Have Endovascular Procedures Negatively Impacted General Surgery Training?
|Daniel J Grabo*, Paul J. DiMuzio*, John C. Kairys*, Stephen E. McIlhenny*, Albert G. Crawford*, Charles J. Yeo |
Thomas Jefferson University, Philadelphia, PA
|OBJECTIVE(S): Technological advances in vascular surgery have changed the field dramatically over the past ten years. Herein, we evaluate the impact of endovascular procedures on general surgery training.|
METHODS: National operative logs from the Residency Review Committee were examined from 1996 through 2006. The mean number of cases reported by all graduating U.S. general surgery residents, reflecting their entire categorical experience, was obtained for: elective open AAA repair, endovascular AAA repair, carotid endarterectomy, femoral-popliteal bypass, balloon angioplasty, and dialysis access creation.
RESULTS: As endovascular surgical therapies became widespread, resident experience dramatically dropped for elective open AAA repair, carotid endarterectomy, and femoral-popliteal bypass (52%, 26%, 45%, respectively over the study period, P<0.0001). Conversely, dialysis access creation, a procedure without an endovascular alternative, has remained stable over this same period. Resident experience in endovascular procedures (AAA, balloon angioplasty) has not increased reciprocally (2.3 and 2.1 cases/resident in 2006, respectively). Overall, resident vascular case volume has decreased by 34% over ten years (P<0.0001).
CONCLUSIONS: General surgery resident experience in index vascular procedures has significantly decreased as technology has advanced within the field. Disappointingly, this loss has not been replaced by direct experience with these new endovascular approaches. These data demonstrate the potential negative impact technology can have on how we currently train general surgeons, and underscore the need to preserve residency education in the face of emerging technologies.
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