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Vascular surgery training in general surgery residency programs: the Canadian experience
1Division of Vascular Surgery, University of Torornto, Ontario, Canada. raviparv@hotmail.com
Insights
General surgery residents in Canada receive insufficient vascular surgery training. Most residents do not intend to perform vascular procedures, and experts agree more specialized training is needed for competence.
Area of Science:
- Surgical Education
- Vascular Surgery Training
- Residency Programs
Background:
- Vascular surgery is traditionally part of general surgery training.
- Evidence suggests improved patient outcomes with surgeon volume and vascular certification.
- Current training requirements for vascular surgery within general surgery are controversial.
Purpose of the Study:
- To assess the experience and perceived competence in common vascular surgery procedures among general surgery residents in Canada.
- To evaluate the alignment of training with the perceived needs for performing vascular procedures.
Main Methods:
- A web-based survey was conducted from January to June 2002.
- Participants included general surgery program directors (GSPDs), vascular surgeons (VSs), and senior general surgery residents (SRs) from 13 Canadian English-speaking programs.
- Survey questions focused on appropriate procedures for general surgeons, training received by SRs, and intended future practice.
Main Results:
- 49% of SRs did not intend to perform vascular procedures post-training.
- Agreement existed that SRs should be trained in varicose vein surgery, leg amputation, and femoral embolectomy.
- Disagreement on training for complex procedures like infrainguinal bypass, carotid endarterectomy, and AAA repair, with SRs more inclined than VSs.
- 76% of VSs believed SRs receive inadequate vascular training.
Conclusions:
- General surgery residency programs in Canada show consensus regarding vascular surgery training content.
- Current general surgery training is insufficient for competence in managing common vascular surgery procedures.
- Additional rotations or fellowship training is necessary; competence in vascular surgery may not be an appropriate objective for general surgery training.
Objectives:
Vascular surgery is traditionally considered a component of general surgery. There is growing evidence of improved patient outcome related to surgeon volume and vascular certification status. The American Board of Surgery in the United States, as well as until recently the Royal College of Physicians and Surgeons in Canada, requires that vascular surgery be considered an essential content area of general surgery training. This requirement is controversial. The purpose of this study was to describe experience and perceived competence in common vascular surgery procedures during general surgery residency training in Canada.
Methods:
This web-based survey was conducted between January and June 2002. General surgery program directors (GSPDs), vascular surgeons involved in general surgery training programs (VSs), and senior general surgery residents (SRs) from the 13 English-speaking general surgery programs in Canada were surveyed. Questions were asked regarding which vascular surgery procedures are appropriate for general surgeons to perform, which procedures SRs are trained to perform, and which procedures SR intend to perform.
Results:
The response rate was 62% for GSPDs, 57% for VSs, and 45% for SRs. Overall, 49% of SRs did not intend to perform any vascular procedures after training. GSPDs, VSs, and SRs indicated that most SRs should be and are trained to perform varicose vein surgery, leg amputation, and femoral embolectomy (P >.05). In addition, GSPDs, VSs, and SRs indicated that SRs should not be and are not trained to perform infrainguinal bypass grafting, carotid endarterectomy, or abdominal aortic aneurysm (AAA) repair (P >.05). There were significant differences with respect to ruptured AAA repair: 49% of SRs, 25% of PDs, and only 12% of VSs believe that general surgeons should be trained to perform ruptured AAA repair (P <.05). Overall, 76% of VSs believe SRs receive too little vascular training.
Conclusion:
There is similarity between GSPDs, VSs, and SRs with respect to vascular surgery training in Canadian general surgery programs. Vascular surgery training cannot be considered a component of general surgery. More rotations or fellowship training is required to become competent in management of common vascular surgery procedures. Perhaps this level of competence should not be an objective of general surgery training.
