Abstract
Background
Peripheral arterial occlusive disease constitutes a substantial portion of clinical
practice in vascular surgery and, as such, trainees must graduate with proficiency
in endovascular and open procedures to become capable vascular surgeons. Case volume
for 0+5 integrated vascular surgery residents in the chief and junior years was compared
with their 5+2 fellowship counterparts for the treatment of peripheral arterial occlusive
disease.
Methods
In this retrospective review, operative volume for peripheral arterial occlusive disease
cases in both vascular training paradigms was evaluated. “Surgeon chief” cases in
the final year of residency training, and “surgeon junior” cases for postgraduate
year 4 and below were gathered for the integrated vascular surgery residents group.
Annual fellow’s case volume was collected using cases logged as “surgeon fellow.”
Procedures were divided by the following anatomic region and compared: aortoiliac,
femoropopliteal, and infrapopliteal. Student’s t tests were used to assess these differences.
Results
An aggregate of 887 residents and fellows from 137 programs were identified. Vascular
surgery fellows consistently performed 1.7-fold (P < .001) and 1.6-fold (P < .001) more total peripheral cases than their integrated vascular surgery residents
chief and junior counterparts, respectively. They also performed 1.8-fold (P = .002) and 1.5-fold (P = .004) more peripheral endovascular cases than their 0+5 chief and junior counterparts
respectively. With respect to endovascular treatment of peripheral arterial occlusive
disease by subgroup, we found the overall volume of aortoiliac and femoropopliteal
increased, whereas infrapopliteal case volume decreased. Vascular surgery fellows
were performing many more of these cases per year than the integrated vascular surgery
residents chiefs and junior residents. When looking at 3 index open procedures, aortobifemoral
bypass, femoropopliteal bypass with vein, and infrapopliteal bypass with vein in the
academic year 2017–2018, the vascular surgery fellow trainees performed more cases
than the integrated vascular surgery residents chief and junior residents.
Conclusion
Earlier studies have compared the operative volume of vascular surgery fellows and
integrated vascular surgery residents in their entire tenure of training. Our study
specifically evaluated the years of training that confer the greatest level of autonomy.
Vascular surgery fellows are performing more endovascular and open cases than their
0+5 counterparts for peripheral arterial occlusive disease during the final phase
of training. These findings suggest that current suspected equipoise of vascular surgery
training paradigms may not reflect what is occurring in practice and therefore warrants
further investigation.
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Article info
Publication history
Published online: April 06, 2019
Accepted:
February 28,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial: Using Accreditation Council for Graduate Medical Education case logs to understand differences in vascular surgery training paradigmsSurgeryVol. 166Issue 2
- PreviewIn this retrospective review of Accreditation Council for Graduate Medical Education case logs from 2012 to 2018 collected from 887 vascular surgery residents and fellows from 137 programs. Phair et al1 document that vascular surgery fellows (VSFs) perform more open and endovascular (and total) lower extremity cases than integrated senior vascular surgery residents (IVSRs). This stands somewhat in contrast to earlier reports,2,3 that suggested that VSFs typically perform equal to or more open vascular cases, while vascular surgery residents tend to perform more endovascular cases in the totality of training, presumably because endovascular cases can be performed earlier in training.
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