Integrated vascular residency recruitment: Start pipeline earlier, engage more deeply

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Our great specialty and the patients we serve face an impending critical shortage of vascular surgeons in the decade ahead. The Association of Program Directors in Vascular Surgery (APDVS) and the Society for Vascular Surgery (SVS) have recognized this issue and responded by redoubling recruitment efforts through the work of their student and resident recruitment and outreach committees. Among various recruitment efforts, the importance of establishing and actively programming vascular surgery interest groups (VSIGs) have been emphasized.

VSIGs are a great place to start, but our standard line-up of VSIG events—including lectures, case presentations, and even hands-on simulation events—may be insufficient. Channeling medical students into the vascular pipeline demands a multifaceted approach.

In order to inspire students to sustain interest and fully explore a career in vascular surgery, we need to give them more than pizza and some Polytetrafluoroethylene (PTFE) to sew on. After several years as the faculty advisor for the University of Utah VSIG, I’ve come to appreciate three phases of recruitment: early engagement, sustaining interest and mentorship for success.

Early engagement is all about generating excitement and curiosity, as well as sharing our professional identity as providers of #ComprehensiveVascularCare. Students can’t choose a career they haven’t heard of, so getting the word out is an important first step—and it’s never too early.

PRE-MED

To fill the pipeline at the outset of medical school, we need to engage with high school STEM and undergraduate pre-medicine programs. Academic and community vascular surgeons alike should engage in recruitment at this broad level, where grass-roots initiatives can truly have an impact. Pre-medical students need to distinguish themselves among their peers, as medical school admission is becoming increasingly competitive. Any opportunity you can offer them to assist in your clinic or research lab will enhance their application while providing early exposure to vascular surgery. Reach out to your nearest college campus, find out if they have a pre-med program, and offer to provide opportunities to interested students.

Here at the University of Utah, first-year (MS1) students host an annual, week-long “Camp Cardiac” summer program for local high school students. I am not too proud to participate in a cardiac program! Every summer, I participate in this camp by giving a lecture about vascular surgery and providing a hands-on experience with expired sheaths, wires and catheters. The high school students love it and the MS1 students—who thought they wanted to be cardiologists—show up in my clinic to shadow.

PRE-CLINICAL MEDICAL STUDENTS

Integration of vascular surgery content into the pre- clinical curricula of medical schools is a task that can only be addressed at the local level. After serving on multiple committees and subcommittees for our Liaison Committee on Medical Education (LCME) site visit this past year, I can tell you that the LCME is focused on process measures in the accreditation of medical schools and, in general, does not evaluate schools in terms of specific curricular content, nor the specialists who are selected to teach it.

Furthermore, all politics are local. Faculty must engage with their local dean’s office to identify where, when and how vascular surgery topics are taught in their curricula. With many schools moving to the likes of case-based, problem-based and team-based learning, stepping in for a traditional lecture about peripheral arterial occlusive disease is unlikely to be an option. Consider more creative ways to share your expertise through curricula on end-of- life decision making, physical exam skills, or, as in my case, quality improvement (QI). Since I started, the number of shadowing requests I receive each year has more than tripled.

“I first met Dr. Smith in an elective course she teaches about QI to first-year students. I had no prior knowledge about vascular surgery but was intrigued by her comments about her patients and career that were woven throughout the lectures as examples. Since shadowing her, I’ve become the co-president of my institution’s VSIG, and am involved with multiple vascular surgery research projects,” says Madeline DeAngelo, an MD-candidate, class of 2023, at the University of Utah School of Medicine.

While the return on investment is admittedly low in the early engagement phase, the time commitment and effort to prepare are minimal. A VSIG can fill much of the need for fun events and pizza with pre-clinical medical students, and is often the mechanism that initially exposes students to vascular surgery. Unfortunately, many institutions lack this crucial starting point.

Only 48 VSIGs are listed on the SVS website, while 59 integrated vascular surgery residency programs participated in the National Resident Matching Program in 2020. With 155 allopathic and 36 osteopathic medical schools in the United States, we can’t rely on the 30% of medical schools that have an integrated program to recruit through their local VSIG—but they should lead the way. Cultivating curiosity and supporting students to investigate our specialty as a career choice is the important follow up that needs to occur.

SUSTAINING INTEREST

Sustaining interest requires deeper and more personal engagement and availability. Vascular surgery faculty, residents and fellows should provide contact information at all early engagement activities. When students reach out to express their interest, we must enthusiastically respond.

“Our VSIG decided to host an endovascular simulation event for interested students with a cap on attendance to ensure everyone who came received plenty of time with the devices and attention from the faculty,” says DeAngelo. “This was a huge hit at my institution. Students mentioned that it was the most exciting and hands-on event they’d ever attended (across all specialties). The integration of anatomical knowledge with the technical skills of using the equipment provided a really unique experience. I hope all VSIGs are able to provide these kinds of immersive events for students.”

As students express their interest more deeply, offer to mentor them on a research project. Many students have free time between the MS1 and MS2 years to engage in research, which can sustain their interest. Ideally, research projects should be thoughtfully selected to optimize the chance to present at a regional or national meeting.

The SVS hosts an incredible student and resident program at the Vascular Annual Meeting (VAM) each year. Unfortunately, many students identify the cost of attending VAM as a significant barrier. Vascular divisions and individual vascular surgeons should consider sponsoring a student to attend.

MENTORSHIP FOR SUCCESS

Personal mentorship is important throughout the process. The SVS VSIG toolkit highlights the importance of organizing and promoting mentorship opportunities. Once the VSIG has helped to make connections, the onus is on us to commit to building meaningful, longitudinal relationships. We can all identify the early mentors who inspired us to pursue vascular surgery.

These mentors were available, making time in packed schedules to meet with us one-on-one. They treated us like colleagues, respected us as professional adults, and didn’t sugar-coat the reality of life as a vascular surgeon. They went the extra mile for us, inviting us to scrub on cases during non-surgical rotations and connecting us with colleagues across the country.

At least, that’s what my mentors at the University of Wisconsin did for me, and what I try my best to do for my students today. These relationships are incredibly important to ensure students interested in vascular surgery are successful in the match, during residency and as they join our proud ranks as faculty.

Finally, we can all personally benefit from VSIG events and providing mentorship. Each of my partners and fellows who have participated in a VSIG event have come away re-energized by these young professionals.

“At one VSIG event, I was taught by a faculty member how to maneuver various catheters and wires and felt like I became a junior vascular surgeon, just for a few seconds,” says DeAngelo. “That one-on-one interaction left me fueled to pursue the specialty and investigate additional involvement opportunities.”

To protect and grow our great specialty, we must engage students early on in their careers, sustain their interest through opportunities to explore the field, and, most importantly, serve as their mentors. Each program that participates in the NRMP and matches an outstanding future vascular surgeon should commit to mentoring at least one student to enter the match each year. If we make this simple commitment, no program should ever go unfilled, and we will be better equipped to meet the needs of our patients in the years ahead.

Brigitte Smith, MD, is vice chair of education for the University of Utah department of surgery, program director of the vascular surgery fellowship, local VSIG advisor, and member of the SVS Resident and Student Outreach Committee.

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