A. T. Mierzwa1, S. F. Markowiak1, S. A. Toraby1, C. Das1, S. Pannell1, M. M. Nazzal1 1University Of Toledo Medical Center,Department Of Sugery,Toledo, OH, USA
Introduction:
The ACGME 80-hour work week, implemented in ‘03-’04, resulted in general surgery residents (GSR) having less exposure to vascular surgery cases in favor to other areas of training, particularly laparoscopic and alimentary tract cases. To rectify this, the ACGME defined category minimums for vascular surgery which increased from 44 to 50 cases per year with a focus on cases traditionally associated with general surgeons. The current trend in vascular care has been shifting from open procedures to endovascular with a decrease in general surgeons performing vascular procedures. With an expected increases in vascular cases nationwide and shortages of formally trained vascular surgeons, the need for general surgeons doing vascular work is unlikely to decrease. The aim of this study was to examine trends in vascular surgery exposure during general surgery residency to help assess the graduating general surgery resident’s preparedness.
Methods:
Data available from Accreditation Council for Graduate Medical Education (ACGME) reports for both General Surgery Residency (GSR), Integrated Vascular, Vascular Surgery Fellowship (VSF) from the years 2009-2016. Case trends were examined for any procedure that had an average number of cases per year greater than 1.5, in any year between ‘09 and ‘16. Trends among major categories in vascular surgery within the same time frame were additionally examined. Each GSR trend was plotted against Integrated and VSF to examine if the trends showed similar variations at each annual time point.
Results:
Carotid Endarterectomy cases are greater than 85% of total Cerebrovascular procedures annually. GSR’s exposure to these cases have decreased (13.6 to 9.8 cases/year), as opposed to increased trend observed in integrated and VSF case volume. Peripheral Obstructive and Vascular Access procedures showed similar trends (23.5 to 20 cases/year and 36.2 to 32.7 cases/year; respectively). Vascular Trauma procedures, however, have increased in both GSR (0.3 to 2.5 cases/year) and Integrated but decreased in VSF.
Conclusion:
Vascular surgery exposure has been limited due to the work-hour restriction with emphasis being placed on alimentary and laparoscopic procedures. Many basic vascular skills are a mainstay in non-vascular surgeries. Using these basic vascular skills, general surgeons can be confident in some of the minor procedures involved with trauma, transplantation, and safe surgical skills overall. With the expected increase in vascular surgery cases nationwide, some minor procedures will inevitably spill over to general surgeons. Our analysis indicates that a percentage (approx. 5-10%) of GSR will not meet the minimum requirement of cases logged for graduation.
