A comparison of the knowledge base and surgical skills of integrated versus independent vascular surgery trainees

© 2016 Objective The purpose of this study was to compare the knowledge base and surgical skills of 0/5 integrated resident (IR) and 5/2 independent fellow (IF) vascular surgery trainees using milestones. Methods An anonymous survey, endorsed by the Association of Program Directors in Vascular Surgery, was sent to all program directors (PDs) of IR and IF training programs. The survey asked PDs to assess their trainees’ milestones in postgraduate year (PGY) 4 to 7 pertinent to knowledge base and surgical skills using a 5-point Likert scale. The PDs were then asked to choose their trainees’ three strongest and weakest milestones and to select from a list which factors were contributing most to the trainees’ strengths and weaknesses. Results were grouped by training paradigm and year, with comparisons made between IR PGY4 and PGY 6 trainees and IF PGY5 and PGY7 trainees. Milestone means and strengths, weaknesses, and contributing factor response rates were compared using a Mann-Whitney U test. Results Of 166 surveys sent, 56 (34%) PDs replied and evaluated a total of 87 trainees, 12 IR PGY4, 12 IR PGY5, 35 IF PGY6, and 28 IF PGY7. IR PGY4s were found to be lower than IF PGY6s in knowledge of procedural anatomy, and there was a trend that all IR PGY4 milestones were lower than IF PGY6 milestones. There was no difference in ranking of strongest milestones. Open surgical skills were ranked as a weakness of IR PGY4s more than of IF PGY6s. Time spent on vascular surgery call contributed more to the IR PGY4\u27s strengths, whereas time spent on general surgery contributed more to the IF PGY6\u27s strengths. Not enough time spent in outpatient clinics contributed more to the IR PGY4\u27s weaknesses, whereas no factors contributed more to the IF PGY6\u27s weaknesses. IR PGY5s were found to be lower than IF PGY7s in open surgical skills, and there was a trend that all IR PGY5 milestones were lower than IF PGY7 milestones. Open surgical skills were ranked as a strength of IF PGY7s more than of IR PGY5s. Open surgical skills were ranked as a weakness of IR PGY5s more than of IF PGY7s. No factors contributed more to the IR PGY5\u27s strengths, whereas time spent on general surgery contributed more to the IF PGY7\u27s strengths. Not enough time spent in the vascular laboratory and performing open surgical procedures contributed more to the IR PGY5\u27s weaknesses, whereas no factors contributed more to IF PGY7\u27s weaknesses. Conclusions PDs of IR trainees should consider increasing time on general surgery and performing open surgical procedures

Strategies of Hemodialysis Access

Chronic kidney disease and end-stage renal disease (ESRD) have become common diagnoses in the United States; in response, several clinical practice guidelines for the surgical placement and maintenance of arteriovenous (AV) hemodialysis access have been published. This review examines temporary hemodialysis access, permanent hemodialysis accesses, and the Hemodialysis Reliable Outflow (HeRO) graft. Figures show trends in the number of incident cases of ESRD, in thousands, by modality, in the US population, 1980 to 2012, Medicare ESRD expenditures, algorithm for access location selection, autogenous posterior radial branch-cephalic wrist direct access (snuff-box fistula),  autogenous radial-cephalic wrist direct access (Brescia-Cimino-Appel fistula), autogenous radial-basilic forearm transposition, prosthetic radial-antecubital forearm straight access, prosthetic brachial (or proximal radial) antecubital forearm looped access, autogenous brachial (or proximal radial) cephalic upper arm direct access,  autogenous brachial (or proximal radial) basilic upper arm transposition, prosthetic brachial (or proximal radial) axillary (or brachial) upper arm straight access, prosthetic superficial femoral-femoral (vein) lower extremity straight access and looped access, prosthetic axillary-axillary (vein) chest looped access,  straight access, and body wall straight access,  HeRO graft, banding of the outflow access tract, distal revascularization with interval ligation, upper extremity edema and varicosities associated with venous hypertension, internal jugular to subclavian venous bypass, and puncture-site pseudoaneurysms of an AV access. Tables list AV access configuration, autogenous AV access patency rates, and prosthetic AV access patency rates.  This review contains 20 figures, 3 tables, and 76 references. Keywords: Chronic Kidney Disease, End-stage renal disease, Short- and Long-term dialysis catheters, Autogenous AV access, Prosthetic AV access, HeRO graft, Arterial Steal, Venous hypertension, Pseudoaneurysm, Megafistula</jats:p

Strategies of Hemodialysis Access

Chronic kidney disease and end-stage renal disease (ESRD) have become common diagnoses in the United States; in response, several clinical practice guidelines for the surgical placement and maintenance of arteriovenous (AV) hemodialysis access have been published. This review examines temporary hemodialysis access, permanent hemodialysis accesses, and the Hemodialysis Reliable Outflow (HeRO) graft. Figures show trends in the number of incident cases of ESRD, in thousands, by modality, in the US population, 1980 to 2012, Medicare ESRD expenditures, algorithm for access location selection, autogenous posterior radial branch-cephalic wrist direct access (snuff-box fistula),  autogenous radial-cephalic wrist direct access (Brescia-Cimino-Appel fistula), autogenous radial-basilic forearm transposition, prosthetic radial-antecubital forearm straight access, prosthetic brachial (or proximal radial) antecubital forearm looped access, autogenous brachial (or proximal radial) cephalic upper arm direct access,  autogenous brachial (or proximal radial) basilic upper arm transposition, prosthetic brachial (or proximal radial) axillary (or brachial) upper arm straight access, prosthetic superficial femoral-femoral (vein) lower extremity straight access and looped access, prosthetic axillary-axillary (vein) chest looped access,  straight access, and body wall straight access,  HeRO graft, banding of the outflow access tract, distal revascularization with interval ligation, upper extremity edema and varicosities associated with venous hypertension, internal jugular to subclavian venous bypass, and puncture-site pseudoaneurysms of an AV access. Tables list AV access configuration, autogenous AV access patency rates, and prosthetic AV access patency rates.  This review contains 20 figures, 3 tables, and 76 references. Keywords: Chronic Kidney Disease, End-stage renal disease, Short- and Long-term dialysis catheters, Autogenous AV access, Prosthetic AV access, HeRO graft, Arterial Steal, Venous hypertension, Pseudoaneurysm, Megafistula</jats:p

Strategies of Hemodialysis Access

Chronic kidney disease and end-stage renal disease (ESRD) have become common diagnoses in the United States; in response, several clinical practice guidelines for the surgical placement and maintenance of arteriovenous (AV) hemodialysis access have been published. This review examines temporary hemodialysis access, permanent hemodialysis accesses, and the Hemodialysis Reliable Outflow (HeRO) graft. Figures show trends in the number of incident cases of ESRD, in thousands, by modality, in the US population, 1980 to 2012, Medicare ESRD expenditures, algorithm for access location selection, autogenous posterior radial branch-cephalic wrist direct access (snuff-box fistula),  autogenous radial-cephalic wrist direct access (Brescia-Cimino-Appel fistula), autogenous radial-basilic forearm transposition, prosthetic radial-antecubital forearm straight access, prosthetic brachial (or proximal radial) antecubital forearm looped access, autogenous brachial (or proximal radial) cephalic upper arm direct access,  autogenous brachial (or proximal radial) basilic upper arm transposition, prosthetic brachial (or proximal radial) axillary (or brachial) upper arm straight access, prosthetic superficial femoral-femoral (vein) lower extremity straight access and looped access, prosthetic axillary-axillary (vein) chest looped access,  straight access, and body wall straight access,  HeRO graft, banding of the outflow access tract, distal revascularization with interval ligation, upper extremity edema and varicosities associated with venous hypertension, internal jugular to subclavian venous bypass, and puncture-site pseudoaneurysms of an AV access. Tables list AV access configuration, autogenous AV access patency rates, and prosthetic AV access patency rates.  This review contains 20 figures, 3 tables, and 76 references. Keywords: Chronic Kidney Disease, End-stage renal disease, Short- and Long-term dialysis catheters, Autogenous AV access, Prosthetic AV access, HeRO graft, Arterial Steal, Venous hypertension, Pseudoaneurysm, Megafistula</jats:p