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Operative experience in open arterial vascular surgery procedures for general surgery residents has significantly declined, according to the results of a study of the Accreditation Council for Graduate Medical Education (ACGME) national case log reports, which lists the mean numbers of operations performed.
“Because fundamental vascular surgery skills are necessary for operative general surgery, vascular surgery should remain an essential content area. However, programs cannot solely depend on operative experience to teach fundamental vascular surgery skills,” John R. Potts III, MD, FACS, and R. James Valentine, MD, FACS, stated in their report published online in Annals of Surgery.
The number of individuals completing ACGME-accredited general surgery and vascular surgery training each year of the study was obtained from public reports of the ACGME as well as the available summary national data regarding the reported operative experience of residents completing general surgery programs.
The researchers found that over 15 years (academic year 2001-2002 through AY 2016-2017), the total vascular operations performed by general surgery residents significantly declined as did the total open arterial vascular procedures, including those in seven of nine categories (P less than .0001).
The issue of adequate exposure to vascular procedures for general surgery residents is complex. “The number of individuals completing general surgery residency annually has increased by approximately 20% since AY 2001-2. During the same period, the number of open arterial operations reported by general surgery residents decreased by approximately 38%. Thus, the declining experience is clearly not simply a matter of distributing the same number of operations to a larger number of individuals,” the investigators reported.
The ACGME-designated “essential content areas” have increased in recent years for general surgery trainees to now encompass alimentary tract, abdomen, breast, head and neck, endocrine system, the surgical management of trauma, soft tissues, pediatric surgery, surgical critical care, surgical oncology, and vascular surgery. The essential content areas compete to varying degrees for the trainee’s time, potentially cutting into not just vascular cases but other areas as well. It is also the case that general surgery trainees are often in an institutional setting where they are competing with vascular surgery residents for the same pool of vascular surgery patients.
During those last 5 years, significant declines occurred in five categories: aneurysm, cerebrovascular disease, arteriovenous dialysis access, peripheral vascular disease, and extra-anatomic bypass, according to the authors.
“Knowledge of arterial anatomy, approaches, control, and repair are crucial to the practice of operative general surgery. In the face of declining experience for their resident as surgeon in open arterial operations, general surgery programs must augment resident education in the principles of vascular surgery through other means,” the authors concluded.
Portions of this study were presented at the2018 meeting of the American Surgical Association.
Dr. Potts and Dr. Valentine reported that they had no conflicts of interest.
SOURCE: Potts JR et al. Ann Surg. 2018 Jul 24. doi: 10.1097/SLA.0000000000002951.
In the role of discussant at the American Surgical Association meeting where this research was presented, K. Craig Kent, MD, a vascular surgeon and former president of the Society for Vascular Surgery, stated: “We don’t have enough open arterial cases to teach our general surgery residents. There is a problem on the other side, too, which is we don’t have enough open arterial cases to teach our vascular surgeons to be confident, open, vascular surgeons. What’s my solution? ... we need to share. We should take the opportunity whenever there’s a great arterial case to have everybody, vascular and general surgery trainees, participate,” he stated.
In the role of discussant at the American Surgical Association meeting where this research was presented, K. Craig Kent, MD, a vascular surgeon and former president of the Society for Vascular Surgery, stated: “We don’t have enough open arterial cases to teach our general surgery residents. There is a problem on the other side, too, which is we don’t have enough open arterial cases to teach our vascular surgeons to be confident, open, vascular surgeons. What’s my solution? ... we need to share. We should take the opportunity whenever there’s a great arterial case to have everybody, vascular and general surgery trainees, participate,” he stated.
In the role of discussant at the American Surgical Association meeting where this research was presented, K. Craig Kent, MD, a vascular surgeon and former president of the Society for Vascular Surgery, stated: “We don’t have enough open arterial cases to teach our general surgery residents. There is a problem on the other side, too, which is we don’t have enough open arterial cases to teach our vascular surgeons to be confident, open, vascular surgeons. What’s my solution? ... we need to share. We should take the opportunity whenever there’s a great arterial case to have everybody, vascular and general surgery trainees, participate,” he stated.
Operative experience in open arterial vascular surgery procedures for general surgery residents has significantly declined, according to the results of a study of the Accreditation Council for Graduate Medical Education (ACGME) national case log reports, which lists the mean numbers of operations performed.
“Because fundamental vascular surgery skills are necessary for operative general surgery, vascular surgery should remain an essential content area. However, programs cannot solely depend on operative experience to teach fundamental vascular surgery skills,” John R. Potts III, MD, FACS, and R. James Valentine, MD, FACS, stated in their report published online in Annals of Surgery.
The number of individuals completing ACGME-accredited general surgery and vascular surgery training each year of the study was obtained from public reports of the ACGME as well as the available summary national data regarding the reported operative experience of residents completing general surgery programs.
The researchers found that over 15 years (academic year 2001-2002 through AY 2016-2017), the total vascular operations performed by general surgery residents significantly declined as did the total open arterial vascular procedures, including those in seven of nine categories (P less than .0001).
The issue of adequate exposure to vascular procedures for general surgery residents is complex. “The number of individuals completing general surgery residency annually has increased by approximately 20% since AY 2001-2. During the same period, the number of open arterial operations reported by general surgery residents decreased by approximately 38%. Thus, the declining experience is clearly not simply a matter of distributing the same number of operations to a larger number of individuals,” the investigators reported.
The ACGME-designated “essential content areas” have increased in recent years for general surgery trainees to now encompass alimentary tract, abdomen, breast, head and neck, endocrine system, the surgical management of trauma, soft tissues, pediatric surgery, surgical critical care, surgical oncology, and vascular surgery. The essential content areas compete to varying degrees for the trainee’s time, potentially cutting into not just vascular cases but other areas as well. It is also the case that general surgery trainees are often in an institutional setting where they are competing with vascular surgery residents for the same pool of vascular surgery patients.
During those last 5 years, significant declines occurred in five categories: aneurysm, cerebrovascular disease, arteriovenous dialysis access, peripheral vascular disease, and extra-anatomic bypass, according to the authors.
“Knowledge of arterial anatomy, approaches, control, and repair are crucial to the practice of operative general surgery. In the face of declining experience for their resident as surgeon in open arterial operations, general surgery programs must augment resident education in the principles of vascular surgery through other means,” the authors concluded.
Portions of this study were presented at the2018 meeting of the American Surgical Association.
Dr. Potts and Dr. Valentine reported that they had no conflicts of interest.
SOURCE: Potts JR et al. Ann Surg. 2018 Jul 24. doi: 10.1097/SLA.0000000000002951.
Operative experience in open arterial vascular surgery procedures for general surgery residents has significantly declined, according to the results of a study of the Accreditation Council for Graduate Medical Education (ACGME) national case log reports, which lists the mean numbers of operations performed.
“Because fundamental vascular surgery skills are necessary for operative general surgery, vascular surgery should remain an essential content area. However, programs cannot solely depend on operative experience to teach fundamental vascular surgery skills,” John R. Potts III, MD, FACS, and R. James Valentine, MD, FACS, stated in their report published online in Annals of Surgery.
The number of individuals completing ACGME-accredited general surgery and vascular surgery training each year of the study was obtained from public reports of the ACGME as well as the available summary national data regarding the reported operative experience of residents completing general surgery programs.
The researchers found that over 15 years (academic year 2001-2002 through AY 2016-2017), the total vascular operations performed by general surgery residents significantly declined as did the total open arterial vascular procedures, including those in seven of nine categories (P less than .0001).
The issue of adequate exposure to vascular procedures for general surgery residents is complex. “The number of individuals completing general surgery residency annually has increased by approximately 20% since AY 2001-2. During the same period, the number of open arterial operations reported by general surgery residents decreased by approximately 38%. Thus, the declining experience is clearly not simply a matter of distributing the same number of operations to a larger number of individuals,” the investigators reported.
The ACGME-designated “essential content areas” have increased in recent years for general surgery trainees to now encompass alimentary tract, abdomen, breast, head and neck, endocrine system, the surgical management of trauma, soft tissues, pediatric surgery, surgical critical care, surgical oncology, and vascular surgery. The essential content areas compete to varying degrees for the trainee’s time, potentially cutting into not just vascular cases but other areas as well. It is also the case that general surgery trainees are often in an institutional setting where they are competing with vascular surgery residents for the same pool of vascular surgery patients.
During those last 5 years, significant declines occurred in five categories: aneurysm, cerebrovascular disease, arteriovenous dialysis access, peripheral vascular disease, and extra-anatomic bypass, according to the authors.
“Knowledge of arterial anatomy, approaches, control, and repair are crucial to the practice of operative general surgery. In the face of declining experience for their resident as surgeon in open arterial operations, general surgery programs must augment resident education in the principles of vascular surgery through other means,” the authors concluded.
Portions of this study were presented at the2018 meeting of the American Surgical Association.
Dr. Potts and Dr. Valentine reported that they had no conflicts of interest.
SOURCE: Potts JR et al. Ann Surg. 2018 Jul 24. doi: 10.1097/SLA.0000000000002951.
FROM ANNALS OF SURGERY
Key clinical point: General surgery residents may need more open vascular experience.
Major finding: The number of open arterial operations reported by general surgery residents has decreased by approximately 38% since academic year 2001-2002.
Study details: An analysis of 15 years of ACGME resident national case load reports.
Disclosures: Dr. Potts and Dr. Valentine reported that they had no conflicts of interest.
Source: Potts JR III et al. Ann Surg. 2018 Jul 24. doi: 10.1097/SLA.0000000000002951.