Ann R Coll Surg Engl 2008; 90: 286-290 286The ability to assess one's own performance critically in surgery is a valuable trait for surgeons throughout training and independent practice. Unfortunately, this remains an underdeveloped skill in surgical training and receives little attention from surgical educators. For trainees, it allows identification of their strengths and, more importantly, weaknesses in their ability, to build upon previous performance and take the necessary remedial action. For surgeons in independent practice, the introduction of new surgical techniques necessitates focused self-assessment.Evidence for self-assessment in surgery is poor, compared self, peer and supervisor ratings with scores on the American Board of Surgery InTraining Examination (ABSITE). The results showed significant correlation between ratings by peers and supervisors (r = 0.92; P < 0.001). The average of peer and supervisor ratings showed a moderate correlation with ABSITE scores (r = 0.58; P < 0.01). Multivariate analysis suggested that supervisors were influenced mainly by the interpersonal skill of the resident and secondarily by their ability. Self-assessment was influenced mainly by the residents' perceptions of their own ability, followed by interpersonal skills and effort.
In 1958, the Union Européene des Médecins Spécialistes (UEMS), or European Union (EU) of Medical Specialists the European Union, was founded by the professional organizations of medical specialists in Europe. Among the objectives of the UEMS are to promote the highest level of patient care in the EU and to promote the harmonization of high-quality training programs within the various specialities throughout the EU. Within the 38 Specialist Sections of the UEMS are the European Boards, which are the working groups of the Specialist Sections. In 2005 Vascular Surgery was recognized as a separate and independent Section, a monospecialty, within the UEMS. The efforts of the UEMS are directed at facilitating the free exchange of training and work of trainees and medical specialists between EU countries. This situation, in combination with large differences in requirements and length of training in vascular surgery within the EU, stresses the importance of harmonization in training and certification in vascular surgery within the EU. For that reason, the European Board of Vascular Surgery has organized voluntary examinations yearly since 1996. The candidates who pass qualify as "Fellow of the European Board of Vascular Surgery" (FEBVS) since 2005. The first part of the examination evaluates the eligibility of the candidate (Certificate of Completion of Specialist Training, training center, logbook). The second part is a viva voce assessment that includes (1) case analyses, (2) a review of a scientific article, (3) an overall assessment, (4) a technical skills, and (5) an endovascular skills assessment. To pass the examination, the candidates must achieve a 67% success rate in each part of the examination. During the last 10 years, approximately 75% of the candidates have successfully taken the examination. In the near future the Section and Board, in close collaboration with the vascular societies in the EU, will develop a European vascular surgical syllabus and curriculum that will further harmonize and professionalize the training and certification of vascular surgery in Europe.
In European countries with VS as an independent specialty, vascular surgeons have a shorter total training period but spend more time in VS training, although they may not undertake a greater proportion of the endovascular procedures their countries appear to have adopted endovascular technologies more rapidly compared to the ones with non-independent VS curricula. Whether such differences influence patient outcomes requires investigation in future studies.
The SVR has enabled us to understand the development and implementation of vascular surgery throughout Spain and to note the increased healthcare activity and the better overall results obtained as a consequence.
The important thing is not to stop questioning. Curiosity has its own reason for existence" e Albert Einstein Two recent articles in EJVES deal with the role of compression after radiofrequency venous ablation (RFA): the first one was published in January and the second in the current issue. In Pihlaja et al.'s 1 paper 177 patients were included, 90 on compression, showing that noncompression was non-inferior to compression therapy in terms of safety and efficacy. Also, Onwudike et al.'s 2 paper after comparing 51 patients on compression to 48 on noncompression achieved the following conclusion "compression post RFA adds no clinical benefit". Therefore, both challenged the standard use of compression after RFA, even combined with foam sclerotherapy. This has long been the standard of care, based on practice after venous stripping, although it was never confirmed for RFA. Houtermans-Auckel was a pioneer in questioning the value of compression after stripping. 3 In his paper, three days of bandage after surgery resulted in the same outcome compared with longer compression. Later, Krasznai et al.' 4 reduced the time to only four hours being non-inferior to three days in preventing leg oedema after stripping. Many other publications introduced doubts on the benefit of compression. The European guidelines 5 recommendation concludes that post-procedural compression is appropriate after superficial venous surgery, endovenous truncal ablation, and sclerosis, with class 1 level A evidence. Consequently, if non-compression after thermal venous ablation is non-inferior to compression therapy, should the guidelines be modified? Based on the two studies, the answer is weakly positive, but it can be argued that more data are needed before guidelines are changed. Studies should include a representative cross section of patients: Chronic venous insufficiency (CVI) of legs affects up to 40%e60% of the adult population in the Western world. Most risk factors such as body mass index, family history, thrombophlebitis, higher C class, and absence of regular of exercise, amongst others that correlate with higher degree of CVI, are absent in most studies. Thus, Pilhlaja excludes 40% and Onwidke 45% of patients with risk factors. Therefore, doubts remain regarding the value of
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.