Future vascular surgeons could face training gap

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The combination of healthier patients, stricter work-hour limits, and the increase in minimally invasive procedures could create a training gap among vascular surgeons, particularly for complex open procedures. That topic was discussed during the Vascular Annual Meeting.

In 2013, a study published in The Annals of Surgery examined the readiness of general surgery residents entering subspecialty fellowships in North America. It found that one in five (21 percent) fellows were unprepared for the operating room and two-thirds (66 percent) were unable to operate independently. Another quarter (24 percent) could not recognize early signs of complications.

Dr. Gustavo Oderich

Test scores raise similar concerns. A 2013 study of thoracic surgery examinations, for instance, found that the failure rate for oral exams administered by the American Board of Thoracic Surgery doubled from 14.4 percent in 2000 to 30 percent in 2012.

The last point is especially significant, according to Gustavo Oderich, MD, Mayo Clinic. While fewer patients require open surgeries, those who do are especially vulnerable to complications.

“There has been a significant decrease in the number of open cases but the open cases that remain are the most difficult ones,” Oderich said.

Even though they’re performing fewer open procedures, surgeons therefore need superior open skills. Without opportunities to develop such skills, a training gap emerges, putting patients with complex vascular disease at risk.

Vascular surgeon John Eidt, MD, chair of the Vascular Surgery Board of the American Board of Surgery, said that instead of a gap in training, the specialty is undergoing an evolution.

“I wouldn’t say there’s a training crisis,” Dr. Eidt said. “We are, however, adjusting to new endovascular technologies. In response, I expect there will be a continued evolution of vascular surgery training.”

Dr. John F. Eidt

Although they disagree on the nature of the challenge, Eidt and Oderich agree on potential solutions, including:

• Relaxing duty hour restrictions on residents and fellows.

• Increasing the availability and quality of surgical simulations.

• Offering “super fellowships” with the opportunity to develop complex skills during an extra year or two of specialized education between surgical residency and independent practice.

• Performing complex open procedures only at select “Centers of Excellence” where the volume of cases is large enough to provide residents, fellows and surgeons with the experience they need to become experts.

“Vascular surgeons are as well trained now as they ever have been,” Eidt said. “In virtually every domain where we look at the quality of surgical care — stroke rates, death rates, amputation rates – patient outcomes are better today than ever before.”

Still, reforms are needed to keep it that way.

“The generation that’s being trained now is going to have an impact on patient care within five to 10 years,” Oderich says. “The biggest shift, however, is going to be in 20 to 30 years, when there will be no one left from the old generation that was trained in the open-surgery era.”

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