VESS14 - The Impact of Reduced General Surgery Requirements on Integrated Vascular Surgery Residents' Operative Experience

Objectives: The Accreditation Council for Graduate Medical Education (ACGME) reduced core surgical requirements during integrated vascular surgery residency from 24 months to 18 months in 2018. The aim of this study is to assess the impact of this reduction on vascular residents’ operative experience.

Methods: A retrospective analysis of public ACGME case logs was performed for the five years following requirement reduction (post-reduction era, 2018-2022) for all vascular surgery residents. Trends were evaluated for mean number of surgeon chief/junior cases over four categories (general surgery open, general surgery laparoscopic, vascular surgery open, and vascular surgery endovascular) in three anatomic regions (head/neck, thoracic, and abdominal) using linear regression in the post-reduction era. The overall averages for the post-reduction era were compared to overall averages from the five years before the reduction (pre-reduction era, 2013-2017) using t-test.

Results: In the post-reduction era, the average number of cases logged per year by integrated residents in all categories was 260.0. General surgery cases consistently accounted for 34-38% of total operative volumes (p=0.88) with an average of 95.3 cases (Fig 1). Operative experience by anatomic region demonstrated no significant changes except for trends toward a decrease in vascular open head/neck cases (54.4 to 42.6 cases, p=0.009) and an increase in endovascular thoracic cases (16.8 to 19.7 cases, p=0.003). General surgery open and laparoscopic cases in all three anatomic categories remained stable. When comparing case averages between pre-reduction and post-reduction eras, there were no significant changes in total operative volume, open cases (including open abdominal aortic aneurysm repair), or the proportion of general versus vascular surgery cases. However, there were statistically significant shifts in types of cases done. There was a minor decrease in general surgery laparoscopic averages in the post-reduction era (49.8 to 44.8 cases, p=0.047) (Fig 2) with concomitant minor increases in general surgery open thoracic and open abdominal averages. Vascular surgery endovascular averages had a minor decrease in the post-reduction era from 63.7 to 61.4 cases (p=0.039), driven mostly by decreased abdominal cases.

Conclusions: This study demonstrates that reducing core surgery requirements for integrated vascular residents from 24 to 18 months did not negatively impact operative volume. The decrease in general surgery laparoscopic cases between the pre- and post-reduction eras suggests a sensible shift towards more relevant general surgery cases for the vascular surgery resident. Thus, a further reduction in general surgery requirements to 12 months is likely a feasible option without compromising surgical training quality.