Assi Roland, Dardik Alan
The Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, New Haven, USA.
Ann Vasc Dis. 2012;5(4):423-7. doi: 10.3400/avd.ra.12.00077. Epub 2012 Nov 15.
Current trends in vascular surgery in the USA are driven by increased demand for endovascular procedures. Traditionally-trained vascular surgeons have adapted to these trends by acquiring endovascular skills; vascular surgery fellowships were standardized to 2-years to incorporate endovascular training. However, the traditional "5 + 2" training paradigm appears to be less appealing to the current generation of surgical students, resulting in fellowship positions going unfilled, and potentially predicting a shortage of vascular surgeons. Recognition of this trend has led to the adoption of alternative training pathways, in particular the integrated "0 + 5" pathway, to supplement the traditional "5 + 2" independent pathway. The integrated pathway has several perceived advantages for vascular surgery trainees including early teaching of endovascular skills. However, it has challenges that include maintaining open operative skills and changing strategies to attract candidates from among the pool of medical students instead of the pool of general surgery residents. Simulators, both open and endovascular, are playing an increasingly important role in training programs as well as for outreach programs to medical students. Recruitment strategies for future generations of vascular surgeons in the USA may need to consider residents' lifestyle preferences as well as outreach to traditionally underrepresented groups such as women and minorities.
美国血管外科的当前趋势是由对血管内手术需求的增加所驱动的。传统培训的血管外科医生通过掌握血管内技能来适应这些趋势；血管外科住院医师培训标准化为两年，以纳入血管内培训。然而，传统的“5 + 2”培训模式似乎对当前一代外科学生吸引力较小，导致住院医师培训职位空缺，并且可能预示着血管外科医生短缺。认识到这一趋势后，人们采用了替代培训途径，特别是综合的“0 + 5”途径，以补充传统的“5 + 2”独立途径。综合途径对血管外科实习生有几个明显的优势，包括早期教授血管内技能。然而，它也面临挑战，包括保持开放手术技能，以及改变策略以从医学生群体而非普通外科住院医师群体中吸引候选人。开放手术模拟器和血管内模拟器在培训项目以及面向医学生的推广项目中发挥着越来越重要的作用。美国未来几代血管外科医生的招募策略可能需要考虑住院医师的生活方式偏好，以及向女性和少数族裔等传统上代表性不足的群体进行推广。
