A focused education session significantly improved primary care residents’ confidence in diagnosing and managing peripheral artery disease (PAD), a new study found. The findings reinforce longstanding concerns about limited PAD awareness in primary care and highlight a scalable solution.
“Our study examined how well current medical education prepares trainees to recognize and manage PAD,” said Kelly Kempe, MD, associate professor of surgery at the University of Oklahoma School of Community Medicine and a senior author on the study. “We know there is a well-documented gap in awareness of PAD, as well as in practical knowledge of how to diagnose and treat it among primary care providers. Our goal was to identify where that gap begins so we can intervene earlier and more effectively.”
To answer that question, Kempe and her colleagues first assessed the baseline comfort of family and internal medicine trainees in diagnosing, treating and referring patients with PAD appropriately. The study’s second part was to determine if a structured education session could improve those perceptions. The intervention included a presentation and hands-on training in foot examinations and doppler use. Residents also completed surveys before and after the session to assess changes in knowledge, attitudes, and treatment practices.
The findings, which were presented at the 2026 annual winter meeting of the Vascular and Endovascular Surgery Society (VESS) in Olympic Valley, California (Feb. 2-8), showed the intervention produced significant improvements after a single session.
“Across the board, there were remarkable strides,” said Kempe. “The residents’ confidence in diagnosing PAD moved from 16% to over 90%. That’s a huge leap and allows the trainees to feel as though they can really make a difference. Similarly, after the lecture, confidence in the treatment of PAD — medical management and exercise therapy, for instance, which are appropriate for primary care practitioners to implement — moved from 12.9% to 71%.”
Natalie Hmeluk, first author on the study, said the findings reveal a significant blind spot in current primary care training. “Before the intervention, almost none of the residents felt highly confident using a vascular doppler or ordering non-invasive tests like an ankle-brachial index,” she said. “This suggests that while medical school might cover the theory of PAD, the actual residency programs aren’t consistently giving trainees the tools to diagnose and treat it at the bedside or in the clinic.”
Kempe said several factors may explain why PAD education has historically lagged behind other cardiovascular topics. “Primary care providers are asked to do a mountain of work,” she said. “There have been a lot of initiatives focused on heart disease and stroke prevention, but we’ve largely ignored the same disease when it affects the legs. I don’t think many providers — or the public — realize that major amputations related to PAD are associated with a very high mortality rate, or that many of these morbid and costly outcomes are preventable. We believe it’s time to bring more attention to these facts and place a greater emphasis on prevention.”
Hmeluk noted that vascular health has traditionally been viewed as a surgical domain. “In many residency programs, if a patient has a lower leg circulation problem, the immediate reflex is to refer them to vascular surgery,” she said. “This creates a hand-off mentality rather than a management mentality.” She added that a trend towards “scan first, exam later” may also be a contributing factor. “This leads to a decline in diagnostic confidence, which is exactly what our educational intervention sought to correct,” she said.
The intervention may also help reduce disparities in PAD care. “The end-stage complication of PAD — major amputation — is one of the most visible markers of health care inequality in the United States. Research shows that Black and Hispanic patients are significantly more likely to be diagnosed with PAD at a late, advanced stage when options for saving the leg are limited,” said Hmeluk. “By empowering the local primary care resident to perform a doppler exam, we are effectively moving specialized diagnostic power into the community where the patient lives.”
Kempe and Hmeluk believe the intervention is highly scalable and can be implemented across institutions without major structural changes because it only takes 90 minutes to complete. For it to work, Kempe said colleagues across institutions would need to come together. Another key aspect for the intervention’s success would be to ensure the material taught is retained.
“The gap in PAD care isn’t a lack of information — it’s a lack of technical confidence,” said Hmeluk. “This study provides a powerful proof of concept that a single hour of collaborative, hands-on training may be enough to begin bridging that gap. By empowering the next generation of primary care physicians with these tools, we can advocate for earlier diagnosis, faster referral and ultimately reduce amputations.”
