American board of vascular surgery: the first 7 years

The American Board of Vascular Surgery (ABVS) was incorporated in 1996 with a vision of improved training standards and certification of vascular surgeons. At that time, 91% of those holding American Board of Surgery Certificates of Added Qualifications in Vascular Surgery supported the formation of the ABVS. Subsequent events have led to a clear definition of specific educational issues important to the vascular surgery community. Unresolved issues relate to the need to complete a general surgery residency before beginning a vascular surgery fellowship, the continued inclusion of vascular surgery as a primary component of general surgery training, and the absence of a designated Residency Review Committee for Vascular Surgery. These issues have persisted since the inception of the ABVS. An application for the ABVS to become an American Board of Medical Specialties (ABMS) primary board was submitted in 2002 with a preliminary hearing before a liaison committee composed of American Medical Association and ABMS members. The American Board of Surgery (ABS) and a minority of the vascular surgery community vigorously opposed the application. The perceived divisiveness created by their actions contributed to the application's initial rejection and the necessity for an appeal. Certain ABS directors have recently stated that they would consider approving multiple track-type training that could allow single certification in vascular surgery, following 5 to 6 years of postgraduate training after medical school. The ABVS cautiously supports this action, recognizing that this radical change for the ABS may not be feasible given the broad-ranging interests of general surgery and restrictive ABMS guidelines for certifying medical specialists. The impact of not resolving the critical issues facing vascular surgery in a timely manner is that there will be inadequate numbers of competent vascular surgeons to provide for society's needs. An independent ABMS-approved ABVS provides a clear opportunity to resolve the recognized failings of the status quo.     

Guidelines for hospital privileges in vascular surgery and endovascular interventions: Recommendations of the Society for Vascular Surgery

The Hospital Privileges Practice Guideline Writing Group of the Society for Vascular Surgery is making the following five recommendations concerning guidelines for hospital privileges for vascular surgery and endovascular therapy. Advanced endovascular procedures are currently entrenched in the everyday practice of specialized vascular interventionalists, including vascular surgeons, but open vascular surgery remains uniquely essential to the specialty. First, we endorse the Residency Review Committee for Surgery recommendations regarding open and endovascular cases during vascular residency and fellowship training. Second, applicants for new hospital privileges wishing to perform vascular surgery should have completed an Accreditation Council for Graduate Medical Education-accredited vascular surgery residency or fellowship or American Osteopathic Association-accredited training program before 2020 and should obtain American Board of Surgery certification in vascular surgery or American Osteopathic Association certification within 7 years of completion of their training. Third, we recommend that applicants for renewal of hospital privileges in vascular surgery include physicians who are board certified in vascular surgery, general surgery, or cardiothoracic surgery. These physicians with an established practice in vascular surgery should participate in Maintenance of Certification programs as established by the American Board of Surgery and maintain their respective board certification. Fourth, we provide recommendations concerning guidelines for endovascular procedures for vascular surgeons and other vascular interventionalists who are applying for new or renewed hospital privileges. All physicians performing open or endovascular procedures should track outcomes using nationally validated registries, ideally by the Vascular Quality Initiative. Fifth, we endorse the Intersocietal Accreditation Commission recommendations for noninvasive vascular laboratory interpretations and examinations to become a Registered Physician in Vascular Interpretation, which is included in the requirements for board eligibility in vascular surgery, but recommend that only physicians with demonstrated clinical experience in the diagnosis and management of vascular disease be allowed to interpret these studies.     

Primary Certification in Vascular Surgery: What Does this Really Mean?

A primary certificate for vascular surgery has recently been approved by both the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education. This new training paradigm will allow training and certification in vascular surgery without first obtaining American Board of Surgery certification in general surgery. There are now several pathways ways to obtain vascular surgery certification, which are described in this article. All programs require an MD or DO degree from an institution accredited by the Liaison Committee of Medical Education or by the American Osteopathic Association. Graduates of schools of medicine from countries other than the United States or Canada must present evidence of final certification by the Education Commission for Foreign Medical Graduates.     

Does the Vascular Surgery Board of the American Board of Surgery work?

Recommendations to form an independent American Board of Vascular Surgery were made several years ago by leaders in vascular surgery. All major vascular societies in the United States voted by majority rule to approve the formation of this organization. Although the Vascular Surgery Board of the American Board of Surgery is well intentioned, its focus and intentions are outdated because it is subservient to the American Board of Surgery.     

New training paradigms and program requirements

Specialized training in vascular surgery evolved over the second half of the 20th century and continues to do so in 2006. Apprenticeship-style training in the 1960s and 1970s gave way to formal curriculum- and case-based programs created in the 1980s to improve the quality and consistency of vascular care. Recent developments have resulted in the Accreditation Council for Graduate Medical Education's approval of additional training pathways leading to certification by the American Board of Surgery. This article summarizes the history of vascular surgery training in the United States and describes the four types of currently approved programs--Standard, Early Specialization, Independent, and Integrated--for specialty training in vascular surgery. These are the only programs that can lead to American Board of Surgery certification in vascular surgery.     

Educational resources for vascular laboratory education in vascular surgery residencies and fellowships: Survey of Vascular Surgery Program Directors

ObjectiveThe Registered Physician in Vascular Interpretation (RPVI) credential is a prerequisite for certification by the Vascular Surgery Board of the American Board of Surgery. Of concern, as more current trainees and recent program graduates take the Physician Vascular Interpretation (PVI) examination, vascular surgery trainee pass rates have decreased. Residents and fellows have a lower PVI examination pass rates than practicing vascular surgeons. The purpose of this study was to assess current vascular laboratory (VL) training for vascular surgery residents and fellows and to identify gaps that residency and fellowship programs might address.MethodsProgram directors (PDs) of Accreditation Council for Graduate Medical Education-accredited vascular surgery programs (107 fellowships, 53 integrated residency programs) were surveyed using a web-based tool. Responses were submitted anonymously. Data collected included information about the program, the PD, accreditation status of the VL, and the curriculum used to meet the PVI prerequisites. Concurrent data (June 2017) on the credentials of all PDs were obtained from the Alliance for Physician Certification and Advancement (APCA).ResultsSixty-one of 117 PDs participated in the survey (52% response rate). Of these, 44 individuals (72% of responders) reported they held the RPVI and/or Registered Vascular Technologist credential. Records from APCA indicated that 51 of 117 PDs of accredited vascular surgery residencies and fellowships (44%) had an RPVI/Registered Vascular Technologist credential. Ninety-four percent reported that their VL was accredited. Practical VL experience for trainees was reported to be 20 hours or less by 62% of respondents. The use of a structured curriculum for practical experience was reported by only 15 programs. Programs with fellowships established for more than 10 years were more likely to have a structured program for didactic instruction (P = .03). Only 23 programs reported a dedicated VL rotation. Didactic instruction provided was 20 hours or less for 75% of the cohort.ConclusionsIn the absence of a standardized VL curriculum, there is variation in the VL instruction provided to trainees. Fellowship programs with longer histories have more structured instruction, but time allocated to VL education is substantially less than the 30 hours of didactic and 40 hours of practical experience recommended by the APCA. Programs and learners may benefit from the development of VL training guidelines and curriculum resources.     

An analysis of vascular surgical manpower requirements and vascular surgical rates in the United States

Inherent in any analysis of vascular surgical manpower must be accurate data on surgical rates and numbers of surgeons who perform vascular operations. For in-depth analysis of age-sex standardized vascular operative rates from 1979 to 1984 and a determination of current manpower levels, data from the National Center for Health Statistics (NCHS) and the American Board of Surgery (ABS) were reviewed. During 1979 to 1984, total vascular surgical procedures increased 50%. In 1983 such operations comprised 11% of all general surgical procedures and 3% of all operations performed in this country. In 1983, 95,000 carotid endarterectomies, 74,000 peripheral bypasses, were performed. Through November 1984, among approximately 1600 surgeons who had applied to take the General Vascular Surgery Examination, 676 took the examination and 545 passed. What percentage of all vascular surgeons these 1600 represent is unknown. Consequently, what percentage of the total vascular operative load their own experiences represent is uncertain. As of May 1985, the Residency Review Committee for General Surgery had approved 42 fellowship positions in 29 vascular training programs. How these training figures will change to meet optimal manpower requirements remains undefined. Although data concerning operative rates have become more precise, forecasting manpower needs will be met with skepticism because of unknown current and future numbers of vascular surgeons and their average caseloads. Regardless of these uncertainties, vascular surgeons, program directors, and health analysts should be aware of such information because until we know how many vascular surgeons are necessary to provide optimal care, training and certification can not rationally evolve.     

Guidelines for hospital privileges in vascular and endovascular surgery: recommendations of the Society for Vascular Surgery

The Clinical Practice Council of the Society for Vascular Surgery (SVS) was charged with providing an updated consensus on guidelines for hospital privileges in vascular and endovascular surgery. One compelling reason to update these recommendations is that vascular surgery as a specialty has continued to evolve with a significant shift towards endovascular therapies. The Society for Vascular Surgery is making the following four recommendations concerning guidelines for hospital privileges for vascular and endovascular surgery. First, anyone applying for new hospital privileges to perform vascular surgery should have completed an Accreditation Council for Graduate Medical-accredited vascular surgery residency and should obtain American Board of Surgery certification in vascular surgery within 3 years of completion of their training. Second, we reaffirm and provide updated recommendations concerning previous established guidelines for peripheral endovascular procedures, thoracic and abdominal aortic endograft replacements, and carotid artery balloon angioplasty and stenting for trainees and already credentialed physicians who are adding these new procedures to their hospital credentials. Third, we endorse the Residency Review Committee for Surgery recommendations regarding open and endovascular cases during vascular residency training. Fourth, we endorse the Inter-societal Commission for Accreditation of Vascular Laboratories (ICAVL) recommendations for noninvasive vascular laboratory interpretations and examinations to become a registered physician in vascular interpretation (RPVI) or a registered vascular technologist (RVT).     

Gefäßchirurgische Ausbildung in Österreich: Gegenwart, Ziele, Visionen

Lengthy training, detouring via general surgical training, the only EU-wide status as an additive subspecialty without international recognition and hitherto inferior training in endovascular techniques all make it difficult to train qualified vascular surgeons in Austria. By developing a curriculum closely based on the European Board of Vascular Surgery (EBVS) standards, the Austrian Society for Vascular Surgery (ÖGG) tries to internationalize training and to include the teaching of endovascular techniques. The large variety in content and trainers necessitates more structuring and better regulation of vascular surgical training to achieve comparable standards. Thorough documentation of all training steps will make these transparent also in later medical practice. Lengthy training and lack of international recognition can only be overcome by creating a separate specialty of vascular surgery. Instituting a medical specialty of vascular medicine, which would combine all competences of angiology, endovascular procedures and vascular surgery, might be a further point for discussion.     

The Australian experience in training and certification of vascular surgery

Training in vascular surgery in Australia and New Zealand has been closely related to the policies and politics of the Royal Australasian College of Surgeons. It has evolved from being part of the training for General Surgery through a two year post Fellowship training program in Vascular Surgery commencing in 1985 to the establishment in 1996, by the College, of a Board in Vascular Surgery responsible for training and examining in Vascular Surgery as specialty independent of the Board in General Surgery.     

219 vascular fellows' perception of the future of vascular surgery

In an attempt to identify the fellows' concerns about the future of the field of vascular surgery, we conducted a survey consisting of 22 questions at an annual national meeting in March from 2004 to 2007. In order to obtain accurate data, all surveys were kept anonymous. The fellows were asked (1) what type of practice they anticipated they would be in, (2) what the new training paradigm for fellows should be, (3) to assess their expectation of the needed manpower with respect to the demand for vascular surgeons, (4) what were major threats to the future of vascular surgery, (5) whether they had heard of and were in favor of the American Board of Vascular Surgery (ABVS), (6) who should be able to obtain vascular privileges, and (7) about their interest in an association for vascular surgical trainees. Of 273 attendees, 219 (80%) completed the survey. Males made up 87% of those surveyed, and 60% were between the ages of 31 and 35 years. Second-year fellows made up 82% of those surveyed. Those expecting to join a private, academic, or mixed practice made up 35%, 28%, and 20% of the respondents, respectively, with 71% anticipating entering a 100% vascular practice. Forty percent felt that 5 years of general surgery with 2 years of vascular surgery should be the training paradigm, while 45% suggested 3 and 3 years, respectively. A majority, 79%, felt that future demand would exceed the available manpower, while 17% suggested that manpower would meet demand. The major challenges to the future of vascular surgery were felt to be competition from cardiology (82%) or radiology (30%) and lack of an independent board (29%). Seventeen percent were not aware of the ABVS, and only 2% were against it; 71% suggested that vascular privileges be restricted to board-certified vascular surgeons. Seventy-six percent were interested in forming an association for vascular trainees to address the issues of the future job market (67%), endovascular training during fellowship (56%), increasing focus on the vascular fellows at national meetings (49%), and representation for the fellows on the national councils (37%). This survey suggests that several significant issues exist in the minds of vascular trainees that have not been addressed and may present opportunities for further dialogue.     

The importance of vascular surgery training in a general surgery practice

The aim of this report was to document the practice of vascular surgery for graduates of 4 general surgery training programs.Graduating residents from 1991 to 1995 were surveyed by phone to document the number of reconstructive vascular and dialysis access procedures that they performed during the most recent 12 months. Those who pursued additional training beyond general surgery or who did not successfully complete the certifying examination of the American Board of Surgery (ABS) were excluded. In addition, the Resident Review Committee for Surgery (RRC-S) defined category report for these same general surgeons during their residency was examined.Fifty-five percent (26 of 47) of the board-certified general surgeons do either reconstructive or dialysis access vascular surgery. The average number of procedures in the RRC-S defined category for this cohort was 76. During the focused 12 months, 1986 vascular procedures were done by these 26 surgeons (76 cases per surgeon).In certain regions of this country, a significant volume of vascular surgery is done by general surgeons who have an ABS primary certificate alone. The technique of control and repair of major arteries and veins, the consequences of distal organ ischemia, reperfusion injury, thrombosis, and embolization are important anatomic and physiologic principles that must be taught in the curriculum to general surgeons, regardless of their future surgical careers. (Curr Surg 57:381-383. Copyright 2000 by the Association of Program Directors in Surgery.)     

Vascular surgery training in general surgery residency programs: the Canadian experience

OBJECTIVES: Vascular surgery is traditionally considered a component of general surgery. There is growing evidence of improved patient outcome related to surgeon volume and vascular certification status. The American Board of Surgery in the United States, as well as until recently the Royal College of Physicians and Surgeons in Canada, requires that vascular surgery be considered an essential content area of general surgery training. This requirement is controversial. The purpose of this study was to describe experience and perceived competence in common vascular surgery procedures during general surgery residency training in Canada. METHODS: This web-based survey was conducted between January and June 2002. General surgery program directors (GSPDs), vascular surgeons involved in general surgery training programs (VSs), and senior general surgery residents (SRs) from the 13 English-speaking general surgery programs in Canada were surveyed. Questions were asked regarding which vascular surgery procedures are appropriate for general surgeons to perform, which procedures SRs are trained to perform, and which procedures SR intend to perform. RESULTS: The response rate was 62% for GSPDs, 57% for VSs, and 45% for SRs. Overall, 49% of SRs did not intend to perform any vascular procedures after training. GSPDs, VSs, and SRs indicated that most SRs should be and are trained to perform varicose vein surgery, leg amputation, and femoral embolectomy (P >.05). In addition, GSPDs, VSs, and SRs indicated that SRs should not be and are not trained to perform infrainguinal bypass grafting, carotid endarterectomy, or abdominal aortic aneurysm (AAA) repair (P >.05). There were significant differences with respect to ruptured AAA repair: 49% of SRs, 25% of PDs, and only 12% of VSs believe that general surgeons should be trained to perform ruptured AAA repair (P <.05). Overall, 76% of VSs believe SRs receive too little vascular training. CONCLUSION: There is similarity between GSPDs, VSs, and SRs with respect to vascular surgery training in Canadian general surgery programs. Vascular surgery training cannot be considered a component of general surgery. More rotations or fellowship training is required to become competent in management of common vascular surgery procedures. Perhaps this level of competence should not be an objective of general surgery training.     

Vascular Surgery Won a Battle But Is Losing the War: A Call to Arms for Every Vascular Surgeon

This paper describes the present status of the initiative to obtain American Board of Medical Specialties (ABMS) approval of an independent American Board of Vascular Surgery (ABVS). The need for such a board arises from the evolution of vascular surgery into a distinct, well-defined specialty that deals with all aspects of vascular disease, including knowledge of its natural history, all methods of noninvasive and invasive diagnosis, conservative and medical treatment, open operative treatment, endovascular treatment, and periprocedural care. Because of the greater skill requirements and increased complexity of vascular surgery, its paradigms of training must be changed. Longer periods of vascular training are required with a reciprocal 2- to 3-year shortening of training in general surgery. This cannot be done without an independent ABVS. The effort to obtain ABVS approval has elicited opposition from the American Board of Surgery (ABS) and from some vascular surgery leaders associated with it, making the ABVS a contentious issue. A successful effort was made to reach consensus within vascular surgery, and the ABVS application was submitted to the ABMS. As a result of an ABS campaign that combined pressure and dire warnings, this application encountered intense opposition within the ABMS and its Liaison Committee for Specialty Boards (LCSB). Institutional and professional self-interest, rather than quality of patient care, appeared to be the overriding considerations in the ABS argument. Measures to overcome this ABS opposition and obstructionism are proposed. They require unity, action, and tangible support from all vascular surgeons. If this call to arms goes unheeded, vascular surgery will not continue to be the self-sufficient specialty it has become and, most importantly, patient care will suffer.     

Factors influencing outcome of the American Board of Surgery Certifying examination: an observational study

BACKGROUND: Because of the content of the American Board of Surgery (ABS) certifying (oral) examination, there is a perception that those in some subspecialty surgical training programs at the time of the examination may have a lower pass rate. In addition, the format of the oral examination has prompted the use of specialized preparation such as "mock orals" and commercial courses. The purpose of this study was to correlate the pass rates on the ABS certifying examination with the practice status and methods of specialized preparation. MATERIALS AND METHODS: A survey covering demographic information, type of surgical practice at the time of the examination, methods of preparation, and results of the examination was distributed to 1997 and 1998 graduates via a request to surgical residency program directors. RESULTS: One hundred one of 268 program directors supplied 717 names. There were 465 responses. Surveys distributed by the other 167 program directors resulted in an additional 81 responses. Four hundred ten (75%) of the respondents had taken the certifying examination. The total pass rate was 91%. There were no significant differences in the pass rate between those in private practice general surgery; those in academic general surgery; Thoracic, Vascular, or Plastic Surgery Fellows; those in other surgical fellowships; and those in the military or research. No significant differences in the pass rates were noted between those who prepared with formal mock orals, with informal mock orals, with a commercial course, with combinations of the three, and with no specialized preparation. CONCLUSION: Performance on the ABS certifying examination was not influenced by the candidate's practice status at the time of the examination. A substantial percentage of examinees either are exposed to or perceive the need to pursue specialized preparation for the examination, a behavior that in general produces good results.     

Evolution of the specialty of colon and rectal surgery: Historical perspective

The field of Colon and Rectal Surgery has a rich history which has significantly evolved over the years from its beginnings as the American Board of Proctology to what is now the American Society of Colon and Rectal Surgery with over 3000 members. Although the training requirements have changed dramatically, the interest of graduating General Surgery Residents for Colon and Rectal Surgery continues to soar. The rising popularity of the field is reflected in the increasing number of fellowship programs as well as the greater number of practicing Colon and Rectal Surgeons.     

Certification and maintenance of certification in surgery

The processes that lead to certification by the American Board of Surgery (ABS) emphasize surgeons' training and qualifications. Moreover, the need for periodic recertification appears to provide strong motivation for surgeons to remain current. Such certification is regarded as having great value among patients, but concerns about quality and safety have increased pressure to assess what surgeons actually do in practice. As a result, the American Board of Medical Specialties (ABMS) member boards have recently initiated Maintenance of Certification (MOC) programs that add a requirement for assessment of practice performance to the elements of traditional certification. This article describes the current ABS certification process and the ABS MOC program in greater detail.     

How Will the Introduction of Primary Certificate Training Programs Change Vascular Surgery Training Programs?

New requirements for vascular surgery training allow several routes to Board eligibility in the specialty. Individuals can enter vascular residency directly from medical school, after 3 years of surgical residency, or after completion of the traditional 5 years of surgery training. Vascular surgery program directors will be faced with the challenges of obtaining institutional support, designing an acceptable educational program, and working closely with the general surgery program director to ensure both programs are successful. Faculty in the vascular program may find working with residents right out of medical school or after only 3 years of surgery training to be a challenge, especially in terms of developing the requisite technical skills. Residents must be able to demonstrate mastery of the six competencies in addition to the skills of vascular surgery. Because, in some ways, this new vascular training scheme is an experiment in redesigning all surgical education, the vascular community will need to carefully evaluate the results by monitoring the practices of those who graduate from these programs.     

A profile of female academic surgeons: training, credentials, and academic success

The objective of this study was to determine the profile (credentials, training, and type of practice) of female academic general surgeons and factors that influenced their career choice. A survey was sent to female academic surgeons identified through general surgery residency programs and American medical schools. The women had to be Board eligible/certified by the American Board of Surgery or equivalent Board and have an academic appointment in a Department of Surgery. Data were analyzed using the SPSS program. Two hundred seventy women (age range, 32-70 years) completed the survey (98.9% response rate). Fellowships were completed by 82.3 per cent (223/270), most commonly in surgical critical care. There were 134 (50.2%, 134/367) who had two or more Board certificates, most frequently (46%, 61/134) in surgical critical care. Full-time academic appointments were held by 86.7 per cent of women, most as assistant professors, clinical track; only 12.4 per cent were tenured professors. The majority of women described their practice as "general surgery" or "general surgery with emphasis on breast." The most frequent administrative title was "Director." Only three women stated that they were "chair" of the department. The top reason for choosing surgery was "gut feeling," whereas "intellectual challenge" was the reason they pursued academic surgery. When asked "Would you do it again?", 77 per cent responded in the affirmative. We conclude that female academic surgeons are well trained, with slightly more than half having two or more Board certificates; that most female academic surgeons are clinically active assistant or associate professors whose practice is "general surgery," often with an emphasis on breast disease; that true leadership positions remain elusive for women in academic general surgery; and that 77 per cent would choose the same career again.     

Surgical oncology: a specialty in evolution.

Surgical oncology has established its role in the multidisciplinary care of the cancer patient. Surgical oncology fellowships are organized to teach multimodality treatment. The typical fellow has completed 6 years of general surgery residency and 1 year in the laboratory with the resultant eight publications. Data compiled from the review of two Society of Surgical Oncology-approved fellowship programs, the Surgical Residency Review Committee and the American Board of Surgery, indicate that the majority of fellows join academic faculties and enhance the training of general surgeons, who, in turn, have the major responsibility for oncologic care of the population at large.