Deficiencies Persist in the Experience of UK Vascular Trainees

Karthikesalingam, Alan; Buxton, Pauline; Marron, Conor; Oshin, Olufemi; Scurr, J.R.H.; Wall, Michael L.

doi:10.1177/1538574412450075

Cited by 9 publications

(4 citation statements)

References 23 publications

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“…When asked about the percentage accounted for by the individual departments in terms of their training in interventional techniques, 38.5 % of respondents estimated that 75–100 % of their training had been obtained in the vascular surgical department, 30.8 % put this figure at 51–75 % and a further 30.8 % at 26–50 %. A UK survey of 217 trainee vascular surgeons, of which 153 (71 %) responded, painted a very different picture [ 19 ]. At the time of the survey 80 of these 153 (52 %) were working in posts that offered no endovascular training and 88 % (123/153) had performed less than 10 peripheral angiograms and/or angioplasties with or without supervision in the previous 12 months.…”

Section: Further Endovascular Trainingmentioning

confidence: 99%

The endovascular performance spectrum of vascular surgery departments in Germany

et al. 2016

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AimTo survey the scope of vascular surgery services in Germany.MethodA total of 308 senior German vascular surgeons received a 19-point questionnaire pertaining to department structure and scope of services. Of these surgeons 223 replied between 16 August 2015 and 23 October 2015 (response rate 72 %), with 62.2 % reporting an additional qualification as an endovascular surgeon according to the guidelines of the German Society for Vascular Surgery and Vascular Medicine (Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin, DGG) and 43.5 % as a DGG® endovascular specialist.ResultsThe number of respondents fully authorized to train in vascular surgery was 71.3 %, while 28.3 % were authorized for limited training. Authorization as a DGG® endovascular surgeon was reported by 24.2 % and authorization as a DGG® endovascular specialist by 17 % of respondents. All respondents performed endovascular interventions on pelvic vessels and 99.1 % also reported carrying out femoral and popliteal endovascular interventions. Endovascular procedures in crural vessels were carried out by 90.1 % and 93.7 % of vascular surgeons performed endovascular procedures in the region of the abdominal aorta (segment V), arteriovenous (AV) fistulas and shunts (85.2 %), upper extremity vessels (80.3 %), the thoracic aorta (segment III, 68.2 %), renal arteries (62.8 %) and visceral aorta (segment IV, 60.5 %). In all 43.5 % of respondents reported experience with endovascular procedures on the carotid bifurcation. Percutaneous arterial procedures formed the focus of endovascular activity, totalling on average 259 interventions per year and department, followed by diagnostic angiography (without intervention) at 166 procedures per year and hybrid arterial interventions at 141 interventions per year.ConclusionThis survey revealed a high level of endovascular expertise among vascular surgeons in Germany. This applies not only to the scope of endovascular activities in diagnosis and treatment but also to the number of estimated annual procedures.

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Section: Further Endovascular Trainingmentioning

confidence: 99%

The endovascular performance spectrum of vascular surgery departments in Germany

et al. 2016

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“…A similar type of study was repeated two years later, which showed no experience of EVLA, RFA or UGFS in 33%, 49% and 46% of trainees, respectively. 25 These are obviously major issues if endovenous treatments are to become first-line treatment with more time needing to be invested in the training of our vascular surgeons of the future.…”

Section: Training In Venous Surgerymentioning

confidence: 99%

Is there a continuing role for traditional surgery?

Coughlin

Berridge

2015

Phlebology

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Despite recent NICE guidance there remains a definite role for surgery in the management of varicose veins. A lot of the available evidence that has driven the transformation of care towards endovenous treatments is of good quality yet published by enthusiasts. No endovenous studies have reported long term results as far out from intervention as the open studies, yet in the meta-analysis from Murad et al, the authors suggested from their results that when surgery was compared with all endoluminal ablation therapies, surgery was associated with a non-significant reduction in the risk of varicose vein recurrence (RR0.63; 95%CI 0.37--1.07). Much of the longer-term data on recurrence following open surgery for primary varicose veins dates back well over 15 years ago. This is prior to the inclusion of routine duplex assessment and sub-specialty designation. The recent Cochrane review (13 randomised controlled studies, 3081 patients). The overall conclusion was that UGFS, EVLT and RFA were at least as effective as surgery in the treatment of the LSV. This meta-analysis did not include the CLASS (Comparison of LAser, Surgery and foam Sclerotherapy as a treatment for varicose veins) trial in which measures of clinical success were similar among the groups. Only 48% of the patients screened were eligible for the CLASS study and of these, only 24% of the eligible patients agreed to take part in the study. Similarly in the study by Carradice out of a total of 772 patients assessed for suitability, 442 did not meet the inclusion criteria. There is no doubt that endovenous surgery will increasingly become first line treatment for patients with symptomatic superficial venous reflux specifically in patients with SSV reflux. However, given the device related limitations with endothermal techniques specifically with regard to adverse anatomical features allied to the poorer results of UGFS within the treatment of LSV reflux, there is without doubt still a role for more traditional open surgical techniques that can be delivered with good short and long term outcomes and still being delivered in a cost effective manner.

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“…Fellowships have been demonstrated to be beneficial to both trainee and training unit in multiple surgical specialities. [1][2][3][4] Trainees gain from experience beyond their base training units in far reaching aspects of their professional development beyond pure technical skills. Nontechnical skills including senior level decision making, case preparation and planning, managing a team and training more junior colleagues all contribute to the overall learning experience.…”

Section: Introductionmentioning

confidence: 99%

Supporting endovascular practice in 2023 and beyond: the BSET Fellowship Programme

Wilton,

Sandford

2023

J.Vasc.Soc.G.B.Irel

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British Society of Endovascular Therapy (BSET) Fellowships were introduced to provide an opportunity for vascular or interventional radiology trainees to acquire new or more complex endovascular skills during a 6-month period in a UK-based endovascular unit of their choice. They were established in 2008 in response to the rapidly expanding field of endovascular practice, with the aim to support high quality endovascular training as well as a new hybrid skillset for those from a vascular surgical background. Since vascular surgery gained independence as a specialty in 2012, evolutions in both vascular surgery and interventional radiology training programmes have facilitated increased exposure to complex endovascular interventions. However, these Fellowships continue to offer a unique opportunity, where trainees benefit from a period of concentrated exposure, working to develop a specific subspecialty interest and ‘fine tune’ their skills in preparation for consultant practice. Further, these Fellowships also offer interventional radiology trainees to be exposed to a larger volume and variety of endovascular procedures, benefiting their future independent practice.

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Deficiencies Persist in the Experience of UK Vascular Trainees

Abstract: Trainee experience is insufficient for a modern specialist practice. Separate specialty training in the United Kingdom must address these deficiencies.

Cited by 9 publications

References 23 publications

The endovascular performance spectrum of vascular surgery departments in Germany

The endovascular performance spectrum of vascular surgery departments in Germany

Is there a continuing role for traditional surgery?

Supporting endovascular practice in 2023 and beyond: the BSET Fellowship Programme

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