Illig Karl A, Kalata Emily, Reed Amy, Glass Carolyn, Gillespie David L
Department of Surgery, Division of Vascular Surgery, The University of Rochester Medical Center, Rochester, NY 14642, USA.
Ann Vasc Surg. 2012 Jan;26(1):1-9. doi: 10.1016/j.avsg.2011.04.003. Epub 2011 Jul 20.
The 0+5 integrated vascular residency training pathway was established in 2006 to allow for trainee-focused training culminating in vascular surgery certification only. An early concern was whether enough medical students could be recruited directly into a vascular internship without the exposure that a general surgery residency provides. We hypothesized that programs that send a large percentage of their general surgical graduates to vascular fellowships have models that can be adapted to medical student recruitment.
Opinions and practices were sought from program directors through survey and from trainees taking the Vascular Surgery In-Training Examination.
Eight programs were identified that sent 20% or more of their residents to vascular fellowships over the past 5 years (projecting a mean of 1.6 residents entering vascular fellowships in 2011). Almost all such programs have a formal mentoring system in place that match mentors to residents by interest, and almost all send residents to academic meetings before their senior year. Seventy-five percent of such programs have formal vascular lecture exposure to the first and second year medical student classes, offer clinical shadowing experiences, and have time on the vascular service during the MS3 clerkship; 83% offer a third- or fourth-year elective in vascular surgery. Vascular Surgery In-Training Examination responses were collected from 156 fellows and 13 "0+5" residents. Although fellows had initially been attracted to vascular surgery by the technical aspects of the field learned during residency (43%), the most important factor initially attracting medical students was an interested mentor (46%). However, the most important factor for both residents and students in making a final decision was the technical aspects of the field (66% and 63%, respectively).
Although residents are automatically exposed to the field during residency, students can only be exposed to vascular surgery if a conscious effort is made by interested educators. Programs that send a high proportion of students and residents into vascular surgery tend to have planned exposure at the MS1 and MS2 levels, formal clinical rotations in place at the MS3 and MS4 levels, and pay personal attention to those who display interest. A guide is presented to help specifically plan these steps. Successful recruiting of students into a 0+5 integrated training program requires specific planning and action.
“0+5”一体化血管外科住院医师培训路径于2006年设立,旨在以学员为中心开展培训,最终仅获得血管外科认证。早期人们担心的是,在没有普通外科住院医师培训经历的情况下,能否直接招募到足够多的医学生进入血管外科实习。我们推测,将很大比例的普通外科毕业生送去参加血管外科专科培训的项目,其模式可适用于医学生招募。
通过调查向项目主任以及参加血管外科住院医师培训考试的学员征求意见和了解做法。
确定了8个项目,在过去5年里,这些项目将20%或更多的住院医师送去参加血管外科专科培训(预计2011年平均有1.6名住院医师进入血管外科专科培训)。几乎所有这类项目都有正式的导师指导体系,根据兴趣为住院医师匹配导师,而且几乎所有项目都会在住院医师高年级之前派他们参加学术会议。75%的这类项目会为大一和大二医学生班级安排正式的血管外科讲座,提供临床见习机会,并让他们在三年级医学生临床实习期间到血管外科服务;83%的项目提供血管外科三年级或四年级选修课。从156名专科培训学员和13名“0+5”住院医师那里收集了血管外科住院医师培训考试的反馈。尽管专科培训学员最初被该领域在住院医师培训期间学到的技术方面所吸引(43%),但最初吸引医学生的最重要因素是感兴趣的导师(46%)。然而,对于住院医师和学生做出最终决定来说,最重要的因素都是该领域的技术方面(分别为66%和63%)。
虽然住院医师在住院医师培训期间会自动接触到该领域,但医学生只有在感兴趣的教育工作者有意识地做出努力的情况下,才能接触到血管外科。将高比例的学生和住院医师送入血管外科的项目往往在大一和大二阶段就有计划地让学生接触该领域,在大三和大四阶段安排正式的临床轮转,并关注那些表现出兴趣的学生。本文提供了一份指南,以帮助具体规划这些步骤。成功将学生招募到“0+5”一体化培训项目需要具体的规划和行动。