Association of Program Directors in Vascular Surgery (APDVS) survey of program selection, knowledge acquisition, and education provided as viewed by vascular trainees from two different training paradigms

Abstract

Methods of learning may differ between generations and even the level of training or the training paradigm, or both. To optimize education, it is important to optimize training designs, and the perspective of those being trained can aid in this quest. The Association of Program Directors in Vascular Surgery leadership sent a survey to all vascular surgical trainees (integrated [0/5], independent current and new graduates [5 + 2]) addressing various aspects of the educational experience. Of 412 surveys sent, 163 (∼40%) responded: 46 integrated, 96 fellows, and 21 graduates. The survey was completed by 52% of the integrated residents, 59% of the independent residents, and 20% of the graduates. When choosing a program for training, the integrated residents are most concerned with program atmosphere and the independent residents with total clinical volume. Concerns after training were thoracic and thoracoabdominal aneurysm procedures and business aspects: 40% to 50% integrated, and 60% fellows/graduates. Integrated trainees found periprocedural discussion the best feedback (79%), with 9% favoring written test review. Surgical training and vascular laboratory and venous training were judged "just right" by 87% and ∼71%, whereas business aspects needed more emphasis (65%-70%). Regarding the 80-hour workweek, 82% felt it prevented fatigue, and 24% thought it was detrimental to patient care. Independent program trainees also found periprocedural discussion the best feedback (71%), with 12% favoring written test review. Surgical training and vascular laboratory/venous training were "just right" by 87% and 60% to 70%, respectively, whereas business aspects needed more emphasis (∼65%-70%). Regarding the 80-hour workweek, 62% felt it was detrimental to patient care, and 42% felt it prevented fatigue. A supportive environment and adequate clinical volume will attract trainees to a program. For "an urgent need to know," the integrated trainees are especially turning to online texts rather than traditional textbooks, which suggests an opportunity for a shift in educational focus. Point-of-care is the best time for education and feedback, suggesting a continued need for dedicated faculty. The business side of training is underserved and should be addressed.

The first assessment of operative logs for traditional vascular fellowship track versus integrated vascular training programs

“…6 Applicants entering these programs tend to be top-tier medical students with similar interests and aspirations as vascular fellows due to an early exposure or mentorship in vascular surgery leading them to seek condensed and supportive environments for their training. [13][14][15] This paradigm shift has sparked a great deal of interest, but concern has been raised regarding the readiness of the 0þ5 trainee to practice vascular surgery upon graduation. According to a survey of 347 Society for Vascular Surgery members and surgical chairpersons, only 32% felt that a 0þ5 graduate would have the same degree of surgical maturity as those from 5þ2 programs.…”

Current issues and future directions for vascular surgery training from the results of the 2016-2017 and 2017-2018 Association of Program Directors in Vascular Surgery annual training survey

“…The annual training survey was sent to 1196 vascular surgery trainees, of which 367 responded, achieving a response rate of 30%, comparable to the survey response rate in previous years. 3 Of those respondents, 53% (n = 191) were integrated residents and 68% (n = 245) were male. The composition of 55% integrated residents (n = 97 and n = 94 in 2016–2017 and 2017–2018, respectively) and 45% fellows (n = 86 and n = 77, respectively) during each year of the survey reflects a composition similar to the recently published work by Janko and Smeds.…”

“…In addition, our respondents were 68% male, which is also comparable to recently published data (64% male) but represents a decrease from previously published APDVS survey results (77% male). 3,4 The median age in both years of the survey was 32 years. Of the respondents, 37% endorsed advanced degrees (beyond a doctor of medicine), and 11% relayed intention to pursue an advanced degree.…”

“…The trainees who may be most affected by distress may have been more likely to fill out the survey, raising the possibility of sample bias. 3,4 Furthermore, the study may also be limited by recall bias, although we strove to mitigate this by repeating the survey in both 2016–2017 and 2017–2018, both of which demonstrated similar results. Even though augmenting structured academic development ranked in the top ways to improve the training experience, our findings did not account for academic development time pursued by vascular fellows during their general surgery residency training.…”

The endovascular performance spectrum of vascular surgery departments in Germany

“…A survey conducted by Dalsing et al. [ 13 ] of vascular surgery residents in training demonstrated where the focus of interest lies among trainee vascular surgeons in the USA today: the teaching faculty and endovascular facilities were the most important factors in their ranking of a training program, with 68.8 % and 60 %, respectively, rating these as very important. These were followed by case volumes in open aortic surgery (43.8 %), open carotid surgery (40.0 %) and thoracic aortic interventions (37.6 %) in the ranking of importance for the choice of training program.…”