A national resident survey about the current state of venous education in vascular surgery training programs

The objective of this study was to characterize U.S. vascular surgery trainees' perceptions, case numbers, and attitudes toward venous disease education, as well as their intent to incorporate it into future practice. These data will provide us with a current snapshot of postgraduate venous education from a resident's perspective.

Institutional Review Board approval was obtained. A 13-question survey was created and distributed to all vascular surgery residents in the United States by SurveyMonkey. Formal electronic distribution remained deidentified as the surveys were e-mailed to residents from the Association of Program Directors in Vascular Surgery.

Of 464 vascular surgery trainees queried, 104 (22%) responded to the survey. The majority of responders (80%) were between 25 and 34 years of age, 60% were male, and 72% were white; 91% reported that they were in an academic training program, and 57% were enrolled in an integrated vascular surgery residency program. Postgraduate years (PGYs) of training among respondents were well represented: PGY 1, 14%; PGY 2, 8%; PGY 3, 14%; PGY 4, 12%; PGY 5, 9%; PGY 6, 18%; and PGY 7, 25%. Vascular resident training experience with venous disease revealed the following: 63% performed <10 inferior vena cava stents, 64% performed <10 vein stripping/ligation procedures, and 50% performed <10 iliac stents; 92% of responders reported having performed <10 venous bypasses during their training. Experience with endothermal ablations was slightly better, with 74% of responders reporting having performed up to 20 cases. Case volumes for endothermal ablation, vein stripping/ligation, inferior vena cava stenting, and iliac stenting increased progressively by clinical training year among integrated vascular residents (P ≤ .02) but were relatively stable for classic 5 + 2 vascular fellows (P ≥ .67). Integrated residents reported having received more didactic venous education than the 5 + 2 vascular surgery fellows (P = .01). There were no differences in overall reported venous procedure volumes between groups (P ≥ .28). The majority of trainees (82%) acknowledged that treating venous disease is part of a standard vascular surgery practice, and many (75%) indicated a desire to have increased venous training. Despite this, 59% of responders reported plans to dedicate <25% of their future vascular surgery practice to venous disease.

In this national survey-based study of vascular surgery trainees, we demonstrate a perceived weakness in venous disease case volumes and didactic education in residency. This training deficit is apparent in both integrated (0 + 5) and traditional (5 + 2) training pathways. Our data suggest that expansion of the venous disease curriculum with clear training standards is warranted and that trainees would welcome such a change.