Vascular surgery residents and fellows graduate at higher levels of proficiency in endovascular as compared to open aortic operations

Le résumé fourni par la source

OBJECTIVE: Practice patterns regarding the surgical management of aortic pathologies have evolved over time, with a shift in care toward endovascular interventions and increasingly complex endovascular techniques. This raises concern for inadequate experience with aortic surgery, both open and endovascular, in vascular surgery training. Although numerous studies have explored trends in the volume of aortic cases completed during training, none have examined graduating proficiency in aortic surgery. We sought to examine the competence and autonomy of graduating vascular surgery trainees performing aortic operations using a multi-institutional sample of trainees. METHODS: Operative performance and autonomy ratings of post-graduate year 4-5 residents and all fellows performing aortic interventions from the Society for Improving Medical Professional Learning application database were collected for vascular surgery participating institutions from 2018 to 2023. 'Supervision only' and 'passive help' ratings were coded as 'autonomous,' whereas 'exceptional performance' and 'practice ready' were coded as 'competent.' Descriptive statistics were calculated for open and endovascular abdominal aortic aneurysm repair. Mixed effects logistic regressions were conducted to estimate the predictive association between procedure type and graduating trainee proficiency for all aortic procedures. RESULTS: A total of 54 trainees and 50 faculty from 19 programs completed 579 assessments (n = 394 endovascular; n = 185 open). For infrarenal aortic aneurysm repair, in the final year of training residents and fellows were assessed as 'autonomous' for 60.9% of endovascular and 21.1% of open procedures and were assessed as competent for independent practice in 50% of endovascular and 22.2% of open procedures. Regarding all aortic procedures, trainees were assessed as autonomous for 58.0% of endovascular and 41% of open procedures, and competent for 49.0% of endovascular and 37.0% of open procedures in their final year. There were no differences when comparing graduating integrated residents and fellows. However, trainees were less likely to achieve autonomous and competent ratings for open, as compared with endovascular, cases by graduation on both faculty (odds ratio, 0.25; 95% confidence interval, 0.11-0.53) and trainee self-assessment (odds ratio, 0.39; 95% confidence interval, 0.19-0.77). CONCLUSIONS: Vascular surgery trainees are more likely to achieve proficient levels of autonomy and competence in endovascular aortic cases by graduation, regardless of training paradigm. Trainees are also more likely to perceive themselves as achieving higher levels of proficiency than their faculty assessors rate them in open aortic procedures. These findings highlight the importance of developing innovative solutions to enhance aortic surgical skills in training.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.