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1.
Eur J Vasc Endovasc Surg ; 61(3): 502-509, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33309171

RESUMO

OBJECTIVE: The aim of this study was to systematically review the literature and give evidence based recommendations for future initiatives for simulation based training (SBT) and assessment in open vascular surgery. DATA SOURCES: PubMed, Embase, and the Cochrane Library. REVIEW METHODS: A systematic review of PubMed, Embase, and the Cochrane Library was performed, with the last search on 31 March 2020, to identify studies describing SBT and assessment in open vascular surgery. Kirkpatrick's levels for efficacy of training were evaluated. Validity evidence for assessment tools was evaluated according to the recommended contemporary framework by Messick. RESULTS: Of 2 844 studies, 51 were included for data extraction. A high degree of heterogeneity in reporting standards and varying types of simulation was found. Vascular anastomosis was the most frequently simulated technical skill (43%). Assessment was mostly carried out using the Objective Structured Assessment of Technical Skills (55%). Validity evidence for assessment tools was found using outdated frameworks, and only one study used Messick's framework. Self directed training is valuable, the low trainer to trainee ratio is important to maximise efficiency, and experienced vascular surgeons are the most effective trainers. CONCLUSION: Carefully designed and structured SBT is effective and can improve technical skills, especially in less experienced trainees. However, the supporting evidence lacks homogeneity in the reporting standards and types of simulations. Pass/fail standards that support proficiency based learning and studies investigating skills transfer should be the focus in future studies. Validity evidence of assessment tools needs to be addressed using contemporary frameworks.


Assuntos
Educação de Pós-Graduação em Medicina , Treinamento por Simulação , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Competência Clínica , Humanos , Curva de Aprendizado
2.
Semin Vasc Surg ; 33(3-4): 34-35, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308593

RESUMO

As a junior colleague of Dr. D. E. Strandness, Jr., for almost 30 years, I had the unique professional opportunity to witness the development of duplex ultrasonography at the University of Washington. "Gene" as he liked to be called, was a surgeon with a persistent curiosity about vascular disease. He led the multidisciplinary team that developed the technique of duplex ultrasound, measured its diagnostic accuracy, and performed research studies to reduce stroke due to carotid bifurcation atherosclerosis. My reflections on the legacy of Dr. Strandness are offered with gratitude for the curiosity "bug" he nurtured in me, which continues today.


Assuntos
Atitude do Pessoal de Saúde , Pesquisa Biomédica/história , Comportamento Exploratório , Cirurgiões/história , Ultrassonografia Doppler Dupla/história , Procedimentos Cirúrgicos Vasculares/história , Educação Médica/história , História do Século XX , História do Século XXI , Humanos , Cirurgiões/psicologia , Procedimentos Cirúrgicos Vasculares/educação
7.
Ann Vasc Surg ; 69: 125-132, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32554201

RESUMO

BACKGROUND: It is not uncommon for medical students seeking surgical residencies to apply to and rank two or more surgical specialties. Level of interest in a specialty is consistently cited as one of the most important factors for program directors when evaluating applicants for 0 + 5 integrated vascular surgery (IVS) programs. The purpose of this study was to examine trends in poly-specialty application submission to IVS and poly-specialty ranking of IVS to determine the percentage of applicants to IVS residencies with vascular surgery as their true preference. METHODS: Electronic Residency Application Service (ERAS) statistics for noninternational medical graduates from 2011 to 2017 were mined for trends in poly-specialty applications between IVS and other surgical disciplines. The poly-specialty application percentage, range, and standard deviation were determined. The National Resident Match Program (NRMP) results and data from 2011 to 2018 were also used to identify those U.S. seniors who ranked IVS programs as their preferred choice, defined as ranking vascular as the only choice or the first-choice specialty. This was compared with those who ranked a specialty other than vascular surgery first but had vascular surgery listed on their rank list. These data were also collected for applicants to orthopedic surgery, neurosurgery, otolaryngology, obstetrics and gynecology, integrated cardiothoracic surgery, and integrated plastic surgery. RESULTS: Between 2011 and 2017, applicants who submitted ERAS applications to IVS most often poly-specialty applied to IVS and general surgery (87%) followed by IVS and the following: preliminary surgery (71%), plastic surgery (22%), orthopedic surgery (19%), neurosurgery (17%), otolaryngology (16%), obstetrics and gynecology (12%), and urology (3%). The percentage of the applicant pool submitting rank lists with multiple specialties fell over the study period from 94% in 2011 to 67% in 2018. Between 2011 and 2018, an average of 14% of IVS applicants (n = 463), who submitted rank lists to the NRMP, ranked a specialty other than vascular as their true preference (range 7-23 SD 5). Only integrated cardiothoracic surgery had a higher percentage of applicants listing a different specialty as their true preference at 25% (range 18-36 SD 7). Nearly all (97-99%) applicants to orthopedic surgery, neurosurgery, otolaryngology, obstetrics and gynecology, and plastic surgery applied to that specialty as their true preference. CONCLUSIONS: IVS residency applicants were most likely to apply for poly-specialty via the ERAS to general surgery and IVS. Compared to the other surgical specialties, those who submitted rank lists to the NRMP listing integrated cardiothoracic and IVS had the highest likelihood of ranking another specialty higher. Care must be taken when evaluating applications to IVS residencies to determine the applicant's level of interest in vascular surgery as a career.


Assuntos
Escolha da Profissão , Educação de Pós-Graduação em Medicina , Internato e Residência , Candidatura a Emprego , Especialização , Estudantes de Medicina/psicologia , Cirurgiões/educação , Cirurgiões/psicologia , Procedimentos Cirúrgicos Vasculares/educação , Humanos , Motivação , Estudos Retrospectivos
8.
Ann Vasc Surg ; 69: 115-124, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32505679

RESUMO

BACKGROUND: There is a paucity of information describing the adoption of social media by the vascular surgery community and social media's effectiveness. We evaluated current trends in social media use by all accredited vascular surgery training programs (VSTPs) in the United States and National and Regional Vascular Societies (NVS) in comparison to hospital/institutions and general surgery programs (GSPs). METHODS: Four major social media platforms (Twitter, Facebook, Instagram, and YouTube) were individually searched for VSTPs, affiliated hospital/institution, affiliated GSP, and NVS profiles (31 societies). Social media presence was evaluated for quantitative and qualitative variables (likes/followers/posts and content) on each platform. Statistical analysis was performed utilizing a two-sample t-test, exact McNemar's and Fischer's exact test, as appropriate, with alpha set at 0.05. RESULTS: Social media accounts were found for 31% of VSTP. VSTP with both fellowship and integrated positions had a greater social media presence than integrated only (45% vs. 10%, P = 0.042) and fellowship only (45% vs. 26%, P = 0.044) programs. For integrated programs, an increase in residency positions filled in the 2019 match was associated with the use of social media (P = 0.002). VSTP social media presence was largest on Twitter (24%) with 232 total posts and 0.32 posts/day. 52% of NVS had a social media platform, with the highest prevalence on Facebook (42%) and highest utilization on Twitter (1422 posts, 0.47 posts/day). Hashtags were used for postings by 78% of VSTP and 100% of NVS. VSTP had a lower overall social media presence than their institutions and GSP (31% vs. 96% and 65%, P < 0.001). Twitter was used by VSTP significantly less than the institutions and GSP (24% vs. 87% and 57%, P < 0.001). Facebook and Instagram were used less by VSTP than institutions or GSP (10% vs. 93% and 26% P < 0.001, 4% vs. 76% and 24% P < 0.001 respectively). YouTube channels were the least used platform in VSTP compared with institutions (3% vs. 92%, P < 0.001), but comparable to GSP (3% vs. 10%, P = 0.062). Regarding content, VSTP accounts were used for comments on academic activity of residents/physicians, faculty research, patient education, and commendations. CONCLUSIONS: There is relative underuse of social media by VSTP in comparison to their associated institutions and general surgery programs. VSTP may modify their approach to recruitment by utilizing the follower base of institutions, surgery programs, and NVS or by leveraging established institutional marketing programs. Adoption of social media may provide vascular surgery increased exposure for trainee and patient recruitment and specialty brand recognition.


Assuntos
Educação de Pós-Graduação em Medicina , Mídias Sociais , Sociedades Médicas , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Bolsas de Estudo , Humanos , Internato e Residência , Avaliação de Programas e Projetos de Saúde , Especialização
13.
Ann Vasc Surg ; 67: 123-133, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32272145

RESUMO

BACKGROUND: Medical students and residents often evaluate training sites in vascular surgery with minimal exposure to those programs. We sought to identify factors associated with vascular surgery trainee satisfaction in relation to their current work environment and how they made their rank list. METHODS: All integrated residents and fellows currently in United States vascular training programs were queried using an anonymous electronic survey for variables of their current training environment, factors that influenced their rank order list, and satisfaction. Questions were graded on a Likert scale. Continuous, ordinal, and categorical variables were respectively analyzed using the two-sample t-test, Mann-Whitney U-test/Wilcoxon rank sum test, and Fisher's exact test. RESULTS: A total of 166 of 517 (32%) trainees completed the survey with equal distribution across postgraduate years. Respondents reported high rates of satisfaction with their training program overall (84%), including 88% (n = 83) of residents and 78% (n = 56) of fellows. Several work environment variables were associated with both resident and fellow satisfaction including program-funded trips for conferences and presentations (P = 0.027 for residents; P = 0.001 for fellows), diversity of operative cases (P = 0.024; P < 0.001), perception of a strong supportive social network at the hospital (P = 0.006; P = 0.001), and perception of appreciation by attending surgeons (P < 0.001; P < 0.001). Fellows who felt appreciated by nursing staff (P = 0.047), ancillary staff (P = 0.013), and patients were more likely to be satisfied (P = 0.011); however, this was not true for integrated residents. Social outings with nontrainee family and friends were associated with satisfaction for fellows (P = 0.002) but not integrated residents (P = 0.138), whereas social outings with vascular trainees were associated with satisfaction for integrated residents (P = 0.047) but not fellows (P = 0.375). Similarly, satisfied integrated residents were more likely to have close relationships with their vascular cotrainees (P = 0.035) than fellows (P = 0.349). No rank list factors were found to be predictive of current trainee satisfaction for integrated residents. Rank list factors associated with fellow satisfaction included recommendation of the institution from a mentor (P < 0.001), success of program graduates (P = 0.002), faculty (P = 0.014), perceived program prestige (P = 0.040), and amount of early operative exposure (P = 0.042). CONCLUSIONS: Vascular surgery trainees report a high level of satisfaction with their training program. Fellow satisfaction was more dependent on the perception of their workplace peers than integrated residents. Satisfied integrated residents were more likely to have close relationships with their vascular cotrainees than fellows.


Assuntos
Atitude do Pessoal de Saúde , Comportamento de Escolha , Educação de Pós-Graduação em Medicina , Internato e Residência , Satisfação no Emprego , Cirurgiões/educação , Cirurgiões/psicologia , Procedimentos Cirúrgicos Vasculares/educação , Adulto , Pesquisa Biomédica , Currículo , Feminino , Humanos , Masculino , Rede Social , Apoio Social , Inquéritos e Questionários , Estados Unidos , Carga de Trabalho , Local de Trabalho/psicologia
14.
Vascular ; 28(4): 342-347, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32241240

RESUMO

BACKGROUND AND AIM: Recognition of structured training in endovascular aortic repair (EVAR) for vascular trainees is increasing. Nevertheless, how trainees can achieve sufficient skills in EVAR sizing and graft selection is sparsely described. The aim of this study was to investigate the effect of systematic training in basic EVAR sizing and graft selection on vascular surgery trainees using a validated assessment tool. METHODS: Sixteen vascular surgery trainees were included in an intensive 6-h hands-on workshop in aortic sizing and stent graft selection for EVAR with a trainer-to-trainee ratio of 1:2. After 1-h lecture, participants did 5 h of supervised training on increasingly complex cases. Finally, the participants were tested using a validated assessment tool. RESULTS: All participants were able to size the test-case and select a stent graft combination in 24:35 (13:30-48:20) min (median and range). The participants' overall test scores (lower is better) were in median 17.9 (11.9-28.4). This did not differ from the scores of experienced EVAR operators 14.7 (11.7-25.2) (<200 EVAR's) (p = .32) but was inferior to the score of EVAR experts 11.2 (9.8 -18.7) (≥200 EVAR's) (p = .01). The sub-score for anatomical measurements was 10.6 (3.9-18.8) and comparable with the experienced group 9.7 (8.1-12.8) (p = .83) but inferior to the expert operators 6.5 (5.2-10.2) (p = .04). The sub-score for stent graft selection was 7.5 (4.9-14.1) and comparable with experienced operators scoring 4.5 (3.6-12.3) (p = .09) but inferior to the expert operators score of 5.0 (3.6-8.4) (p = .01). CONCLUSION: This study presents the results of a standardised one-day basic EVAR sizing and graft selection workshop. Vascular surgery trainees with no prior EVAR experience learned to size and select stent grafts for a simple infra-renal AAA on par with experienced EVAR operators.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Educação de Pós-Graduação em Medicina , Aprendizagem , Stents , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Procedimentos Cirúrgicos Vasculares/instrumentação , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Competência Clínica , Congressos como Assunto , Currículo , Avaliação Educacional , Escolaridade , Humanos , Desenho de Prótese , Análise e Desempenho de Tarefas
15.
Ann Vasc Surg ; 67: 497-502, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32179143

RESUMO

BACKGROUND: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an integrated 5-year vascular surgery residency program creating a 2-tiered system of training for vascular surgeons. The question remains if the new paradigm is equivalent to the traditional training. The true test of this may be looking at data from fully trained surgeons in their first years of practice. It is hard to obtain this data. There are surrogate methods that can be used. Operative experience of trainees is readily available as a substitute. The purpose of this study is to compare the operative experience of those graduating from the traditional (5 + 2) vascular training program with the integrated (0 + 5) program. METHODS: National operative case log data supplied by the ACGME was gathered and organized for vascular surgery residents graduating between 2013 and 2019. Mean case numbers were compared between integrated vascular residents and traditional vascular fellows (mean case numbers for vascular fellows included cases from their general surgery residencies). RESULTS: The 5 + 2 trainees performed an average of 35% more total procedures than the 0 + 5 trainees (1,662 ± 7 vs. 1,084 ± 12). The greater number of overall procedures performed by the 5 + 2 trainees was primarily realized by an increased number of abdominal (e.g., biliary, small/large intestine) cases. However, the 0 + 5 trainees performed 8% more vascular procedures (858 ± 10 vs. 794 ± 3). The greater number of vascular procedures performed by the 0 + 5 trainees was primarily realized by increased mean numbers of endovascular and venous procedure cases. CONCLUSIONS: The integrated 0 + 5 graduates performed more total vascular procedures than their 5 + 2 counterparts. The overall total operative experience remains greater for the traditional 5 + 2 graduates, given their additional 2 years of training. Further longitudinal studies will be needed to fully assess the effect of the newer integrated 0 + 5 training paradigm.


Assuntos
Educação de Pós-Graduação em Medicina , Internato e Residência , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Carga de Trabalho , Currículo , Escolaridade , Humanos , Fatores de Tempo
18.
Ann Vasc Surg ; 67: 115-122, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32171862

RESUMO

BACKGROUND: The digital footprint of vascular residency and fellowship programs may have an impact on an applicant's likelihood of selecting a given program. This may include content and accessibility of a particular program's website as well as its social media presence. The goal of this study is to evaluate the online presence of all accredited vascular surgery training programs in the United States and Canada. METHODS: A list of accredited vascular surgery training programs in the United States was obtained from the Accreditation Council for Graduate Medical Education and the Society for Vascular Surgery websites. Canadian program websites were sourced from the Canadian Society for Vascular Surgery website. Each program website was individually queried. A systematic Google search of each program was carried out to determine website accessibility. Thirty-one individual content and quality metrics were used to appraise the websites. Three major social media platforms (Twitter, Facebook, and Instagram) were individually searched for program profiles. RESULTS: A total of 105 independent vascular surgery fellowship programs in the 5 + 2 paradigm and 55 integrated vascular surgery residency programs in the 0 + 5 paradigm were identified in the United States. An additional 10 Canadian programs were also identified, including 10 integrated residency programs and 4 independent fellowships. Ninety-nine percent of integrated residency and fellowship programs were accessible through Google search. Program description was also almost universally available. Significant differences between US and Canadian programs were observed including the mention of salary information (43% vs. 10%, P = 0.039), clinic responsibilities (38% vs. 90%, P = 0.001), teaching responsibilities (34% vs. 100%, P < 0.0001), program director contact information (47% vs. 80%, P = 0.045), mention of journal club (52% vs. 100%, P = 0.003), research requirements (50% vs. 90%, P = 0.014), and past and current research (30% vs. 70%, P = 0.009 and 37% vs. 80%, P = 0.008, respectively). Additionally, there were significant differences in mention of institutions from which trainees came from (48% vs. 10%, P = 0.021), mention of hybrid operating room (42% vs. 100%, P = 0.0003), advertised medical student rotations (25% vs. 90%, P < 0.0001), and finally social media presence (13% vs. 70%, P < 0.0001). CONCLUSIONS: The overall digital footprint of the majority of training programs in the United States was small, unlike their Canadian counterparts. Although the vast majority of websites for vascular surgery training programs were accessible via simple internet searches, they lacked information that could have been important to applicants. Additionally, the significant underuse of social media platforms by American vascular surgery programs indicated a potential missed opportunity to target the millennials who make up most of the applicant pool to these programs.


Assuntos
Educação de Pós-Graduação em Medicina , Internet , Internato e Residência , Mídias Sociais , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Canadá , Comportamento de Escolha , Currículo , Humanos , Cirurgiões/psicologia , Estados Unidos
19.
J Vasc Surg ; 72(1): 298-303, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32037082

RESUMO

OBJECTIVE: The purpose of this study was to examine trends in application submission, rank lists, and applicant quality for vascular surgery integrated residency. METHODS: The National Resident Matching Program Results and Data reports and the Electronic Residency Application Service Statistics from 2007 to 2017 were compiled and mined for trends in terms of application submission and the number of applicants a program needed to rank to fill all residency positions. Applicant pool depth and percentage of programs applied to were calculated. Outcome data from the National Resident Matching Program were reviewed for 2014 and 2016 for United States Medical Licensing Examination Step scores and experiences. RESULTS: During the last 10 years, the number of vascular surgery integrated residency spots rose from 9 to 60 per year. Most programs offer one spot per year; none offer more than two. The average number of applications received by programs rose from 17 applications in 2008 to 63.8 in 2017. The average rank list depth needed by programs to fill the spots has not increased (range, 2.5-5.1; standard deviation, 0.73). The proportional depth of the applicant pool decreased from 4.6 U.S. and Canadian applicants for every one residency spot in 2008 to 1.7 applicants for every one residency spot in 2017. Applicant quality metrics were available for 2 years (2014 and 2016). Step 1 scores (237/239), Step 2 scores (250/250), research experiences (3.7/4.2), and volunteer experiences (5.9/5.5) remained nearly unchanged. The number of contiguous ranks for matched applicants remained stable (12.3/12.8). CONCLUSIONS: The current system promotes multiple inefficiencies, resulting in application glut. Fewer applicants are flooding programs with an increasing number of applications. More money is being spent on Electronic Residency Application Service applications without changes in the number needed to rank by applicants or programs to achieve a match. There is no improvement in the quality of the applicant. Should these trends continue, they represent an unsustainable model for resident selection.


Assuntos
Educação de Pós-Graduação em Medicina/tendências , Internato e Residência/tendências , Seleção de Pessoal/tendências , Cirurgiões/educação , Cirurgiões/tendências , Procedimentos Cirúrgicos Vasculares/educação , Procedimentos Cirúrgicos Vasculares/tendências , Currículo/tendências , Eficiência Organizacional/tendências , Humanos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Tempo
20.
Am J Surg ; 220(2): 322-327, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31910989

RESUMO

BACKGROUND/AIM: To investigate whether teaching procedures and surgical experience are associated with surgical site infection (SSI) rates. METHODS: This prospective cohort study of patients undergoing general, orthopedic trauma and vascular surgery procedures was done between 2012 and 2015 at two tertiary care hospitals in Switzerland/Europe. RESULTS: Out of a total of 4560 patients/surgeries, 1403 (30.8%) were classified as teaching operations. The overall SSI rate was 5.1% (n = 233). Teaching operations (OR 0.78, 95% CI 0.57-1.07, p = 0.120), junior surgeons (OR 0.80, 95% CI 0.55-1.15, p = 0.229) and surgical experience (OR 0.997, 95% CI 0.982-1.012, p = 0.676) were overall not independently associated with the odds of SSI. However, for surgeons' seniority and experience, these associations depended on the duration of surgery. CONCLUSIONS: In procedures of shorter and medium duration, teaching procedures and junior as well as less experienced surgeons are not independently associated with increased odds of SSI.


Assuntos
Cirurgia Geral/educação , Salas Cirúrgicas , Procedimentos Ortopédicos/educação , Infecção da Ferida Cirúrgica/epidemiologia , Procedimentos Cirúrgicos Vasculares/educação , Competência Clínica , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Fatores de Risco , Suíça/epidemiologia
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