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Operative Confidence Of Graduating Vascular Surgery Trainees
Jin Park, MD1, Sameh Yousef
1, Dawn Salvatore, MD
2, Michael Nooromid, MD
2, Paul DiMuzio, MD
2, Babak Abai, MD
2.
1Mercy Catholic Medical Center, Darby, PA, USA,
2Thomas Jefferson University Hospital, Philadelphia, PA, USA.
OBJECTIVES: Vascular surgery has undergone a shift towards minimally invasive techniques that has impacted vascular training. This study assesses factors that influence the operative confidence of recent vascular surgery graduates in performing critical open and endovascular procedures.
METHODS: A 16 question online survey was distributed to vascular surgery trainees who graduated from 2022 to 2024. Multivariate logistic regression was performed to evaluate the effects of demographic and program related variables on the operative confidence of 22 procedures. Analysis of variance and unpaired t test was used to identify differences in procedural confidence by case volume and between endovascular and open procedures respectively.
RESULTS:Of 55 graduate trainees, 72.7%, 40%, 27.3%, 21.8%, 18.2%, 12.7% required at least moderate supervision for open repair of thoracoabdominal aortic aneurysm (TAAA), ruptured and elective abdominal aortic aneurysm (AAA), visceral bypass, aortobifemoral bypass, and mesenteric embolectomy respectively. Graduating with more than 45 open abdominal cases demonstrated improved operative confidence in open repair of ruptured AAA (p=.017), elective AAA (p=.037), aortobifemoral bypass (p=.003) compared to those with 30-45 cases. Graduating with greater than 60 open abdominal cases improved confidence in TAAA repair (p=.004), visceral bypass (p=.049) and mesenteric embolectomy (p=.047)(Figure 1). There were higher confidence levels for endovascular repair of ruptured (p<.001) and elective AAA (p<.001), thoracic endovascular aortic repair (p<.001), aortoiliac stent (p<.001), visceral stent (p<.001) compared to their respective open procedures. There was no difference in confidence between femoral popliteal stent versus bypass (p=.095) and transcarotid artery revascularization versus carotid endarterectomy (p=.110). 100% graduate trainees were confident in extremity thromboembolectomy, brachiocephalic fistula creation, femoral and carotid endarterectomy, below and above knee amputations. Gender(p=.206), fellowship or integrated vascular training(p=.885), location of the program(p=.873), community or university-based(p=.578), number of attendings(p=.216), age(p=.303) had no significant effect on operative confidence.
CONCLUSIONS: Graduating vascular surgery trainees indicate a lack of confidence in certain core open vascular procedures. This decrease in confidence is associated with case volume. Graduates with lower case volumes should consider additional training or practice where there is direct senior supervision. Studies are needed to address these confidence deficits to ensure graduates are adequately prepared for independent practice.
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