APDVS: Tapping the Minds of Vascular Trainees

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CHICAGO – Vascular surgery trainees are increasingly turning to online texts for clinical information and seek more training on the business aspects of vascular surgery and noninvasive laboratory studies, according to a survey by the Association of Program Directors in Vascular Surgery.

The survey included 163 respondents, of which 46 were in an integrated (0-5) residency program and 117 were currently in or new graduates of an independent (5+2) program.

When asked how they obtained clinical information on the wards or prior to an operation, integrated program respondents said online text books were their go-to source, while independent responders preferred a traditional textbook. Asking a colleague came in second for both groups.

“You can certainly figure out why that might be,” said Dr. Michael Dalsing who reported the findings at the annual meeting of the Peripheral Vascular Surgical Society. “If you’re a PGY 1 – 3, patient care is your primary concern. While for those with additional levels of training, specific vascular concerns and surgery are most important.”

One-on-one instruction was the best way both groups of trainees reported learning new information. Integrated residents were less enthusiastic than independent residents about small group discussions, while simulation training ranked higher among integrated residents.

When asked to grade their overall program, both programs ranked their endovascular training as excellent.

“Less than a decade you would not have seen endovascular training as the best part of their program, and now nearly 70% said it’s excellent,” said Dr. Dalsing, of Indiana University.

Other “excellent” ratings included involvement of teaching faculty, open abdominal and aortic/mesenteric/renal training, didactic teaching and responsiveness to resident stresses. Appropriate performance feedback and support in their job search received “good” marks.

When asked if training in a specific area was appropriate, the business aspects of vascular surgery were judged the most underserved among both integrated and independent (69% vs. 70%) trainees, followed by coding and billing (66% and 64%). The next closest area in need of more attention was formal clinical research training, with just 27% and 35% of trainees, respectively, expressing this opinion. Surgical training and vascular lab/venous training were judged “just right” by more than 75% of respondents.

The ability to actually perform noninvasive vascular laboratory studies requires more attention, with a whopping 49% of integrated program trainees and 59% of independent program trainees viewing training in this area as “fair or nonexistent.” Training in vascular laboratory interpretation received the same marks by 29% and 34% of trainees, respectively. About 85% of all trainees, however, view noninvasive vascular lab training as essential in future practice.

Dr. Joseph Mills, of the University of Arizona, rose from the audience to express alarm at these findings and asked what is being done to standardize the curriculum in the vascular lab. Dr. Dalsing said that CDs are available to educators to standardize training, but added that educators will have to become more aggressive in quantifying that the educational experience at their institution has met expected standards.

The two groups of trainees were split over the 80-hour work week. Independent trainees were significantly more likely than integrated trainees to view the 80-hour work week as detrimental to the continuity of care (62% vs. 24%, P value = .0001), while integrated trainees were significantly more likely to view the rule as essential to avoid fatigue and errors (82% vs. 42%, P = .0001).

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