From the Journals

Vascular surgery trainees perceive weakness in venous education, case volumes


Key clinical point: National survey indicates perceived inadequacies in venous training by vascular trainees.

Major finding: Of the of vascular trainees who responded to the survey, 75% reported a desire for increased venous training.

Data source: Nationwide U.S. survey of vascular trainees resulting in a 104/464 (22%) response rate.

Disclosures: The authors reported having no conflicts of interest.



Venous training during vascular residency programs is perceived to be lacking in both case volume and didactic education, based on the results of a national survey of vascular trainees.

The majority of respondents (82%) believed that treating venous disease is part of a standard vascular practice, and 75% indicated a desire for increased venous training, according to article in press published online in the Journal of Vascular Surgery: Venous and Lymphatic Disorders.

Surgeons work on a patient in the operating room Dmitrii Kotin/Thinkstock
A 13-question survey was distributed to all 464 vascular surgery residents in the United States. Of these, 104 (22%) responded. The majority (80%) of the responders were aged 25-34 years, 40% were women, 72% were white, 91% reported that they were in an academic training program, and 57% were enrolled in an integrated vascular surgery residency program. There was good representation of the various postgraduate years (PGY 1, 14%; PGY 2, 8%; PGY 3, 14%; PGY 4, 12%; PGY 5, 9%; PGY 6, 18%; and PGY 7, 25%), according to Caitlin W. Hicks, MD, of the department of vascular surgery and endovascular therapy at Johns Hopkins Hospital, Baltimore, and her colleagues (J Vasc Surg Venous Lymphat Disord. 2017. doi: 10.1016/j.jvsv.2017.06.014).

In terms of case loads, the responders reported the following:

  • 63% had performed fewer than 10 inferior vena cava stents.
  • 64% had performed fewer than 10 vein stripping/ligation procedures.
  • 50% had performed fewer than 10 iliac stents.
  • 92% had performed fewer than 10 venous bypasses.

In contrast, 74% of responders reported having performed as many as 20 cases of endothermal ablation.

Currently, the Accreditation Council for Graduate Medical Education does not demand a minimum number of venous cases before graduation from a vascular training program, Dr. Hicks and her colleagues wrote.

Although integrated and traditional vascular surgery trainees showed no overall differences in reported venous procedure volumes (P less than or equal to .28), integrated students reported receiving significantly more didactic education than their traditionally trained peers (P less than or equal to .01).

Both integrated and traditional vascular surgery trainees recognized a need for a more comprehensive educational curriculum in venous disease in terms of both didactic education and case exposure, the authors reported.

“Our data suggest that expansion of the venous training curriculum with clear training standards is warranted and that trainees would welcome such a change,” wrote Dr. Hicks and her colleagues.

“Further study will be required to determine if the perceived deficits affect recent graduates’ experiences with venous disease in their developing practice and if increasing training in venous disease during vascular residency will increase the venous work performed by practicing vascular surgeons,” they concluded.

The authors reported that they had no conflicts of interest.

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