title: The evolving integrated vascular surgery residency curriculum.
abstract: BACKGROUND
  Since their introduction several years ago, integrated (0 + 5) vascular surgery residency programs are being increasingly developed across the country. To date, however, there is no defined "universal" curriculum for these programs and each program is responsible for creating its own curriculum. The aim of this study was to review the experiences of current 0 + 5 program directors (PDs) to determine what factors contributed to the curricular development within their institution.
  
  
  METHODS
  Semistructured interviews were conducted with 0 + 5 PDs to explore their experiences with program development, factors influencing the latter, and rationale for current curricula. The interview script was loosely structured to explore several factors including time of incoming residents' first exposure to the vascular surgical service, timing and rationale behind the timing of core surgical rotations throughout the 5 year program, educational value of nonsurgical rotations, opportunities for leadership and scholarly activity, and influence the general surgery program and institutional climate had on curricular structure. All interviews were conducted by a single interviewer. All interviews were qualitatively analyzed using emergent theme analysis.
  
  
  RESULTS
  Twenty-six 0 + 5 PDs participated in the study. A total of 69% believed establishing professional identity early reduces resident attrition and recommend starting incoming trainees on vascular surgical services. Sixty-two percent spread core surgical rotations over the first 3 years to optimize general surgical exposure and most of the programs have eliminated specific rotations, as they were not considered valuable to the goals of training. Factors considered most important by PDs in curricular development include building on existing institutional opportunities (96%), avoiding rotations considered unsuccessful by "experienced" programs (92%), and maintaining a good working relationship with general surgery (77%). Fifty-eight percent of PDs voiced concern over the lack of standardization among the differing programs and most of the PDs agree that some degree of programmatic standardization is critical for the continued success of the 0 + 5 training paradigm.
  
  
  CONCLUSIONS
  Qualitative evaluation of PD experiences with the development of 0 + 5 vascular surgery residency programs reveals the key factors that commonly influence program design. Programs continue to evolve in both structure and content as PDs respond to these influences. Learning from the collective experience of PDs and some standardization of the curricula may help current and future programs avoid common pitfalls in curricular development.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, WI. Electronic address: bsmith5@uwhealth.org.
authors.forename: Brigitte K
authors.initials: BK
authors.lastname: Smith
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Greenberg
authors.affiliation: Division of Vascular and Endovascular Surgery, Oregon Health & Science University, Portland, OR.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013043:Specialties, Surgical / Q000193:education; D014656:Vascular Surgical Procedures / Q000193:education*