Seminars in vascular surgery
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New requirements for vascular surgery training allow several routes to Board eligibility in the specialty. Individuals can enter vascular residency directly from medical school, after 3 years of surgical residency, or after completion of the traditional 5 years of surgery training. ⋯ Residents must be able to demonstrate mastery of the six competencies in addition to the skills of vascular surgery. Because, in some ways, this new vascular training scheme is an experiment in redesigning all surgical education, the vascular community will need to carefully evaluate the results by monitoring the practices of those who graduate from these programs.
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Core training for surgeons in any surgical specialty should include education in the relevant basic science knowledge, training in fundamental diagnostic skills, the development of surgical technical skills and considerable experience in patient care. However, for a number of reasons it is no longer acceptable to guide such training based only on such broad goals, not the least of which is the advent of resident duty-hour limitations that make it unrealistic to expect residents to simply acquire, by random observation and participation, all of the important elements of their future practices. Rather, it is necessary to provide a curriculum of learning opportunities specifically structured to allow them to gain the requisite knowledge and skills. ⋯ Now evaluation must relate to specific educational objectives. This is all a daunting task currently being undertaken by vascular surgery program directors, albeit with input from the Residency Review Committee and the Vascular Surgery Board of the American Board of Surgery. Eventually, overall surgical curriculum will evolve to satisfy these educational ground rules, but currently it is very much a work in progress in most programs.
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The complexity of surgical science and surgical patient care is increasing at an accelerating pace. As a consequence, many areas of surgical practice once within the scope of general surgery have evolved into distinct specialties with unique advanced training requirements. ⋯ The structure of surgical training, including the definition of core surgical training and the optimal structure to introduce advanced specialty training tracks, is the central issue in this debate. This article reviews the question and current deliberations of the stakeholders in graduate surgical education and training.
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In the 25 years that formalized vascular surgery training and certification has been, in effect, the treatment of patients with peripheral vascular disease has undergone dramatic changes, largely due to the emergence of a wide variety of endoluminal techniques and devices that enable minimally invasive treatment of conditions that formerly required operative intervention. Unfortunately, vascular surgeons, for the most part, were painfully slow to embrace these new and evolving technologies, which became increasingly complex as they expanded to treat virtually all vascular maladies in all peripheral vascular territories. Not surprisingly, this left vascular surgeons disadvantaged relative to other disciplines for whom these techniques were more familiar, and we have spent the better part of the last decade playing catch-up to master them and regain our role as the only specialty qualified to offer all types of therapies to our patients with vascular disease. ⋯ While the knee-jerk response is to consider special or supplemental training programs for these advanced techniques, or even certificates of added qualifications for the more challenging of them, such as carotid stenting, we believe that all that is really needed is for the vascular surgical community as a whole, and particularly those faculty in training programs, to truly embrace these new technologies and apply them to the patients they are already rendering care to. Given the prevalence of vascular disease and overall wealth of clinical material already present in most training programs, the simple willingness to apply endoluminal therapies to our existing patient populations is all that would really be needed to insure that all future graduates of vascular surgery training programs are fully competent in all of the current endoluminal therapies and well-positioned to continue to evolve with the field. The real question to be considering, which is beyond the focus of this article, is how we are to maintain our open surgical skills in the era of minimally invasive treatment of vascular disease.
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Fellowship training in vascular surgery over the last several decades has typically involved 1 to 2 years of clinical training incorporating open surgical techniques, some noninvasive vascular diagnostic laboratory, outpatient and inpatient experiences, occasionally basic science research, and more recently training in endovascular procedures. In order to meet the projected increased need for vascular care in the future, vascular surgery training needs to undergo both structural and content modifications if the field is to stay at the forefront in caring for the patient with vascular disease. This article addresses these issues and potential solutions.