Generalist vascular training in a subspecialising specialty: operative exposure and workforce implications from a national UK vascular surgery eLogbook analysis

Vascular surgery became a standalone specialty in the United Kingdom (UK) in 2012, breaking away from general surgery, with trainees completing a 6-year Higher Specialty Training (HST) programme to attain a Certificate of Completion of Training (CCT) in vascular surgery. Operative exposure in this new training programme and time to CCT remain poorly described, with implications for workforce planning and training structure.

A retrospective observational analysis of anonymised eLogbook data was performed for all National Training Number holders awarded CCT in vascular surgery between 1 January 2023 and 31 December 2024. Data were obtained from the Joint Committee on Surgical Training and mapped to ten portfolio index procedural categories.

Thirty-six trainees achieved CCT during the study period. Fewer than half completed within the planned 6-year duration (median 6.75 years, IQR 6-8.63). In total, 48 636 operative cases were logged, and median active operative participation was 1 000 cases per trainee(IQR 901 - 1 161). Major and minor amputations, alongside debridement formed the largest index category (192 cases, IQR 138 - 232); vascular access surgery was the lowest (38 cases, IQR 21 - 72). When AAA repair was considered as two distinct procedures, median exposure for both open and endovascular repair fell below that of vascular access surgery.

Training duration routinely exceeds the nominal 6-year pathway, with implications for workforce supply modelling. Operative exposure is unevenly distributed, raising questions about the adequacy of a generalist training model in a subspecialising specialty and the role of targeted post-CCT fellowship provision.