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General Surgery Residents Competence and Autonomy in Core Vascular Surgery Procedures
Taylor M Carter1, M Libby Weaver2, Ting Sun3
1Office of Surgical Education, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah; Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Journal of Surgical Education
|January 22, 2025
Summary
General surgery residents (GSR) struggle with core vascular procedures, showing low competence in arteriovenous fistula creation and lower extremity amputations. Training needs reassessment for vascular surgery skills.
Area of Science:
- Vascular Surgery Training
- General Surgery Education
- Surgical Competency Assessment
Background:
- Vascular surgery sub-specialization raises questions about general surgery residents' (GSR) capabilities.
- Understanding GSR competence in essential vascular procedures is crucial.
Purpose of the Study:
- To assess the competence and autonomy of general surgery residents in performing core vascular surgery procedures.
- To evaluate performance in lower extremity amputations, arteriovenous fistula creation, and lower extremity embolectomy/thrombectomy.
Main Methods:
- Analysis of 1950 operative assessments from the System for Improving and Measuring Procedural Learning (SIMPL) between 2018-2022.
- Utilized descriptive statistics, chi-square tests, and logistic generalized linear mixed models (GLMM).
- Focused on three core vascular procedures: LE amputations, AVF creation, and LE thromboembolectomy.
Main Results:
- Senior residents demonstrated high competence (82%) and autonomy (66%) in LE amputations.
- Competence (50%) and autonomy (32%) were lower for AVF creation.
- Most senior residents lacked competence (80%) and autonomy (67%) in LE thromboembolectomy.
- Junior and midlevel residents showed limited competence and autonomy across all three procedures.
Conclusions:
- General surgery residents (GSR) frequently fail to achieve competence and autonomy in key vascular procedures like AVF creation.
- Current training may not adequately prepare GSRs for vascular surgery entrustment, particularly for AVF creation, a new Entrustable Professional Activity (EPA).
- Reassessment of general surgery residency training requirements for vascular surgery is recommended.
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