Cui Christina L, Murillo Alyssa D, Coleman Dawn M, Burton Erin, Richmond Robyn E, Layne Desmond, Cortez Alexander R, Kim Young
Division of Vascular and Endovascular Surgery, Duke University, Durham, NC.
Department of Surgery, University of California, San Francisco, San Francisco, CA.
J Vasc Surg. 2025 Feb;81(2):466-471. doi: 10.1016/j.jvs.2024.09.029. Epub 2024 Sep 30.
There remains a progressive projected deficit in the vascular surgery (VS) workforce for decades. Despite the expanding integrated VS residency pathway, the fellowship training model remains critical in supporting our future workforce. Therefore, it is imperative to understand the resident and program-specific factors that influence VS specialization among general surgery (GS) residents.
Data from the United States Resident OPerative Experience (ROPE) Consortium, which comprises 20 Accreditation Council for Graduate Medical Education-accredited GS residency programs across the United States, were queried for resident demographics and residency program-related details. Logistic regression analysis was used to identify factors associated with VS specialization.
From 2010 to 2020, a total of 1343 graduating GS residents were included in the study. Of these, 135 (10.1%) pursued VS fellowship training. Residents pursuing VS were more frequently male (80.7% vs 62.8%; P < .0001) and younger (median age, 32 vs 33 years; P = .03) compared with other GS residents. Racial and ethnic group, underrepresented in medicine status, and international medical graduate status were similar between the VS and non-VS groups. Residency program-level details were also similar between groups, including program type (university vs community-based), region, size, resident volume, dedicated research experience, and National Institutes of Health funding. Dedicated vascular rotations were common among all GS programs (95.4%), and total months spent on a VS rotation (median, 4 vs 4.5 months; P = .11) did not differ among residents pursuing VS and all other residents. The presence of a collocated traditional (5 + 2) VS fellowship (91.1% vs 90.4%; P = .79) or integrated (0 + 5) VS residency (56.3% vs 55.0%; P = .77) were also similar between groups. On multivariate analysis, only male sex (odds ratio, 2.34; 95% confidence interval, 1.50-3.81; P < .001) was associated with pursuing VS fellowship. Factors that did not impact VS specialization included resident age, underrepresented in medicine status, international medical graduate status, program volume, dedicated research experience, or total months spent on a VS rotation.
In this multi-institutional study, we did not find any program-specific factors that influence VS specialization among GS residents. Notably, the presence of a collocated 0 + 5 residency or 5 + 2 fellowship program did not appear to deter GS residents from pursuing a VS fellowship. These data suggest that individual factors, such as mentorship, may be more impactful in recruiting GS residents to the VS specialty.
数十年来，血管外科（VS）劳动力预计仍将持续短缺。尽管综合VS住院医师培训途径不断扩大，但专科培训模式对于支持我们未来的劳动力仍至关重要。因此，必须了解影响普通外科（GS）住院医师选择VS专科的住院医师及项目特定因素。
查询来自美国住院医师手术经验（ROPE）联盟的数据，该联盟由美国20个经研究生医学教育认证委员会认证的GS住院医师培训项目组成，获取住院医师人口统计学信息和与住院医师培训项目相关的详细信息。采用逻辑回归分析确定与VS专科相关的因素。
2010年至2020年，共有1343名即将毕业的GS住院医师纳入本研究。其中，135名（10.1%）接受VS专科培训。与其他GS住院医师相比，选择VS的住院医师男性比例更高（80.7%对62.8%；P <.0001）且更年轻（中位年龄32岁对33岁；P =.03）。VS组和非VS组在种族和族裔群体、医学领域代表性不足状况以及国际医学毕业生身份方面相似。两组在住院医师培训项目层面的详细信息也相似，包括项目类型（大学型与社区型）、地区、规模、住院医师数量、专门的研究经历以及美国国立卫生研究院的资金。所有GS项目中进行专门血管外科轮转很常见（95.4%），选择VS的住院医师与所有其他住院医师在血管外科轮转的总月数（中位值4个月对4.5个月；P =.11）上没有差异。两组中配套的传统（5 + 2）VS专科培训（91.1%对90.4%；P =.79）或综合（0 + 5）VS住院医师培训（56.3%对55.0%；P =.77）的情况也相似。多因素分析显示，只有男性性别（优势比，2.34；95%置信区间，1.50 - 3.81；P <.001）与选择VS专科培训相关。不影响VS专科选择的因素包括住院医师年龄、医学领域代表性不足状况、国际医学毕业生身份、项目规模、专门的研究经历或在血管外科轮转的总月数。
在这项多机构研究中，我们未发现任何影响GS住院医师选择VS专科的项目特定因素。值得注意的是，配套的0 + 5住院医师培训或5 + 2专科培训项目的存在似乎并未阻碍GS住院医师选择VS专科培训。这些数据表明，诸如导师指导等个人因素在吸引GS住院医师选择VS专科方面可能更具影响力。
