Young Vascular Surgeons Research Articles

Evaluation of a web-based surgical training approach and insights from the Distal Bypass Competition 2021 using a simulator kit

ObjectiveThe study aimed to assess a novel web-based surgical training approach among young vascular surgeons and validate web-based evaluation methods for assessing anastomosis skills through the online Distal Bypass Competition (DBC). MethodsThe OSATS was used to assess anastomosis proficiency using a simulator among 42 participants (17 junior and 25 senior surgeons) in the DBC 2021. An initial evaluation of basic anastomosis skills was conducted via recorded videos, comparing OSATS scores with instructor-derived impression-based scores (Comprehensive Evaluation Score [CES]) during the nomination round. Real-time evaluations conducted over Zoom focused on assessing technical and composition scores of the anastomoses to determine finalists. The ice-skating method addresses potential variability among judges by excluding the highest and lowest scores for each procedural element from the final evaluation. This method, demonstrated in real time, provides trainees with valuable feedback on which movements are highly rated, enhancing the educational impact. Evaluation criteria included precision in needlework, external appearance, handling of the intima, and internal morphology of the anastomosis. Furthermore, voluntary survey questionnaires were administered to gather participant feedback on their experience with DBC 2021. ResultsThe OSATS was associated with a lower coefficient of variation (CV) than was the CES (0.19 ± 0.07 vs 0.24 ± 0.09) (P = .01) with regard to the evaluation of basic anastomotic skills in the nomination round. Interestingly, there was no significant difference in CV between the Procedural Element Score based on OSATS and CES in the senior class (0.16 ± 0.06 vs 0.22 ± 0.09) (P = .13), but a significant difference was particularly evident in the junior class (0.12 ± 0.07 vs 0.27 ± 09) (P = .03). Lower scores were associated with higher CVs in both classes, but the OSATS improved the CV among participants who had inadequate anastomosis skills. In real-time evaluation, composition scores exhibited higher CVs compared with technical scores, even among high-scoring participants. Notably, the internal morphology of the anastomosis had the largest CV in the composition scores. The ice-skating method decreased the CV as compared with the original data evaluated using the OSATS (0.15 ± 0.04 vs 0.09 ± 0.02 for the technical score [P < .01] and .18 ± 1.00 vs 0.07 ± 0.05 for the composition score [P = .03]); accordingly, the ice-skating method was more conducive to objective, real-time evaluation. The results of the post-DBC survey indicated that 89% of participants reported increased training time, and one-half of these participants indicated that their confidence in their clinical skills related to this procedure increased owing to the process of training for the DBC. ConclusionsThe OSATS yielded more detailed evaluations of anastomosis skill with a lower variability compared with the instructor's impression-based evaluation in this web-based training. Real-time evaluation methods, such as the ice-skating method, have proven to be valuable tools for the standardized assessment of web-based surgical education.

Outcome of a dedicated complex aortic surgery fellowship program.

Advancements in endovascular therapy, especially in complex aortic procedures, underscore the need for additional post-certification training. Dedicated post-residency vascular fellowship programs offer exposure to diverse cases, research opportunities, and professional networking. The study aims to describe and present outcomes from the complex aortic fellowship program at the Vascular Surgery Department of the Uppsala University Hospital. Nine former fellows who completed the aortic fellowship program at the Uppsala University Hospital from 2018 to 2023 were invited to take part in an anonymous 29-question survey through email. Demographic data, information about the existence of local aortic programs as well as on the types of aortic procedures performed were gained. The overall experience and impact of the fellowship were assessed using multiple interval scale questions, with a rating scale (1 excellent to 5 very poor). Finally, we provided the option to the participants to share additional feedback. Median age of participants was 34 years (IQR, 30.5-36), with 44.4% being women (4/9). There was a significant variation in the number of publications produced during the fellowship, with an overall mean of 4 papers (IQR, 2-10). Regarding the long-term impact of the fellowship, 5/9 (55.6%) of the fellows have contributed to the implementation of a complex aortic program after finishing the fellowship, providing a broad range of complex aortic procedures. All fellows (9/9, 100%) stated that the quality of the fellowship was excellent. The clinical experience 7/9 (77.8%), the academic environment 7/9 (77.8%) and the research opportunities 7/9 (77.8%) together with the mentorship 9/9 (100%) and the work environment 8/9 (88.9%), were considered of most value among the fellows. In general, the survey participants agreed that the fellowship atmosphere was suitable for learning, 9/9 (100%), and that it had a positive impact on their current practice, 7/9 (77.8%). Currently, 5/9 (55.5%) of the fellows hold a position including academic involvement. There is a universal need for additional post-certification training. The current study showed that a balanced clinical and scientific exposure to complex aortic diseases is broadly welcomed among young vascular surgeons. The extension of the fellowship to cover other disciplines dealing with complex aortic procedures can be of value.

The value of mentorship to the young vascular surgeon

Mentorship is a cornerstone of a successful career in medicine and surgery. From medical school through our career, the opportunity to receive feedback, guidance, and support from mentors helps to shape our decisions, both clinical and professional, plays a role in our success. As vascular surgeons pivot from trainee to practicing surgeon, the nature and structure of their mentoring relationship will likely change as well. The purpose of this article was to outline the different types of mentoring, the ways in which it can be impactful in your career, and common barriers encountered among both mentors and mentees. We review the data that support the value of mentors to young vascular surgeons and offer resources available to individuals from the trainee to midcareer levels to make for lasting and productive mentor-mentee relationships.

Professionalism in (vascular) surgery: What does it mean?

A publication in the August 2020 issue of the Journal of Vascular Surgery, “Prevalence of unprofessional social media content among young vascular surgeons,” brought the concept of professionalism in the vascular surgery community to the forefront. In response to the methodology used in the article, and the definitions of professionalism, a global backlash from health care providers and lay people ensued. The article has since been retracted; however, its publication highlighted the need to reexamine current definitions and philosophies surrounding professionalism in medicine and surgery that may be discriminatory and exclusive. The term professionalism has no standard definition as evidenced by varying definitions among different societies and organizations. The lack of a structured, universally accepted definition of professionalism in the medical and surgical communities has resulted in no standard by which to measure the actions of physicians and surgeons. The definition of professionalism need not be complex and should not vary among specialties and societies. In its most simplistic form, the core definition of “professionalism” embedded in the volumes of publications, guidelines, and charters that exist on the subject of professionalism in medicine is respect. We propose a tiered approach to define professionalism in medicine that builds on fundamental principles of respect and inclusivity, and includes actionable steps at three levels: (1) individual, (2) organizational, and (3) societal. Through this approach, any physician, regardless of specialty, practice type or location, can apply these concepts to ensure they consistently embody what it means to be “professional.”

RETRACTED: Prevalence of unprofessional social media content among young vascular surgeons

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the authors, the Editor-in-Chief and the Senior Editor of the Journal of Vascular Surgery. This article has been retracted in accordance with the Committee on Publication Ethics (COPE) Retraction Guidelines because the authors did not have permission to use the Association of Program Directors in Vascular Surgery (APDVS) directory of program directors and trainees to conduct research. In addition, the methodology, analysis and conclusions of this article were based on published but not validated criteria, judging a series of behaviors including attire, alcohol consumption, controversial political and religious comments like abortion or gun control, in which significant conscious and unconscious biases were pervasive. The methodology was in part predicated on highly subjective assessments of professionalism based on antiquated norms and a predominantly male authorship supervised the assessments made by junior, male students and trainees. The authors did not identify biases in the methodology, i.e., judging public social media posts of women wearing bikinis on off-hours as “potentially unprofessional”. The goal of professionalism in medicine is to help ensure trust among patients, colleagues and hospital staff. However, professionalism has historically been defined by and for white, heterosexual men and does not always speak to the diversity of our workforce or our patients. The Editors deeply regret the failures in the Journal’s peer review process which allowed this paper to be published. The Editors and the review process failed to identify errors in the design of the study, to detect unauthorized use of the data, and to recognize the conscious and unconscious biases plaguing the methodology. For this, we express our most sincere apology.

Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons

Past surveys demonstrated that a significant number of patients thought that social media content would affect their choice of physician, hospital, or medical facility. Our goal was to evaluate the extent of unprofessional social media content among recent vascular surgery fellows and residents. The Association of Program Directors in Vascular Surgery directory was used to compile a list of the vascular trainees from 2016 to 2018. Neutral Facebook, Twitter, and Instagram accounts were searched for public information. All content was screened by two separate investigators for predetermined material categorized as either unprofessional or potentially objectionable. Unprofessional content included Health Insurance Portability and Accountability Act violations, appearing intoxicated, unlawful behavior, possession of drugs or drug paraphernalia, and uncensored profanity or offensive comments about colleagues and work or patients. Potentially objectionable content included holding or consuming alcohol, inappropriate attire, censored profanity, controversial political or religious comments, and controversial social topics. Evaluation of 480 vascular trainees revealed that 325 (68%) were male, 456 (95%) held MD degrees, and 115 (24%) were integrated 0 + 5 residents; 61 (30%) account holders had either unprofessional or potentially objectionable content, with 8 (3.4%) containing content categorized as unprofessional. The only forms of unprofessional content identified were obvious alcohol intoxication in three Facebook accounts and uncensored profanity or offensive comments about colleagues and work or patients in one Facebook and five Twitter accounts. Potentially objectionable content included holding or consuming alcohol (12.3%), controversial political comments (9.4%), inappropriate or offensive attire (3.8%), censored profanity (3.4%), controversial social topics (2.5%), and controversial religious comments (0.9%). There was no significant difference in objectionable content between sex, training (MD vs non-MD), or track (0 + 5 or 5 + 2; all P > .05). However, there was more unprofessional or potentially objectionable content for those who self-identified as vascular surgeons (33% vs 17%; P = .007). Half of recent and current vascular trainees had an identifiable social media account, with nearly a third of these containing unprofessional or potentially objectionable content. Account holders who self-identified as vascular surgeons were more likely to be associated with objectionable social media behavior. Young surgeons should be aware of the permanent public exposure of potentially objectionable content that can be accessed by peers, patients, and current or future employers.

PC012. Surgical Training of Young Vascular Surgeons for Open Abdominal Aortic Aneurysm Repair Considering the Learning Curve

PC012. Surgical Training of Young Vascular Surgeons for Open Abdominal Aortic Aneurysm Repair Considering the Learning Curve

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.

"EVAR First" also in "Fit-for-Open-Repair" Patients? - 'CON' Statement

Our own long-term results and the numerous published data from the literature indicate that after open surgery or endovascular treatment, there is no significant difference with regard to morbidity and lethality in the early and long-term postoperative outcome of patients with low comorbidity ("low-risk" patients or patients "fit for open repair"). The advantage of endovascular aneurysmatic "repair" (EVAR) is revealed only in risk patients resulting in the fact that patient selection has a decisive role for the prognosis. Typical EVAR-associated complications such as late ruptures and secondary conversions, the re-intervention rate post-EVAR between 20 and 30 % as well as the appropriate training of young vascular surgeons favour a not too stringent limitation, i.e., preservation of open abdominal aneurysm surgery in suitable patients and indications.

Critical issues in vascular surgery: Education in Brazil

Vascular surgery practice and education vary widely across the globe. In Brazil, the largest and most populated country of South America, vascular surgery is an independent specialty, with >3000 practicing specialists. Vascular surgery education in Brazil consists of 6 years of medical school, followed by a 4-year residency in vascular surgery. Endovascular surgery training is provided by part-time mini-fellowships after a residency program has been completed. The author of this report, who represents the Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) or Brazilian Society of Angiology and Vascular Surgery, presents the critical issues in vascular surgery education in Brazil. An informal survey was conducted among residency program directors and members of the SBACV National Board to identify the critical issues in vascular surgical education in Brazil. The 25 responders pointed to two issues as the most critical. The first is funding for vascular surgical education. Currently, 73 vascular residency programs are accredited, with 142 first-year positions and 288 residents in training. Vascular surgery residents are paid a meager stipend, but instructors receive no pay. Endovascular fellows have to pay for their training. This has led to endovascular training being financed by the industry, despite the potential conflicts of interest created by this situation. The second critical issue is endovascular surgery training. The vascular surgical community in Brazil faces the huge task of how to offer training in endovascular techniques to the 140 or so young vascular surgeons coming out of residency programs every year, as well as how to teach endovascular techniques to several hundred certified vascular surgeons already in practice. Funding vascular surgery educational programs and training surgeons in the new endovascular techniques are the critical issues faced by vascular surgical educators in Brazil.

Education in vascular surgery: Critical issues in India

The first department of vascular surgery in India was established in 1978, and the first training course in peripheral vascular surgery was started in 1985. Despite this, vascular surgery has been slow to develop in India. The widespread misconception that vascular diseases are uncommon and that the result of vascular reconstruction is poor has resulted in vascular surgery not being popular among the medical students. Only 10 medical colleges have dedicated vascular surgical departments; hence, most students do not have enough knowledge about vascular diseases and the treatment options. This lack of awareness has resulted in a delay in diagnosis of vascular problems that results in poor outcome. At present there are only seven training centers for vascular surgery, training 12 students every year. Students receive adequate training in open surgical procedures, but endovascular training is still inadequate. Endovascular treatment has not picked up because of the expense and nonavailability of catheterization laboratories to vascular surgeons. The Vascular Society of India (VSI) has proposed to correct these problems by starting more training centers in private hospitals, starting vascular services in different parts of the country, conducting a nationwide awareness campaign, and conducting more continuing medical education programs and workshops for the general surgical trainees. VSI has been conducting endovascular workshops for the vascular trainees and has arranged for fellowships abroad in reputed vascular units. VSI is looking forward to having active interaction with World Federation of Vascular Societies to create more training opportunities for the young vascular surgeons.

Research and emergence of the Lifeline Foundation

Research and emergence of the Lifeline Foundation

The E. J. Wylie Traveling Fellowship

In 1987 a Traveling Fellowship named after Dr. E. Jack Wylie was established by the Society (Fig. 1). Dr. Edwin Jack Wylie was born in Cincinnati, Ohio, into a medical family on October 13, 1918. His father was a general practitioner who later specialized in pediatrics and practiced in San Bernardino, Calif. Dr. Wylie went to Pomona College where he became Phi Beta Kappa and, at graduation in 1939, received the Kneeland Prize in debate. He followed in his father's footsteps and studied medicine. He graduated from Harvard Medical School in the Class of 1943-A. Dr. Wylie completed his internship in surgery at New York/Cornell Medical Center and was accepted into the General Surgery Residency at the University of California, San Francisco (UCSF), where he trained under H. Glenn Bell, MD, professor and chairman, between June 1944 and September 1948. During his residency he studied with Dr. Norman Freeman, "the country's first vascular surgeon to confine his professional life to vascular surgery," who was the chief of the Vascular Surgery Clinic. Dr. Wylie was stimulated by Dr. Freeman's teachings, and, because there were no formal training opportunities available at the end of his residency, he practiced vascular surgery briefly with Dr. Freeman. Dr. Wylie then established an independent private vascular surgery practice in San Francisco, with a medical school affiliation at UCSF. Dr. Wylie's pioneering and perhaps most significant contribution was performing the first aortoiliac endarterectomy in the United States in 1951. He returned to UCSF after his discharge from the army and spent his career as an academic surgeon, rising to the rank of full professor in 1967 and vice-chairman of the department, titles that he held until his death in 1982. Dr. Wylie died after a full operating day on September 2, 1982. He was 6 weeks short of his sixty-fourth birthday. At his memorial service, his

Vascular surgery in the united kingdom

An encouraging feature of the last 10 years in the U.K. (population 57.5 millions) has been the emergence of a corps of young vascular surgeons and interventional radiologists into the mainstream of clinical practice in district hospitals. There are now 500 consultant members of the national vascular surgical societ~ and the great majority are general surgeons with a specialist interest in vascular surgery. Advertisements for surgical and radiological vacancies in the medical press have lately been dominated by these appointments, and this new specialist cadre is a potent force for local change in operating departments, radiology suites and intensive therapy units. The benefits of vascular interventions to the community are felt at grassroots level by patients, family doctors and by local healthcare purchasers. As an example, the surgical service needs of the south west of England, which has a population of 3.5 millions, are met by a teaching hospital in Bristol and 12 district hospitals. There are 66 general surgeons of whom no less than 24 (36%) have a vascular interest and three quarters of all arterial operations in the region are done in district hospitals.

Research and research funding in vascular surgery

The presentation summarized the current status of funding available for vascular surgeons. In spite of the shrinking support for research by the federal government, there are opportunities for young investigators to pursue an academic career. Success of a grant application depends on preparation, design, and hypothesis. Potential applicants are encouraged to pay special attention to the many publications on how to prepare a research grant.12–17 Although there is an increase in participation by vascular surgeons in NIH-supported research, the funding support and focus on vascular surgery remains unsatisfactory. Despite the high ranking of death from aortic aneurysm, there is virtually no funded project on aortic aneurysm in either basic or clinical study. New technology such as laser has received some support, but clinical trial comparing this modality with standard treatment is lacking and not forthcoming. The participation by vascular surgeons in the American Heart Association-funded research activities remains unknown, even though the American Heart Association claims to have spent millions on research in heart and vascular diseases. To promote the study of and research in vascular disease, the members of this distinguished Society need to guide young vascular surgeons to submit grant proposals to various organizations.