title: Effects of increased vascular surgical specialization on general surgery trainees, practicing surgeons, and the provision of vascular surgical care.
abstract: BACKGROUND
  Vascular surgical education for general surgery residents is concerning as endovascular interventions increase and vascular surgery expands. The purpose of this study was to examine the effects these factors have on vascular surgery case numbers for general surgery residents and statewide surgeons and to report on former general surgery residents' perceptions of vascular surgery in training and practice.
  
  
  METHODS
  Case numbers for all general surgery residents graduating from the Greenville Hospital System from 1991 to 2007 and for the vascular surgery fellows graduating from 2003 to 2007 were obtained. A database identified case numbers and physician specialty for vascular procedures from 1997 through 2006. A survey gained perspectives of graduated general surgery residents on the vascular experience during residency and practice and on postresidency vascular caseload.
  
  
  RESULTS
  There was significant decline in resident participation in open abdominal aortic aneurysm (22.4 versus 7.7), carotid endarterectomy (37.2 versus 31.1), aortobifemoral bypass (18.6 versus 5.5), and lower extremity bypass (42.8 versus 19.1). Numbers for dialysis access creation (49.0 versus 57.1) were maintained. Statewide, comparing 1997 with 2006, the percentages of procedures performed by vascular surgeons were: abdominal aortic aneurysm (29.3% versus 49%; p < 0.001), carotid endarterectomy (28.9% versus 45.5%; p < 0.001), and dialysis access (4.6% versus 12.3%; p=0.020). The survey of general surgery graduates revealed lower extremity bypass, carotid endarterectomy, abdominal aortic aneurysm, and dialysis access are important in training. Dialysis access was the most common operation performed by the general surgery graduates.
  
  
  CONCLUSIONS
  There is a trend toward vascular surgeons and vascular residents performing most open vascular cases. Currently practicing surgeons believe there is value to vascular exposure for general surgeons in training, and vascular surgery should remain in general surgery training.
authors.affiliation: Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, SC 29605-5601, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Joels
authors.forename: Eugene M
authors.initials: EM
authors.lastname: Langan
authors.forename: David L
authors.initials: DL
authors.lastname: Cull
authors.forename: Corey A
authors.initials: CA
authors.lastname: Kalbaugh
authors.forename: Spence M
authors.initials: SM
authors.lastname: Taylor
mesh_terms: D000328:Adult; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000193:education / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data; D013502:General Surgery / Q000193:education*; D019538:Health Care Surveys; D006801:Humans; D007396:Internship and Residency; D012189:Retrospective Studies; D013022:South Carolina; D014656:Vascular Surgical Procedures / Q000193:education* / Q000706:statistics & numerical data / Q000639:trends