Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
J Surg Educ. 2021 Nov-Dec;78(6):2127-2137. doi: 10.1016/j.jsurg.2021.05.010. Epub 2021 Jun 22.
When the integrated vascular surgery training pathway was introduced, training was comprised of nearly equal amounts of core general surgery and vascular surgery experience. However, specific requirements for case numbers or types were not defined. Over time, the time spent on core general surgery requirements has been reduced, most recently in 2018, from 24 to 18 months. We sought to determine trends in general surgery case volume and type over the past 10 years for vascular surgery residents.
We conducted a retrospective review of the Accreditation Council for Graduate Medical Education case log data for integrated vascular surgery graduates from 2012-2018. We evaluated trends in mean numbers of cases, categorized as general surgery open (GS-open), general surgery laparoscopic (GS-laparoscopic), vascular surgery open (VS-open), and vascular surgery endovascular (VS-endo). Cases were also categorized by anatomic region as head/neck, thoracic, or abdominal.
The mean number of total head/neck, thoracic, or abdominal cases logged by graduating integrated vascular surgery trainees was 263.5. This total, as well as the proportion of general surgery cases (35%-38%, p = 0.99) has remained constant over time. The type of general surgery cases has changed significantly, with an upward trend in the mean number of GS-open cases and downward trend in mean GS-laparoscopic cases (GS-open p = 0.006, GS-laparoscopic p = 0.048). Among head/neck and thoracic subgroups, no significant changes were observed, while in the abdominal subgroup, there has been a significant increase in GS-open over time (p = 0.005). Additionally, the number of open vascular abdominal aortic cases has remained stable, with an average of 36.82 per graduating trainee per year.
In the 10 years since the introduction of integrated vascular surgery programs, total case volume and proportion of general surgery cases have remained remarkably stable. The type of general surgery cases has shifted though, with a decrease in GS-laparoscopic cases, replaced primarily by open abdominal cases. These changes likely reflect integrated vascular residents actively seeking out these opportunities during their core rotations and a willingness by general surgery partners to provide these opportunities. At the program level, these data may help guide program directors' choices about the specific core rotations they incorporate into their curriculum. At the national level, this information may contribute to future discussions regarding the optimal number of core general surgery rotation requirements.
当引入综合血管外科学培训途径时，培训由几乎相等数量的核心普通外科和血管外科学经验组成。然而，并没有定义病例数量或类型的具体要求。随着时间的推移，核心普通外科要求的时间已经减少，最近一次是在 2018 年，从 24 个月减少到 18 个月。我们试图确定过去 10 年来血管外科住院医师普通外科手术量和类型的趋势。
我们对 2012-2018 年综合血管外科学毕业生的研究生医学教育病例记录数据进行了回顾性分析。我们评估了过去 10 年来普通外科手术病例数量和类型的变化趋势，这些病例分为普通外科开放性手术（GS-open）、普通外科腹腔镜手术（GS-laparoscopic）、血管外科开放性手术（VS-open）和血管外科腔内手术（VS-endo）。病例还按头颈部、胸部或腹部解剖区域进行分类。
毕业的综合血管外科学住院医师记录的头颈部、胸部或腹部总病例数的平均值为 263.5 例。这个总数，以及普通外科病例的比例（35%-38%，p=0.99）一直保持不变。普通外科手术的类型发生了显著变化，GS-open 病例的平均数量呈上升趋势，而 GS-laparoscopic 病例的平均数量呈下降趋势（GS-open p=0.006，GS-laparoscopic p=0.048）。在头颈部和胸部亚组中，没有观察到显著变化，而在腹部亚组中，GS-open 的数量随着时间的推移显著增加（p=0.005）。此外，每年每个毕业住院医师的开放血管腹主动脉病例数量保持稳定，平均为 36.82 例。
在引入综合血管外科学项目的 10 年中，总病例数量和普通外科病例的比例保持惊人的稳定。然而，普通外科手术的类型发生了变化，腹腔镜手术的数量减少，主要被开放腹部手术所取代。这些变化可能反映了综合血管外科住院医师在核心轮转期间积极寻求这些机会，以及普通外科合作伙伴愿意提供这些机会。在项目层面上，这些数据可能有助于指导项目主任选择他们纳入课程的具体核心轮转。在国家层面上，这些信息可能有助于未来讨论核心普通外科轮转要求的最佳数量。
