Co-Existing Vascular Surgery Integrated Residencies are Associated with Increased General Surgery Resident Proficiency and Autonomy in Vascular Cases.

ABSTRACT

OBJECTIVES: Integrated vascular surgery residency positions have doubled over the last decade. Studies have investigated the impact of co-existing subspecialty surgical training programs on case volume of general surgery residents (GSR). However, no studies have explored the impact of subspecialty training on GSR operative competency. The aim of this study is to understand the impact of integrated residencies on operative performance and autonomy of GSR performing vascular procedures. METHODS: Autonomy and performance ratings of GSR participating in vascular surgery cases were collected from all institutions participating in the Society for Improving Medical Professional Learning (SIMPL) application database from 2015-2023. Faculty and self-assessments of autonomy and performance on vascular cases performed by GSR at programs with co-existing vascular integrated residents (VIR), fellows only (VSF), or no vascular trainees (VX) were compared using Fisher's exact tests with Bonferroni corrections across training levels and case complexity. RESULTS: 11,175 assessments (26% at institutions with VIR, 46% VSF, 28% VX) were submitted by 920 GSR and 343 faculty. Senior GSR at programs with VSF achieved lower autonomy than those with VIR (p = 0.049) or VX (p = 0.042) based on faculty assessment. GSR achieved a level of 'practice ready' at significantly higher rates when training at programs with VIR, and at the lowest rates with VSF (p < 0.001). However, self-perception of autonomy and performance was highest among GSR at programs with VX compared to VIR and VSF (p < 0.001). CONCLUSION: The presence of VIR was associated with higher achievement of 'practice ready' competency and higher levels of operative autonomy among senior GSR performing vascular procedures. Shared learning among peers and faculty expertise in teaching resident-level trainees may contribute to this finding.