A. Tanious1, M. Wooster1, A. Jung1, P. Nelson1, M. Shames1 1University Of South Florida,Vascular And Endovascular Surgery,Tampa, FL, USA
Introduction: As the integrated vascular residency program reaches almost a decade of maturity, various groups have analyzed the training provided by this paradigm to assess its ability to produce technically proficient vascular surgeons. A common area of concern amongst trainees is the adequacy of open abdominal surgical training. Truncating the general surgery training component has likely negatively affected the integrated vascular residents’ overall exposure to open abdominal surgical cases. However, it is our belief that, although their overall exposure to open abdominal procedures has decreased, integrated vascular residents have a focused, effective exposure to open aortic surgery during training.
Methods: National operative case log data supplied by the Accreditation Council for Graduate Medical Education was compiled for both graduating integrated vascular surgery residents and graduating categorical general surgery residents for the years 2012 – 2014. Mean total and open abdominal case numbers were compared between the vascular and general surgery residents with more in depth exploration into open abdominal procedures by organ system.
Results: Overall, the mean total 5-year case volume of integrated vascular residents was 1430 cases compared to 980 total cases for general surgery residents during the same time frame. For the vascular residents, this included a mean of 92.2 open abdominal cases compared to 192.1 for general surgery residents. 68% of the open abdominal experience for vascular residents was focused on procedures involving the aorta and its branches with an average of 62.3 open aortic cases throughout their training. The remaining open abdominal cases were accumulated during their general surgery rotations. 98% of the general surgery residents’ open abdominal experience involved non-vascular abdominal surgery spread over 10 different organ systems including an average of 12.1 (6%) pancreatic cases, 12.9 hepatic cases (7%), 62 large intestine cases (32%), and only 4.4 open aortic procedures (2%). Open aortic surgery comprises an average of 9.1% of the total major vascular cases for the vascular residents, whereas open alimentary tract-large intestinal surgery at 6.2% comprises the largest proportion for the average general surgery resident experience.
Conclusion: Integrated vascular surgery residents graduate with less than half of the overall open abdominal surgical case numbers when compared with concurrent graduating general surgery residents. General surgery residents’ open abdominal exposure is divided across 10 separate organ systems with small numbers in high complexity areas like hepatobiliary procedures and an inadequate exposure to aortic procedures. In contrast, vascular residents’ open surgical experience is heavily focused on aortic surgery indicating that the integrated vascular paradigm offers efficient, focused exposure to open aortic procedures.