Forbes Thomas L, Harris Kenneth A
Division of Vascular Surgery, London Health Sciences Centre and the University of Western Ontario, London, ON.
Can J Surg. 2005 Aug;48(4):311-8.
With the aging of the North American population and therefore the need for more modern vascular surgeons familiar with open operations and less invasive diagnostic and therapeutic regimens, we wished to obtain suggestions and recommendations that would allow our training programs to more adequately fulfil these needs. Our objectives were to assess recent trends in Canadian vascular surgery training with respect to the trainee's operative and nonoperative experience.
We mailed a survey to the directors of the 8 Canadian vascular surgery training programs, to ascertain the yearly operative volumes of their 3 most recent trainees with respect to 6 index operations: carotid endarterectomy (CEA), types I-IV thoracoabdominal aortic aneurysm (TAA) repair, elective open infrarenal aortic aneurysm (eAAA) repair, ruptured abdominal aortic aneurysm (rAAA) repair, endovascular abdominal aortic aneurysm repair (EVAR) and lower extremity arterial bypass (LEB). Additionally, information pertaining to nonvascular surgery rotations and the final practice location and type of practice for each trainee was requested.
Seven (88%) of 8 program directors completed the survey. Between 1999 and 2002, vascular surgery trainees in Canadian training programs were exposed to the following yearly clinical volumes (expressed as mean [and standard deviation]): CEA 55.4 (33.9), TAA 6.2 (3.8), eAAA 63.8 (30.0), rAAA 13.5 (9.4), EVAR 14.9 (9.6) and LEB 74.5 (34.5). The range of yearly clinical volumes were: CEA 21-124, TAA 1-18, eAAA 30-133, rAAA 3-45, EVAR 0-34 and LEB 20-143. Nonvascular surgery rotations included: endovascular therapy, interventional radiology, noninvasive diagnostics and research. Forty-five (80.4%) of 56 recent graduates practise only vascular surgery. Most (73.2%) of our recent trainees have remained in Canada, with 41.1% settling in the province in which they trained.
Canadian vascular surgery training programs provide more than sufficient operative experience for their trainees. Although some programs have been successful at providing training in endovascular therapies, the integration of such experience in our training programs continues to be a challenge.
随着北美人口老龄化，因此需要更多熟悉开放手术以及侵入性较小的诊断和治疗方案的现代血管外科医生，我们希望获得相关建议，以使我们的培训项目能够更充分地满足这些需求。我们的目标是评估加拿大血管外科培训在学员手术和非手术经验方面的近期趋势。
我们向加拿大8个血管外科培训项目的主任邮寄了一份调查问卷，以确定他们最近3名学员在6种索引手术方面的年度手术量：颈动脉内膜切除术（CEA）、I-IV型胸腹主动脉瘤（TAA）修复术、择期开放性肾下腹主动脉瘤（eAAA）修复术、破裂性腹主动脉瘤（rAAA）修复术、血管腔内腹主动脉瘤修复术（EVAR）和下肢动脉搭桥术（LEB）。此外，还要求提供与非血管外科轮转以及每位学员的最终执业地点和执业类型相关的信息。
8名项目主任中有7名（88%）完成了调查。1999年至2002年期间，加拿大培训项目中的血管外科受训人员每年接触的临床病例数量如下（以平均值[和标准差]表示）：CEA为55.4（33.9）例、TAA为6.2（3.8）例、eAAA为63.8（30.0）例、rAAA为13.5（9.4）例、EVAR为14.9（9.6）例、LEB为74.5（34.5）例。年度临床病例数量范围为：CEA为21 - 124例、TAA为1 - 18例、eAAA为30 - 133例、rAAA为3 - 45例、EVAR为0 - 34例、LEB为20 - 143例。非血管外科轮转包括：血管腔内治疗、介入放射学、非侵入性诊断和研究。56名近期毕业生中有45名（80.4%）仅从事血管外科工作。我们最近的受训人员中大多数（73.2%）留在了加拿大，其中41.1%在他们接受培训的省份定居。
加拿大血管外科培训项目为其学员提供了足够多的手术经验。尽管一些项目在提供血管腔内治疗培训方面取得了成功，但将此类经验融入我们的培训项目仍然是一项挑战。
