Vascular Educational Needs in the “Real World” and Teaching of Vascular Surgery in Medical Schools

Abstract

The prevalence of peripheral arterial disease (PAD) is 3% to 10% in the general population, increasing to 15% to 20% in those older than 70 years. 1 The Reduction of Atherothrombosis for Continued Health survey showed that almost 66% of patients with PAD had clinical evidence of other vascular disease. 2 Coronary artery disease is the most common cause of death among patients with PAD (40%-60%), cerebral artery disease accounts for 10% to 20% of deaths, 1,2 and 10% of deaths have been attributed to other vascular events, mostly ruptured aortic aneurysm.Although PAD is a major cause of mortality and morbidity, postgraduate doctors have poor knowledge about this topic. 3 Schwarcz et al recorded a moderate percentage of correct answers by internal medicine interns when questioned with respect to prevalence, screening, and treatment of vascular diseases (48.9%, 33.8%, and 45.0%, respectively). 4 Although the ankle-brachial index (ABI) is considered a reliable and accurate vascular biomarker in primary and secondary prevention of cardiovascular events, 5 Wyatt et al documented a poor level of baseline knowledge of calculation and interpretation of ABI among internal medicine residents, irrespective of the year of residency. 6 Likewise, Chaudru et al reported poor scores of 22%, 13%, and 41% among residents from 6 different medical schools in France regarding correct ABI measurement, calculation, and interpretation, respectively. 7 Therefore, it is not surprising that Campbell et al recorded uncertainty and disagreement about the skills expected from medical students by their tutors, with only one-third of the instructors considering the ability to estimate ABI using a Doppler device as necessary. 8 In agreement with deficient PAD knowledge at pre-and immediate postgraduate level, a survey in central Greece documented that PAD remains underdiagnosed and undertreated not only due to insufficient patient information and screening but also due to lack of awareness and inadequate vascular examination by many physicians in primary care. 9

Vascular surgery: What increases the flow of students to the speciality?

“…The importance of early exposure to specialties is showcased by a number of papers published [7][8][9][10][11][12][13][14] throughout the last few years. They assess the limitations in the medical school curriculum, with some showing that only 56% of medical students were exposed to vascular surgery at university.…”

The state of vascular surgery education in the United States

“…Schwartz et al studied the knowledge of internal medicine interns regarding the prevalence, screening, and treatment of vascular disease. Their findings demonstrated that residents scored moderately on these questions and were therefore not well equipped to handle vascular pathology due to gaps in their prior medical education ( 13 ). The Ankle-brachial Index (ABI) is a known and reliable vascular biomarker for the detection of PAD and for primary and secondary prevention of cardiovascular events.…”

“…The Ankle-brachial Index (ABI) is a known and reliable vascular biomarker for the detection of PAD and for primary and secondary prevention of cardiovascular events. Despite its importance in the diagnosis of PAD, Wyatt et al documented a poor level of baseline knowledge of calculation and interpretation of ABI among internal medicine residents, irrespective of the year of residency ( 13 ). These findings highlight an inadequacy of knowledge within the sphere of vascular care and requires attention as this could be related to general understanding, exposure, and interest of medical students in the patient pool largely treated by vascular surgeons.…”