Effect Of New Integrated Vascular Surgery Programs On Vascular Case Volumes Of Residents In Associated General Surgery Programs: Observations From A Retrospective Multicenter Study

The impact of integrated (0+5) vascular surgery residency programs (IVSRPs) on the associated general surgery (GS) resident program vascular case volume has not yet been clearly evaluated. We aim to assess the effect of introducing a new IVSRP on the vascular surgery operative experience for trainees in the associated general surgery (GS) program. Accredited IVSRPs were identified along with completion dates of their first graduates (CDFG). For both a meaningful period of observation and temporally clustered results, only IVSRPs with a CDFG of June 30, 2013 (group 1; 7 programs), June 30, 2014 (group 2; 7 programs), and June 30, 2015 (group 3; 7 programs) were included. The vascular operations of residents completing GS programs 3 years prior to the CDFG in the associated IVSRPs (ie, the postgraduate year (PGY)3 year of the first integrated vascular resident) until June 30, 2018 were analyzed (Fig 1). Descriptive statistics are shown as mean ± standard deviation. For the 21 GS programs included in the study, overall average vascular surgery case total decreased from 115.9 ± 8.9 in academic year (AY) 2010 to 2011 to 81.2 ± 8.1 in AY 2017 to 2018. During that time, the average number of vascular cases recorded for GS residents nationwide was 126.0 ± 10.2 in AY 2010 to 2011 and 122.7 ± 9.0 in AY 2017 to 2018 (Fig 2). From 3 years prior to the CDFG in the associated IVSRPs until 2018 in group 1 (8-year period), the total vascular operations recorded by GS residents fell significantly from 103.2 ± 11.9 to 80.3 ± 2.3 (P = .002). Over 7 years, the total vascular operations recorded by group 2 GS residents fell significantly from 110.5 ± 8.3 to 84.9 ± 6.4 (P < .05). Over 6 years, the total vascular operations recorded by group 3 GS residents remained stable at 91.5 ± 8.1 and 91.2 ± 0.6 (P = .47). When pooling years prior to and directly after CDFG for groups 1, 2, and 3, there was a statistically significant decline in average vascular case volume of the years prior to CDFG (101.8 ± 12.2) as compared with the years after CDFG (83.9 ± 5.7; P = .0001). New IVSRPs can be associated with significant declines in the number of vascular operations performed by residents in associated GS programs. Program administrators should be aware of these data if considering establishing a new IVSRP, particularly in light of an overall national decline in vascular surgery case experience for residents of GS programs.Fig 2Average number of vascular surgery cases per general surgery (GS) resident for each academic year from 2010 to 2018, stratified by groups 1, 2, and 3. CDFG, completion date first integrated vascular surgery trainee.View Large Image Figure ViewerDownload Hi-res image Download (PPT)