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Perspectives on Endovascular Training in Traditional (5+2) Vascular Surgery Fellowship Programs (TVSFP)
Thomas N. Carruthers, MD, Kaveh Shahmohammadi, MD, Denis Rybin, MS, Gheorghe Doros, PhD, James T. McPhee, MD, Alik Farber, MD, Jeffrey A. Kalish, MD, Naomi M. Hamburg, MD, Robert T. Eberhardt, MD, Mohammad H. Eslami, MD.
Boston University Medical Center, Boston, MA, USA.
OBJECTIVES:
To compare faculty expectations and evaluations to those of fellows in TVSFPs with regards to the fellow’s endovascular skills (EVS), types of training offered, fellow satisfaction, and prospects after graduation.
METHODS:
Anonymous surveys were sent to fellows (n=235) and Program Directors (PD,n=147) in accredited TVSFPs. PDs were asked to forward the survey to their faculty. Questions about fellows’ EVS, types of training offered, and endovascular simulators (EVSim) were posed. Fellows’ satisfaction with training and prediction of post-graduation capabilities were compared with responses from the faculty group. Fellows’ responses were also compared based on the presence (VF/+F) or absence of a vascular fellowship (VF/-F) at their general surgery residency program. Results were tabulated and comparisons were performed using Fisher’s exact test.
RESULTS:
79(33.6%) fellows and 65(28.6%) faculty replied. First and second year fellows were equally represented, and 64.6% of faculty were PDs. Fellows expected significantly more of themselves in terms of EVS prior to starting fellowship than the faculty group expected of them. However, assessments by faculty of fellows’ actual pre-training EVS were significantly worse than the fellows’ self-assessment. 45.2% of the faculty responders thought that incoming fellows’ pre-training EVS improved over the previous ten years. The majority of fellows (84.3%) were satisfied with their overall endovascular training, similar to faculty impressions (92.8%), but fellows were significantly less satisfied with the structured aspects than the faculty believed them to be (58.5% vs. 73.4%, p=0.020). VF/-F fellows expected more structured training than VF/+F fellows, but the training received was similar. Both fellows and attendings valued simulation and didactic training (62.8% vs. 54.5% and 82.8% vs. 78.0%), but a large majority felt that intraprocedural faculty teaching was extremely useful (97.3% vs. 100%). Exposure to EVSim was similar between fellows and faculty (88.5% vs. 80.5%), and both groups had similar positive feelings regarding its utility as part of a training program. However, only 2.6% of fellows felt that the presence of EVSim affected how they ranked TVSFPs, compared to 32.2% of faculty (p<0.001).
CONCLUSIONS:
Fellows in TVSFPs desire more structured endovascular training, which is not recognized by faculty. Incoming fellows have high expectations of themselves, but may overestimate their actual pre-training EVS. EVSim are valued, but may not be a significant draw in the match process.
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