2014 and approximately one-half of senior trainees had exposure to fewer than five OAR in 2014. ConclusionsExposure to OAR among vascular surgery training programs has dramatically decreased, with nearly one-half of senior trainees performing fewer than five OAR in 2014. The variable and diminishing OAR exposure among vascular surgery training program highlights growing concerns surrounding competence in complex open repairs and suggest that only a small proportion of current trainees have ample opportunity to develop confidence and proficiency in this high-risk operation.