Vascular Surgery Training Research Articles

Collaborative simulation rotation with integrated cardiothoracic and vascular surgery junior residents accelerates technical skill progression

ObjectiveIntegrated cardiothoracic surgery (CTS) and vascular surgery (VS) residents must achieve operative independence in fewer years compared with residents in traditional training paradigms. Developing a strong foundation early in training from which to build technical skills is of paramount importance. We hypothesized that intensive simulation performed by CTS and VS junior residents would accelerate technical skill progression and improve confidence. MethodsIn July 2021, 7 post-graduate year (PGY)-1 and 5 PGY-2 residents from integrated CTS and VS programs at a single institution participated in a collaborative simulation rotation. Training included low-fidelity vascular anastomoses, high-fidelity cadaver operative simulation, and core surgical tasks. Residents rated confidence levels before and after training. Performance during end-to-end and end-to-side vascular anastomoses (pre- and post-simulation) were evaluated for: respect for tissue, time and motion, needle handling, needle angles, and knot tying. ResultsEnd-to-end anastomosis scores increased from 10.4 to 19 (p < .001); completion times reduced from 10.8 to 8.7 min (p = .02). End-to-side anastomosis scores increased from 11.4 to 14.6 (p < .001); completion time was unchanged at 8.8 vs. 8.9 min. Trainee confidence level increased for these core tasks: knot tying (3.4 vs 4.1, p = .03), end-to-end anastomosis (2.1 vs 3.6, p < .01), end-to-side anastomosis (1.9 vs 3.3, p < .01), Castroviejo needle driver handling (2.7 vs 3.8, p < .01), ultrasound guided vascular access (2.4 vs 3.5, p = .01), bronchoscopy (1.8 vs 3.1, p = .01), and chest tube placement (1.9 vs 3.1, p < .01). ConclusionsDedicated collaborative simulation focusing on technical skills relevant to both CTS and VS trainees accelerates skills progression and increases resident confidence.

Predicting Performance at Graduation From Early ACGME Milestone Ratings: Longitudinal Learning Analytics in Professionalism and Communication in Vascular Surgery

Program directors in surgical disciplines need more tools from the ACGME to help them use Milestone ratings to improve trainees' performance. This is especially true in competencies that are notoriously difficult to measure, such as professionalism (PROF) and interpersonal and communication skills (ICS). It is now widely understood that skills in these two areas have direct impact on patient care outcomes. This study investigated the potential for generating early predictors of final Milestone ratings within the PROF and ICS competency categories. This retrospective cohort study utilized Milestone ratings from all ACGME-accredited vascular surgery training programs, covering residents and fellows who completed training in June 2019. The outcome measure studied was the rate of achieving the recommended graduation target of Milestone Level 4 (possible range: 1-5), while the predictors were the Milestone ratings attained at earlier stages of training. Predictive probability values (PPVs) were calculated for each of the 3 PROF and two ICS sub-competencies to estimate the probability of trainees not reaching the recommended graduation target based on their previous Milestone ratings. All ACGME-accredited vascular surgery training programs within the United States. All trainees completing a 2 year vascular surgery fellowship (VSF) in June 2019 (n = 119) or a 5 year integrated vascular surgery residency (IVSR) in June 2019 (n = 52) were included in the analyses. The overall rate of failing to achieve the recommended graduation target across all PROF and ICS sub-competencies ranged from 7.7% to 21.8% of all trainees. For trainees with a Milestone rating at ≤ 2.5 with 1 year remaining in their training program, the predictive probability of not achieving the recommended graduation target ranged from 37.0% to 71.5% across sub-competencies, with the highest risks observed under PROF for "Administrative Tasks" (71.5%) and under ICS for "Communication with the Healthcare Team" (56.7%). As many as 1 in 4 vascular surgery trainees did not achieve the ACGME vascular surgery Milestones targets for graduation in at least one of the PROF and ICS sub-competencies. Biannual ACGME Milestone assessment ratings of PROF and ICS during early training can be used to predict achievement of competency targets at time of graduation. Early clues to problems in PROF and ICS enable programs to address potential deficits early in training to ensure competency in these essential non-technical skills prior to entering unsupervised practice.

A Survey of Vascular Surgery Program Directors: Perspectives following USMLE Step 1 Conversion to Pass/Fail and Virtual Only Interviews

Step 1 of the United States Medical Licensing Examination (USMLE), a historically important factor in the selection of vascular surgery residents and fellows, transitioned to completely pass/fail on January 26, 2022. Due to the COVID-19 pandemic, residency and fellowship interviews were conducted virtually during the 2020-21 and 2021-22 application cycles. Given these significant changes in the evaluation of candidates for residency training, we sought to understand vascular surgery program directors' (PDs) perspectives regarding the change in step 1 scoring and use of virtual interviews as well as determine which factors will assume importance when applying to vascular surgery training programs in the future. A 26-item survey questionnaire was created using Qualtrics survey tools with questions regarding attitudes toward the change in step 1 scoring and virtual interviews, the importance of additional factors utilized by programs in selecting candidates for interviews and ranking applicants for residency/fellowship selection, and programmatic demographics. This was distributed anonymously to all vascular surgery training programs over a 2-week period using a comprehensive list of 249 unique email addresses created by cross-referencing the Accreditation Council for Graduate Medical Education list of certified vascular training programs with email addresses from individual program websites identifying current program leadership. Responses were analyzed with descriptive statistics with values listed as average Likert scale weight±standard deviation (SD) or percentages. Sixty-eight of 249 (27.3%) program and associate PDs responded to the survey. Of which, 33.9% of respondents strongly disagreed with step 1 going completely pass/fail. In the absence of a scored USMLE step 1, letters of recommendation (average Likert scale weight±SD, 4.43±0.92), dedication to specialty (4.14±1.03), and USMLE step 2 CK (4.06±0.92) had the highest average scores for deciding which applicants to interview for integrated vascular surgery residency. For determining which candidates to interview for vascular surgery fellowship, letters of recommendation (4.51±0.84), dedication to specialty (4.12±0.90), and research (4.10±0.80) had the highest average scores. For ranking residency candidates, the interviewee's perceived "fit" (4.61±0.55), letters of recommendation (4.53±0.76), and an overall interview experience (4.47±0.62) had the highest average scores. Similarly, the factors with the highest average Likert scores for ranking fellowship candidates included the interviewee's perceived "fit" (4.69±0.51), letters of recommendation (4.65±0.52), and an overall interview experience (4.51±0.59). The majority (72.2%) of PDs preferred in-person interviews; however, 50% of respondents were at least "somewhat satisfied" with virtual interviews during the 2021-22 application cycle as they could judge applicants' interview skills at least "moderately well." The minority (18.8%) who preferred virtual interviews most commonly noted a "reduction of the financial burden for applicants" as the reason for this preference. Most vascular surgery program and associate PDs were dissatisfied with USMLE step 1 going pass/fail with most indicating prescreening applicants using both step 1 and step 2 clinical knowledge (CK) during the residency and fellowship selection processes. In the absence of a scored step 1, the top factors for interviewing and ranking integrated vascular surgery residency and fellowship candidates included letters of recommendation, dedication to specialty, research, USMLE step 2 CK, the interviewee's perceived "fit," and overall interview experience. Though most PDs preferred face-to-face interviews, they were overall at least "somewhat satisfied" with the virtual format that took place during the 2021-22 cycle.

The motivators and barriers to a career in cardiothoracic surgery: a cross-sectional study among surgical residents in India.

A consistent decline in the number of applicants to cardiothoracic and vascular surgery (CTVS) training programs has been observed across the country over the last few years. This disenchantment with the speciality will lead to a shortage of trained CTVS surgeons at a time when incidence of cardiovascular diseases is continuously rising in India. The aim of the study was to reflect on the reasons that averted applicants from pursuing a career in CTVS and measures that would make CTVS a more attractive option to future applicants. An online nationwide prospective cross-sectional survey was conducted. The participants were from a pool of general surgery residents/residents who had just completed the training. A 5-point Likert scale was utilized to rate and evaluate the factors influencing CTVS as the primary choice, factors influencing any super-speciality, and factors that would aid in decision-making and encourage an interest in CTVS. A total of 618 responses were obtained, 25.6% (N = 158) of the responses were from female residents. Only 10.7% (N = 66) of the respondents wanted to pursue CTVS as their primary choice. While interest in CTVS among the 1st year residents was 26%, it was further observed to decline to 18.72% after completion of training. The main disincentives for pursuing CTVS were the need for a hospital with required infrastructure and the dependence on a multi-disciplinary team. The perception of the participants that the cardiologist will take over CTVS procedures was another misguided but important factor. Those residents interested in pursuing CTVS identified the dynamic nature of the speciality as well as the thrills of being a cardiac surgeon as important motivators. Participants felt that adding catheter-based technology to the CTVS curriculum, mandatory CTVS rotation during surgical training, and closer interaction with CTVS residents will generate more interest in CTVS. Although surgical residents report early interest in CTVS, a lack of adequate exposure to the speciality leads to a decline in interest in CTVS. An overhaul of the surgical training that mandates rotating to CTVS, increased interactions with medical students and surgical trainees by CTVS faculty, and incorporation of catheter-based training in the CTVS syllabus is urgently required to increase the number of applicants to CTVS. The online version contains supplementary material available at 10.1007/s12055-022-01406-2.

We have built it, and they are coming

As Dr Davies and his colleagues have shown in their excellent review,1 there is growing evidence that recruitment measures, such as mentorship and simulation, effectively increase medical student interest in vascular surgery. Still, more studies are needed in this crucial undertaking. Active, coordinated efforts to inspire surgical residents and medical students to pursue training in vascular surgery are relatively new endeavors. Dr Anton Sidawy predicted this need in his 2003 Presidential address to the Eastern Vascular Society,2 also noting, “Although women represent 50% of the available talent in the graduating medical school class, only 9.6% of active vascular fellows in the academic year 2001 to 2002 were women…” Dr Sidawy’s words were prescient; from 2004 to 2006, three consecutive disastrous matches followed.

Competency in trauma surgery: a national survey of trainees and consultants

BackgroundThe current sparsity of surgical trainees’ exposure to training in operative trauma surgery is multifactorial. This concern has been addressed in the revised Intercollegiate Surgical Curriculum Programme (ISCP) for general and vascular surgery (2021). In the lead up to its implementation, we aimed to assess both trainee and consultant confidence levels as a surrogate reflection in the core competency operative skills in general emergency trauma surgery, identify individual experience in commonly performed trauma procedures and gauge interest in a career in trauma surgery.MethodAn online survey was circulated to general surgery and vascular surgery trainees and consultants. Self-reported competencies were assessed using a 1–10 confidence rating scale. Most questions were based on competencies in emergency trauma surgery as set out by the ISCP.ResultsOut of 251 surgical trainees and consultants, 119 responded to our survey (47.4% response rate). Less than half (44.1%; n = 52) of respondents had experienced a trauma thoracotomy. Respondents scored ‘somewhat’ or ‘not at all’ competent in the majority of competencies assessed.ConclusionSelf-reported competencies in operative trauma skills across all subgroups were sub-standard with incremental levels of perceived competence proportional to years of surgical training. Our data supports the necessity of the new curriculum, in addition to modern training pathways with direct exposure to operative trauma surgery involving dedicated trauma centres and networks, and responsibility of training pathways in the provision of training trauma surgery.

Endovascular infrarenal aortic aneurysm repair: Perhaps we've gone about it all wrong

Endovascular infrarenal aortic aneurysm repair: Perhaps we've gone about it all wrong

The true length of training in vascular surgery

INTRODUCTION Workforce planning in vascular surgery remains challenging since there are no data on career path intentions of trainees. The Rouleaux Club, which is the UK vascular trainee association, undertook a snapshot survey of the vascular surgery trainee workforce to help guide the allocation of the future vascular surgery workforce. METHODS An anonymous survey was sent to national training number (NTN) and non-NTN vascular surgery trainees. The survey was open for four weeks from 26 September to 23 October 2020. Data were analysed by two Rouleaux Club executive committee members using Microsoft Excel®. RESULTS The survey was completed by 147 trainees (130 NTN and 17 non-NTN trainees). When taking into consideration time out of training and less than full-time training, the average predicted Certificate of Completion of Training date for NTN trainees is delayed by one year. Eleven per cent of NTN trainees had completed or were in less than full-time training at the time of the survey. Time out of training was taken by 75% and parental leave by 28%. Just under half (47%) of NTN trainees were planning on taking parental leave in the future. Over half (51%) of NTN trainees expected to retire aged between 61 and 65 years. CONCLUSIONS Our findings suggest that vascular surgery training is not a simple six-year higher surgical training experience and may vary considerably between individuals. Future vascular workforce planning needs to take these factors into consideration. Action must be taken now to recruit and retain the future workforce so that the demand for vascular surgeons can be met.

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

BackgroundWith 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.ObjectiveThe aim of this study is to evaluate the accessibility and availability of online content for those integrated residency programs.MethodsA list of accredited vascular surgery, thoracic surgery, and interventional radiology residencies was obtained from the Accreditation Council for Graduate Medical Education (ACGME) database. 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.ResultsOf 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=.12). Vascular surgery websites contained a median of 26 (IQR 20-32) content items, thoracic surgery websites contained a median of 27 (IQR 21-32) content items, and interventional radiology websites contained a median of 23 (IQR 18-27) content items. Two content items considered highly influential to applicant program decisions are procedural experience and faculty mentorship, which were reported at 32% (18/56) and 11% (6/56) for vascular surgery, 19% (5/27) and 11% (3/27) for thoracic surgery, and 50% (37/74) and 15% (11/74) for interventional radiology (P=.008 and P=.75), respectively. Key deficits were work hours, debt management, and curriculum for interventional radiology; resident profiles, sample contracts, and research interests in vascular surgery; and operative experiences and the program director’s contact and message for thoracic surgery. Interventional radiology deficits were work hours, and thoracic surgery deficits were procedural experience. Both interventional radiology and thoracic surgery websites lacked information on evaluation criteria and faculty mentorship.ConclusionsThis study has uncovered key differences in the 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 to attract valuable candidates.

Virtual Simulation of Intraoperative Decision-Making for Open Abdominal Aortic Aneurysm Repair: A Mixed Methods Analysis

Study designMulticenter simulation training using an explanatory sequential mixed methods study.Key findingsA total of 17 vascular and general surgery trainees and 6 vascular surgery faculty participated in an online virtual simulation of major decision making during open abdominal aortic aneurysm repair. Of the 23 participants, 93% reported feeling they were making real intraoperative decisions, 85% stated it had added to their knowledge base, and 96% requested additional simulations. Several themes emerged from the results of a questionnaire, including the benefits of virtual learning to standardize the training experience and how managing the unexpected as a trainee is an important part of surgical education growth.ConclusionOperative simulation training should focus on both technical skills and intraoperative decision-making, especially when encountering the unexpected. The learners' responses indicated that this virtual platform can allow for intraoperative decision-making practice in a remote learning environment.CommentaryThis study examined the value of simulated intraoperative decision-making, which tackles a problem that seems more amenable to virtual training. I still wonder whether performing one arteriovenous fistula anastomosis in a real patient would be more beneficial to a trainee than performing 10 virtual simulation anastomoses using a piece of plastic tubing. I question whether performing one open aortic anastomosis to an alternately calcified and friable aorta is more beneficial than performing 10 virtual simulation anastomoses in a model that reminded me of a rubber chicken when I participated in a session. I am still not sure that mandatory virtual simulation training is necessary or even advantageous for all vascular training centers, especially if the afternoon spent in a simulation training center performing an anastomosis to a plastic tube or rubber chicken means the trainee will miss participating in a couple of real cases with real patients.Nonetheless, the Association of Program Directors in Vascular Surgery and other vascular groups have emphasized the value of virtual simulation training for several years. The reality is that the level of experience has been decreasing, often to an unacceptable level, for performing certain open vascular operations, especially aortic surgery, among our trainees. The two most likely solutions for vascular trainees are simulation training or establishing centers of excellence, at which high-volume cases are performed and to which trainees can rotate.Take-home messageIn the past, I have urged caution about adopting vascular trainee learning strategies such as virtual simulation training or centers of excellence, but the future is now. Study designMulticenter simulation training using an explanatory sequential mixed methods study. Multicenter simulation training using an explanatory sequential mixed methods study. Key findingsA total of 17 vascular and general surgery trainees and 6 vascular surgery faculty participated in an online virtual simulation of major decision making during open abdominal aortic aneurysm repair. Of the 23 participants, 93% reported feeling they were making real intraoperative decisions, 85% stated it had added to their knowledge base, and 96% requested additional simulations. Several themes emerged from the results of a questionnaire, including the benefits of virtual learning to standardize the training experience and how managing the unexpected as a trainee is an important part of surgical education growth. A total of 17 vascular and general surgery trainees and 6 vascular surgery faculty participated in an online virtual simulation of major decision making during open abdominal aortic aneurysm repair. Of the 23 participants, 93% reported feeling they were making real intraoperative decisions, 85% stated it had added to their knowledge base, and 96% requested additional simulations. Several themes emerged from the results of a questionnaire, including the benefits of virtual learning to standardize the training experience and how managing the unexpected as a trainee is an important part of surgical education growth. ConclusionOperative simulation training should focus on both technical skills and intraoperative decision-making, especially when encountering the unexpected. The learners' responses indicated that this virtual platform can allow for intraoperative decision-making practice in a remote learning environment. Operative simulation training should focus on both technical skills and intraoperative decision-making, especially when encountering the unexpected. The learners' responses indicated that this virtual platform can allow for intraoperative decision-making practice in a remote learning environment.

Cadaver Simulation is Associated with Increased Comfort in Performing Open Vascular Surgery Among Integrated Vascular Surgery (0+5) Residents and Recent Graduates

With the evolution in vascular surgery toward increased endovascular therapy and decreased open surgical training, comfort with open procedures by current trainees is declining. A proposed method to improve this discomfort is simulator training. We hypothesized that open, cadaver, and endovascular surgery simulation would be associated with increased self-perceived comfort in performing corresponding procedures. Integrated (0+5) vascular surgery residents and recent graduates in the United States were asked to complete a survey quantifying comfort via a Likert scale with procedures and experience with simulation training. Simulation groups were then matched using coarsened exact matching. Ordinal logistic regression assessed the association between simulation experience and comfort in performing procedures. Surveys were completed by 68 trainees and 20 attending surgeons in their first 5years of practice. On unmatched analyses, there were no significant differences in comfort in performing any open or endovascular aorto-mesenteric or peripheral vascular procedures between respondents who reported experience with open or endovascular simulation, respectively. However, respondents who reported cadaver simulation experience (58%, 51/88) had a significantly higher reported comfort score performing open juxtarenal aortic repair (2.4 vs. 1.7), superior mesenteric artery thrombectomy or bypass (2.5 vs. 1.9), inferior vena cava or iliac vein repair (2.2 vs. 1.7), axillary-femoral artery bypass (3.4 vs. 2.5), femoral-popliteal artery bypass (3.7 vs. 2.8), and inframalleolar artery bypass (2.8 vs. 2.1; all P<0.05). After matching on training level, number of abdominal cases completed, and number of open vascular cases completed, ordinal logistic regression demonstrated that previous cadaver simulation was significantly associated with increased comfort in performing open aortic repairs, venous repair, visceral revascularization, and peripheral bypasses. In this nationally representative sample, cadaver, but not open or endovascular, simulation was associated with increased comfort in performing open vascular surgery. Providing cadaver simulation to trainees may help to improve comfort levels in performing open surgery. Integrated vascular surgery training programs should consider implementing these experiences into their curriculum.

Persistent Racial Discrimination Among Vascular Surgery Trainees Threatens Wellness

Racial discrimination is a common form of mistreatment and a known risk factor for physician burnout. This study aims to assess the frequencies and sources of specific racial discrimination behaviors among vascular surgery trainees.

Educational Shortage in Vascular Surgery: A 10-Year Analysis of Vascular Surgery Education Publications

As vascular surgery training has evolved to include integrated vascular surgery residency (0+5) programs, optimizing the education for vascular surgery trainees, both fellows and 0+5 residents, has become increasingly important. This study aimed to determine the prevalence and types of vascular surgery education publications across journals.

Defining Sources and Ramifications of Mistreatment Among Female Vascular Surgery Trainees

Defining Sources and Ramifications of Mistreatment Among Female Vascular Surgery Trainees

Attitudes Regarding Pregnancy Among Vascular Surgery Trainees and Program Directors Based on a Survey of Vascular Residents, Vascular Fellows, and the Association of Program Directors in Vascular Surgery.

Introduction: We conducted a survey of vascular surgery (VS) trainees and program directors (PDs) to examine differing attitudes regarding pregnancy, starting a family, and work-life balance. Methods: A 20 question survey was e-mailed to VS residents (0+5), fellows (5+2) and PDs using Survey Monkey Inc. (San Mateo, California). Results: The survey was sent to 781 participants (608 VS trainees, 173 PDs) with a similar response rate among residents [39% (133/343)), fellows [37% (98/265)], and PDs [38% (65/173)]. Of the 296 total respondents, most were male [61% (181)] and ≤40years old [81% (240)]. VS trainees and PDs believed their work load or scheduling-coverage issues significantly increased when a trainee or peer was pregnant [PDs = 73% (38/52); fellows = 66% (59/89); residents = 54% (38/71), 13 PDs, 7 fellows and 59 residents had never worked with a pregnant peer or trainee]. Male respondents overall were significantly more likely than females to opine that a pregnant vascular trainee or attending was less capable of performing her job while pregnant [28% (50/179) vs.16% (18/110); P = .024). Women overall reported each of the following factors more commonly than men as reasons for delaying childbearing: impairing professional advancement [42% (42/99) vs 14% (23/165); P < .001], limited time to devote to children [60% (59/99) vs 39% (64/165); P = .001], not wanting to burden peers or associates [36% (36/99) vs 13% (22/165); P < .001), extra stress [67% (66/99) vs 30% (50/165); P < .001], perceived negative view of peers and program directors towards pregnancy [29% (29/99) vs 1% (2/165); P < .001], and encouragement not to have children from peers or attending [15% (15/99) vs 2% (3/165); P < .001). More females than males overall regret their career choice in VS as it relates to starting a family [22% (24/107) vs. 12%; 21/170); P = .028]. When asked about the major barriers for female vascular surgeons who wanted to become pregnant, PDs cited an unsupportive home environment more than trainees [37% (24/65) vs 22% (51/231); P = .015], whereas trainees cited safety concerns affecting the pregnancy, such as radiation, more than PDs [71% (164/231) vs 43% (28/65); P < .001] Conclusions: There are significant differences in views toward pregnancy among males and females and among trainees and PDs overall. Contrasting gender-based perceptions of the impact of pregnancy on vascular training need to be addressed before adequate solutions to the challenge of work-life balance can be achieved. Significant opportunities exist for trainees and PDs to address these knowledge gaps.

Simulation-based training as a continuous means of vascular surgical education—a roadmap

Summary Background Simulation-based training has become an important part of the educational approach in many professions. Over the past decades it has slowly found recognition in the medical field and in surgery in particular. Research has clearly shown the advantages of learning and honing skills on simulators in safe environments, especially for junior doctors. For this purpose, a number of models and methods have been developed to enable open vascular surgery training. Methods Extensive research was performed for the development of simulation-based training for vascular surgery. Different types of models and techniques were investigated. Aspects of specific theoretical and practical means of education and training were considered. This initiated the development of a simulation center for open vascular surgery. Results Perfused simulators and necessary surgical instruments were acquired for open vascular surgery training at the Simulation Center of the Styrian state hospitals, located at the University Hospital, Graz Medical University, in Graz. A fully equipped mock operating room is available for simulation. In-house junior and senior doctors from the Department of Vascular Surgery have the monthly opportunity to perform simulation-based training. Courses for all state hospitals are planned twice per year. Conclusion Simulation-based training is a safe, efficient, and well-manageable possibility for improving the education of future experts in open vascular surgery. It can help hone simple skills such as suture techniques as well as prepare for complex surgical procedures. In time we hope to further integrate simulation-based training in the existing curriculum.

Systematic review of vascular surgery recruitment strategies for medical students and general surgery residents

ObjectivesRecruitment into the vascular surgery specialty is an imperative as the specialty faces significant demographic changes. Due to the changing dynamics in vascular surgery training pathways, we sought to review current literature on recruitment strategies and their effectiveness with medical students and general surgery residents. MethodsA systematic search, following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, was performed by searching MEDLINE, EMBASE, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Education Resources Information Center (ERIC) databases for studies on vascular surgery recruitment methods for medical students and general surgery residents from inception of databases to December 31, 2021. Reports in English discussing recruitment strategies were included. Reports lacking recruitment method data and those with insufficient data were excluded. ResultsTen reports met inclusion criteria and studied a total of 688 participants. Seven reports (70%) employed simulation, didactic, or online courses. The remaining 30% of studies included data on mentorship, research, or other interventions. Most of the studies (50%) reported data for medical students (MS1-MS4). Interventions specific to residents or both students and residents comprised the other 50% of studies. Simulation and didactic courses increased interest in vascular surgery by a median of 50% (interquartile range, 38%-64%) for both medical students and residents. Importantly, without reinforcement, interest was seen to decrease over time. ConclusionsRecruitment interventions are useful in increasing student interest in vascular surgery. Early exposure to simulated vascular surgery procedures and mentorship are cited as common reasons for entering the field. Further studies on recruitment strategies focused on long-term outcomes are required.

Virtual Simulation of Intra-operative Decision-Making for Open Abdominal Aortic Aneurysm Repair: A Mixed Methods Analysis

To create and pilot test a novel open abdominal aortic aneurysm (AAA) repair virtual simulation focused on intraoperative decision-making. To identify if the simulation replicated real-time intra-operative decision-making and discover how learners' respond to this type of simulation. An explanatory sequential mixed methods study. We developed a step-by-step outline of major intra-operative decision points within a standard open AAA repair. Perioperative and intraoperative decision-making trees were developed and coded into an online virtual simulation. The simulation was piloted. Quantitative data was collected from the simulation platform. We then performed a qualitative thematic analysis on feedback from interviewed participants. Four academic general and vascular surgical training programs across the US. Seventeen vascular and general surgery trainees and 6 vascular surgery faculty. Participants spent on average 27 minutes (range: 8-45 minutes) interacting with the interface. 93% of participants reported feeling they were making real intraoperative decisions. 85% said it added to their knowledge base. 96% requested additional simulations. 22 interviews were completed: 241 primary codes were collapsed into 21 parent codes, and 6 emerging themes identified. Themes included the benefit of how (1) "Virtual Learning Could Standardize the Training Experience"; how (2) "Dealing with the Unexpected" as a trainee is an important part of surgical education growth, and that this (3) "Choose Your Own Adventure" virtual format simulates this intraoperative growth experience. Participants requested a (4) "Looping Feature Feedback Diagram" for future simulation iterations and highlighted that (5) "Fancier is Not Necessarily More Educational." Finally, many trainees wondered about (6) "The Attending Impact" from the simulation: if faculty would notice a difference between trainees who did vs did not utilize the simulation for case preparation. Operative simulation training should focus on both technical skills and intra-operative decision-making, particularly "dealing with the unexpected." The learners' responses indicate that a low-fidelity, scalable, virtual platform can effectively deliver knowledge and allow for intra-operative decision-making practice in a remote learning environment.

Vascular trainee perceptions of diversity, equity, and inclusion within United States vascular surgery training programs

ObjectivesVascular surgery training programs face multiple pressures, including attracting and retaining trainees. Current knowledge of trainees’ views with respect to diversity and equity in vascular training programs is limited. We sought to understand United States vascular surgery trainees’ perceptions and expectations regarding diversity, equity, and inclusion (DEI). MethodsThe Association of Program Directors in Vascular Surgery designed and administered the Annual Training Survey to specifically address DEI and administered it to all trainees (Integrated Residents/Fellows; n = 637) at 122 institutions in August 2020. ResultsOf the 637 vascular trainees, 227 (35%) responded. The respondents included 115 male and 62 female trainees, with 50 not disclosing or not answering the question. The majority of respondents (96.9%) believed their programs incorporated a diverse background of trainees. Of the trainees, 89.8% felt that the faculty were similarly comprised of a diverse background. The majority of respondents (63.6%) felt that their training program was both more diverse and focused on inclusion compared with other training programs at their institution. However, 20% of respondents had experienced discrimination. Seventy-three percent (n = 143) of trainees felt empowered to disagree or engage in a discussion should they observe a faculty member make a disparaging remark about a patient’s background/race/gender, although 27% (n = 35) trainees expressed fear of retaliation as a reason to not engage. Trainees view their program director (82.6%), faculty mentor (60.9%), and Graduate Medical Education office (52.7%) as potential resources for support. Overall, 83.7% (n = 160) of trainees believe that their program has been open to discussion of race relations within the medical community. ConclusionsTrainees are committed to multifaceted diversity and inclusion. The perception of trainees regarding DEI issues within vascular surgery training programs appears to be positive; however, trainees did describe discrimination and gender biases in their institutions. This data has the potential to improve institutional education of faculty and trainees about the multidimensional levels of diversity and increased awareness and incorporation of this philosophy can assist in the recruitment of diverse vascular surgeons.

Recruitment & Retainment of Vascular Surgeons: Prophylactic Measures to Improve the Current Workforce Crisis

The vascular surgery workforce is in jeopardy with the current and increasing shortages. This study explores target populations for recruitment and aims to identify potential modifiable and nonmodifiable risk factors associated with reduced job satisfaction among practicing vascular surgeons to improve retention and prevent early retirement. A cross-sectional national survey of surgeons (n=1,043) was conducted from September 2016 to May 2017. Data included, demographic and occupational characteristics, as well as psychological, work-life balance, work-environment, and job-satisfaction variables. Surgeons were grouped into general surgery (n=507), obstetrics and gynecology (n=272), surgical subspecialties (n=212), and vascular surgery (n=52). Vascular surgeons were recategorized as more satisfied and less satisfied, and potential risk factors for job dissatisfaction were identified. As compared with general surgeons, obstetrics and gynecology, as well as other surgical subspecialties, vascular surgery tended to be male-dominated with higher rates of non-white, minority groups (P<0.05). Less vascular surgery respondents were found in the Midwest (P<0.001). Vascular surgeons worked more hours on average than other surgical fields and were less satisfied with work (P<0.05). Potential job dissatisfaction risk factors among vascular surgeons include: unhealthy work-life balance, poor camaraderie/coworker dissatisfaction, insufficient hospital support, hostile hospital culture, discontent with supervision, minimal patient diversity, dissatisfaction with work in general, and unhappiness with career choice (P<0.05). Recruiting new vascular surgery trainees while simultaneously preventing early retirement and attrition is critical to combatting the current workforce crisis. Potential interventions include (1) re-branding of the field with prioritization of work-life balance, (2) increasing hospital administration's support, (3) creating a collaborative work environment, and (4) facilitating personal accomplishment in work.