Trainees

TRAINING Bolstering the vascular workforce: Session details how to start a training program

The workforce shortage issues set to plague vascular surgery over the next few decades, alongside an aging population and increase in vascular disease, forms the backdrop to a Thursday afternoon session designed to help surgeons navigate the tricky waters of starting a vascular training program, writes Bryan Kay.

Malachi Sheahan III, MD and Jeffrey Jim, MD, who together chaired the new program development section of the SVS Future of Vascular Surgery Task Force, will moderate and attempt to answer two top-line questions for those mulling over the possibility: “Do you have the resources? And where can you find help?”

The session will help usher attendees through the process of establishing programs, including leadership and faculty requirements, the constitution of curricula, and other needs like a vascular lab.

Sheahan will introduce a guidebook, entitled How to Develop A Vascular Surgery Training Program, a collaborative work from the Association of Program Directors in Vascular Surgery (APDVS) and the Society for Vascular Surgery (SVS).

“The U.S. population is increasing and aging,” he will tell those looking to help plug the workforce shortages expected to ensue through 2050. With cardiovascular disease continuing to be the country’s leading cause of death and morbidity, and the prevalence increasing 1–2% annually, the burden will remain, he will outline. The workforce phenomenon is international, Sheahan will add, sharing statistics laying out the scale of shortages in the United Kingdom, France and Canada. The session will look to explore the concept of increasing the supply of vascular surgeons, meaning more trainees, and explore the question of “can we preserve vascular surgery?—which comes amid a burgeoning field of “vascular specialists” who are not vascular surgeons, Sheahan tells Vascular Specialist@VAM.

Through the APDVS-SVS guidebook, a session aid, attendees will learn about the complexities and intricacies of both the five-year integrated vascular residency and the vascular fellowship.

Earlier this year, Sheahan and Jim outlined the scale of the task at hand in a presentation at the

“With a bit of a push, there are a lot of people out there who want to train vascular surgeons”

MALACHI SHEAHAN III

annual meeting of the Society for Clinical Vascular Surgery (SCVS) annual meeting in Las Vegas. Helped by the task force’s efforts, Sheahan explained, 28 new vascular training programs had been established nationwide.

The collaboration formed between the SVS and APDVS helped clear up the prerequisites of the Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education (ACGME) for the faculty and program director requirements needed to start both an integrated program and a fellowship.

The APDVS also provided stewardship to help guide those getting started through an often “byzantine and confusing” process, Sheahan said. They also increased outreach efforts through such mediums as the VAM 2022 session in question, which is currently a recurring feature on the VAM schedule. “With a bit of a push, there are a lot of people out there who want to train vascular surgeons,” Sheahan said.

Malachi Sheahan III

The session takes place in Hynes Convention Center Room 310 from 2–3 p.m.

EXAM PREPARATION

REVIEW BOOK SEEKS TO PLUG HOLE IN VSITE PREPARATION PROCESS

WHEN UNIVERSITY OF

Massachusetts Medical School integrated vascular surgery resident Thomas Creeden, DO, was preparing for his first Vascular Surgery In-Training Exam (VSITE), it struck him there was a gap in the market. While those training in most other surgical specialties had access to a high-yield textbook with which to prepare for exams, boards and even rotations, he mused, vascular surgery did not. “The modern-day textbook is something like 4,000-pages long, and seems kind of daunting,” Creeden tells Vascular Specailist@VAM.

So he decided to do something about the anomaly: After some encouragement from mentors, he went ahead and produced one himself. The result is The Vascular Surgery Review Book.

What started out as a culling-together of his notes in intern year morphed into a more organized undertaking during the second and third. Eventually, he got serious with the encouragement of UMass vascular chief Andres Schanzer, MD, and program director Jessica Simons, MD.

The driving force was to create a reference text that would be fundamentally easier and quicker to work through.

The book was published in the middle of June, and is available both in print and as a Kindle edition. It was also be available at the University of Massachusetts table at the General Surgery Resident/Medical Student Program: Residency Fair on Friday (5–6:30 p.m., Hall A).

Creeden, who will be in attendance at the table, was himself drawn to vascular surgery after a process of elimination, realizing he enjoyed the blend of minimally invasive procedures, open surgery, medicine and critical care.

“Once I spent a month on it, I wanted to spend another month on it, and then another month, and it just started snowballing for me,” he says.

The book publishing process ramped things up a notch. Creeden spent much of his spare time putting the title together, but then realized over the last three or four months the easy part was writing it.

Once he had navigated potential copyright pitfalls, he hired professional help to complete the publishing process, including a medical illustrator and a cover designer. “I’ve been very encouraged hearing other vascular surgery training programs are already utilizing the book and providing copies for their residents,” he adds.— Bryan Kay

TRAINEES

EXPLORING ALTERNATIVE TRAINING PATHWAYS TO BOLSTER VASCULAR SURGEON-FORCE

THE ROLE OF ALTERNATIVE AND

collaborative training pathways in concert with the integrated vascular surgery residency (0+5) and the vascular fellowship (5+2) will play an important role as the specialty tackles the expected shortfalls in workforce numbers over the next 30 years.

That was the main thrust of the message put forward by Jeffrey Jim, MD, chair of vascular and endovascular surgery at the Minneapolis Heart Institute-Abbott Northwestern Hospital in Minneapolis, yesterday afternoon during a VAM 2022 Concurrent Session entitled, “Progressing and Sustaining our Vascular Surgery Workforce into the Future through Innovation in Surgical Education.”

Jim spoke on the rise of the 0+5, the fate of the 5+2 and how innovation might help drive the specialty forward as vascular surgery confronts the highest projected growth in demand for its services as the population continues to increase.

The introduction of the integrated pathway in 2006 was popular with academic institutions, attracted “top” candidates from medical school and allows control of the entirety of a future vascular surgeon’s training. However, the financial cost is significant and can be labor intensive, Jim pointed out.

The 5+2 fellowship, was the standard in training for decades. In 2018, a change in requirements allows “community practice” based fellowships, which eliminated the need for an affiliated medical school or surgery residency and is associated with lower cost. This has allowed an increased growth in programs in the past couple of years, Jim continued.

Ultimately, Jim said that starting new fellowship programs “may be the most efficient way to increase the number of trainees.”

Alternative pathways are myriad and present a mixture of opportunities and challenges, he noted. They include postgraduate mentoring that encourages trainees into smaller communities; “+3” vascular training among trainees who have already competed two years of core training; community training programs that offer a year of vascular training to general surgery graduates committed to community practice. Jim also noted opportunities to partner with community hospitals to develop rotations to increase trainee clinical experience. This in particular may help boost trainee involvement in open aortic procedures amid the declining number of such cases to which graduates are exposed. This type of collaboration will also allow programs to increase the number of trainee positions.

There will be a shortage of available vascular surgeons in the U.S., Jim told attendees. But despite the successes in increasing the number of graduates in the last decade, he added, “we need to be flexible and innovative” to ensure future success.—Bryan Kay