Tanious Adam, Wooster Mathew, Jung Andrew, Nelson Peter R, Armstrong Paul A, Shames Murray L
Division of Vascular and Endovascular Surgery, USF Health Morsani School of Medicine, Tampa, Fla.
Division of Vascular and Endovascular Surgery, USF Health Morsani School of Medicine, Tampa, Fla.
J Vasc Surg. 2017 Jul;66(1):307-310. doi: 10.1016/j.jvs.2017.03.414. Epub 2017 May 3.
After almost 10 years since its approval, residents in integrated vascular surgery training programs now outnumber traditional vascular fellows. We examined the Accreditation Council for Graduate Medical Education (ACGME) case log data to assess whether there is a difference in operative experience between the graduating integrated residents and vascular fellows.
We analyzed the total clinical experience of vascular surgery trainees during the academic years between 2012 and 2014 for the 30 graduated integrated vascular surgery residents (VSRs) and the 243 graduated vascular surgery fellows (VSFs). Data were compared on the basis of reported categories defined by the ACGME operation reporting system. VSR case totals were calculated by combining "surgeon chief," "surgeon junior," and "secondary procedures" categories. VSF "surgeon fellow" and "secondary procedures" case totals were combined with all vascular cases done in general surgery residency (using averages of general surgery resident ACGME case log data from the same years) to reflect their total vascular experience.
The average total vascular experience reported by VSRs was 1446.0 compared with 1421.8 for VSFs (P = .2086). VSRs performed 694.7 major vascular procedures on average compared with 616.3 major cases for VSFs (P = .0106). Highlighted comparisons include the following: open aortic aneurysm cases, VSRs 20.6 and VSFs 22.2 (P = .320); endovascular aortic aneurysm cases, VSRs 80.0 and VSFs 80.6 (P = .945); cerebrovascular cases, VSRs 78.8 and VSFs 85.0 (P = .1132); and peripheral obstructive cases, VSRs 343.6 and VSFs 293.4 (P = .0032).
Integrated VSRs and traditional VSFs graduate with comparable overall vascular surgery clinical experience. VSRs reported, on average, a significantly higher number of major vascular procedures during their tenure as trainees as well as a significantly increased number of cases in six of the other ACGME categories.
自从整合血管外科培训项目获批近10年来，如今参加该项目培训的住院医师人数已超过传统血管外科专科住院医师。我们研究了毕业后医学教育认证委员会（ACGME）的病例记录数据，以评估毕业的整合住院医师与血管外科专科住院医师在手术经验上是否存在差异。
我们分析了2012年至2014年学年期间30名毕业的整合血管外科住院医师（VSR）和243名毕业的血管外科专科住院医师（VSF）的血管外科培训学员的总体临床经验。数据根据ACGME手术报告系统定义的报告类别进行比较。VSR的病例总数通过合并“主刀医生”“助手医生”和“二级手术”类别来计算。VSF的“专科住院医师”和“二级手术”病例总数与普通外科住院医师期间完成的所有血管手术（使用同一年普通外科住院医师ACGME病例记录数据的平均值）合并，以反映他们的总体血管手术经验。
VSR报告的平均总体血管手术经验为1446.0，而VSF为1421.8（P = 0.2086）。VSR平均进行694.7例主要血管手术，而VSF为616.3例主要病例（P = 0.0106）。突出的比较结果如下：开放性主动脉瘤病例，VSR为20.6例，VSF为22.2例（P = 0.320）；血管腔内主动脉瘤病例，VSR为80.0例，VSF为80.6例（P = 0.945）；脑血管病例，VSR为78.8例，VSF为85.0例（P = 0.1132）；外周阻塞性病例，VSR为343.6例，VSF为293.4例（P = 0.0032）。
毕业时，整合血管外科住院医师（VSR）与传统血管外科专科住院医师（VSF）的总体血管外科临床经验相当。VSR报告称，在培训期间，他们平均进行的主要血管手术数量显著更多，并且在ACGME的其他六个类别中的病例数量也显著增加。
