San Antonio Military Medicine Consortium, Wilford Hall USAF Medical Center, 2200 Bergquist Drive, Lackland Air Force Base, Texas 78236, USA.
J Surg Educ. 2009 Sep-Oct;66(5):239-47. doi: 10.1016/j.jsurg.2009.09.007.
The modern era has witnessed an increase in endovascular techniques used by physicians to treat vascular injury and age-related disease. As a consequence, the number of open vascular operations available for general surgical education has decreased dramatically. This changing paradigm threatens competence in vascular injury management achieved during surgical residency. The objective of this study is to sample perceptions on vascular injury treatment in the United States to highlight the need for planning for this important tenet of surgical education.
An electronic survey was extended to board-certified surgeons through 3 professional societies, the Peripheral Vascular Surgery Society (PVSS), the Eastern Association for the Surgery of Trauma (EAST), and the American College of Surgeons (ACS).
A total of 520 respondents were self-categorized as trauma (59%; n = 307), vascular (17%; n = 90), or general (19%; n = 99) surgeons. Respondents reported that general surgeons currently manage less than 10% of vascular injuries at their respective institutions. A 2.5-fold increase in endovascular treatment of vascular injury during the past decade was reported with interventional radiologists now involved in the management of up to 25% of injuries. Few general or trauma surgeons surveyed possessed a catheter-based skill set, although 38% of trauma surgeons expressed great interest in endovascular training. Additionally, a cadre of vascular surgeons (67%) affirmed a commitment to teaching vascular injury management.
The results of this study confirm a diminished role for non-fellowship-trained surgeons in managing vascular injury. Despite an increased acceptance of endovascular techniques to manage trauma, general and trauma surgeons do not possess the skill set. Collaboration between surgical communities will be especially important to maintain high standards in vascular injury management.
现代社会见证了医师采用的血管内技术治疗血管损伤和与年龄相关疾病的增多。因此，可供普通外科教育使用的开放血管手术数量急剧减少。这种不断变化的模式威胁到外科住院医师培训期间获得的血管损伤管理能力。本研究的目的是对美国血管损伤治疗的看法进行抽样调查，以强调需要为这一重要的外科教育原则进行规划。
通过 3 个专业协会（外周血管外科学会（PVSS）、东部创伤外科学会（EAST）和美国外科医师学院（ACS））向认证外科医师发送电子调查。
共有 520 名受访者自我归类为创伤外科医生（59%，n=307）、血管外科医生（17%，n=90）或普通外科医生（19%，n=99）。受访者报告称，普通外科医生目前在各自机构管理的血管损伤不到 10%。过去十年中，血管损伤的血管内治疗增加了 2.5 倍，介入放射科医生现在参与了多达 25%的损伤管理。尽管 38%的创伤外科医生对血管内培训表示极大兴趣，但接受过基于导管的技能培训的普通或创伤外科医生很少。此外，血管外科医生（67%）确认致力于教授血管损伤管理。
本研究结果证实，非专科培训的外科医生在管理血管损伤方面的作用减弱。尽管接受血管内技术治疗创伤的程度有所增加，但普通外科和创伤外科医生不具备这种技能。外科医生社区之间的合作对于维持血管损伤管理的高标准尤为重要。
