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Expert Consensus On The ACGME Competencies That Align With Vascular Quality Initiative Surgical Outcomes
Brigitte K. Smith, MD, MHPE1, Kenji Yamazaki, PhD2, Ara Tekian, PhD, MHPE3, Benjamin S. Brooke, MD, PhD1, Eric Holmboe, MD2, Stanley J. Hamstra, PhD4, Erica L. Mitchell, MD, MEd5, Yoon Soo Park, PhD6.
1University of Utah, Salt Lake City, UT, USA, 2Accreditation Council for Graduate Medical Education, Chicago, IL, USA, 3University of Illinois at Chicago, Chicago, IL, USA, 4University of Toronto, Toronto, ON, Canada, 5University of Tennessee, Memphis, TN, USA, 6Massachusetts General Hospital, Boston, MA, USA.

ObjectiveThe policy and practice of vascular surgical education has evolved significantly since the advent of the Accreditation Council for Graduate Medical Education (ACGME) Milestones. Concomitantly, greater emphasis has been placed nationally on vascular surgery (VS) quality and outcomes as measured by the Vascular Quality Initiative (VQI) procedure registries. As such, no data support the association between VS ACGME Milestones performance with patient outcomes. In order to investigate associations between training and surgical outcomes, a critical first step is to determine which ACGME competencies contribute to patient outcomes. We sought to investigate the VS Milestones considered essential for quality patient care outcomes vis-a-vis 8 VQI registries.
MethodsExperts in both VS clinical care and education were recruited to participate in a modified Delphi consensus building process. A master list of items for competency rating was created using the 31 ACGME VS sub-competencies and 8 VQI procedure registries. These items were entered into a 2-round Delphi process. Positive consensus was reached when > 75% of participants ranked a competency as mandatory to quality outcomes. (Table)
Results13 VS experts and contributors to the VS Milestones participated; 12 experts (92%) participated in all rounds of the Delphi process. Expert consensus deemed only 9 to 15 of the 31 subcompetencies as mandatory to quality patient outcomes vis-a-vis the 8 VQI clinical modules. Practice-based learning and improvement (PBLI), and professionalism were deemed not essential to quality patient outcomes. Radiation safety was the only systems-based practice (SBP) sub-competency uniformly defined as supportive to patient outcomes.
ConclusionsEstablishing a translational link between training and clinical outcomes is essential to enhancing the quality of educational practice and policy. This study advances this effort through national expert consensus, demonstrating high degree of agreement among VS experts regarding the relevance of ACGME sub-competencies to quality patient outcomes as captured by the 8 VQI clinical registries. SBP, PBLI, and Professionalism competencies were identified as unlikely to be associated with clinical outcomes. Future research should investigate the relevance of these core competencies to other measures of surgeon performance not captured in the VQI, such as patient reported outcomes and practice management.

Vascular Surgery ACGME SubcompetenciesVascular Quality Initiative (VQI) Outcomes
CEACASOpen AAAEVARTEVARSupra BypassInfra BypassPVI
MeanSDMeanSDMeanSDMeanSDMeanSDMeanSDMeanSDMeanSD
PC-1Patient Data2.58.902.58.902.67.892.67.892.67.892.58.902.58.902.58.90
PC-2Vascular Medicine2.25.972.33.892.081.002.25.972.25.97
PC-3Perioperative Care2.83.392.83.392.83.392.67.492.75.452.75.452.83.392.58.51
PC-4Longitudinal Care2.08.902.17.941.92.792.421.002.33.982.17.942.421.002.421.00
PC-5Technical Skills Procedural Preparation2.58.512.75.452.67.492.75.452.75.452.67.492.75.452.67.49
PC-6Technical Skills Open Surgical Skills3.00.003.00.003.00.003.00.00
PC-7Technical Skills Endovascular3.00.002.75.452.67.492.92.29
PC-8Vascular Imaging2.42.672.83.582.33.653.00.003.00.002.17.582.58.672.83.39
MK-1Procedural Rationale Basic Procedures
MK-2Procedural Anatomy Basic Procedures
MK-3Procedural Understanding Basic Procedures
MK-4Crisis Management Basoc Procedures
MK-5Procedural Rationale Intermediate Procedures2.75.622.58.672.83.58
MK-6Procedural Anatomy Intermediate Procedures2.83.392.83.392.92.292.67.49
MK-7Procedural Understanding Intermediate Procedures2.92.292.92.292.92.292.75.45
MK-8Crisis Management Intermediate Procedures2.92.292.92.292.92.292.83.39
MK-9Procedural Rationale Advanced Procedures2.171.192.75.622.75.622.421.002.67.652.67.652.421.002.421.00
MK-10Procedural Anatomy Advanced Procedures2.251.142.92.292.92.292.58.902.83.392.75.452.58.902.50.90
MK-11Procedural Understanding Advanced Procedures2.421.163.00.003.00.002.67.892.92.292.92.292.67.892.67.89
MK-12Crisis Management Advanced Procedures2.331.152.92.292.92.292.58.902.92.292.92.292.58.902.58.90
SBP-1Radiation Safety2.33.782.50.802.50.802.42.79
SBP-2Coordination of Care1.92.512.17.582.25.622.25.622.33.652.17.582.17.582.08.67
SBP-3Improvement of Care
PBLI-1Teaching
PBLI-2Self-directed Learning2.08.902.08.902.00.852.17.942.25.972.00.851.92.792.17.94
PBLI-3Quality Improvement2.08.792.17.832.25.872.25.872.25.872.17.832.17.832.17.83
PROF-1Integrity2.331.072.331.072.331.072.331.072.331.072.331.072.331.072.331.07
PROF-2Personal Wellbeing
PROF-3Administrative Tasks
ICS-1Communication with Patients and Families2.33.652.50.672.50.672.33.652.50.672.50.672.33.652.50.67
ICS-2Communications with Healthcare Team2.50.522.67.492.50.522.67.492.67.492.50.522.67.492.67.49


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