title: Assessment of open operative vascular surgical experience among general surgery residents.
abstract: BACKGROUND
  General surgeons have traditionally performed open vascular operations. However, endovascular interventions, vascular residencies, and work-hour limitations may have had an impact on open vascular surgery training among general surgery residents. We evaluated the temporal trend of open vascular operations performed by general surgery residents to assess any changes that have occurred.
  
  
  METHODS
  The Accreditation Council for Graduate Medical Education's database was used to evaluate graduating general surgery residents' cases from 1999 to 2013. Mean and median case volumes were analyzed for carotid endarterectomy, open aortoiliac aneurysm repair, and lower extremity bypass. Significance of temporal trends were identified using the R(2) test.
  
  
  RESULTS
  The average number of carotid endarterectomies performed by general surgery residents decreased from 23.1 ± 14 (11.6 ± 9 chief, 11.4 + 10 junior) cases per resident in 1999 to 10.7 ± 9 (3.4 ± 5 chief, 7.3 ± 6 junior) in 2012 (R(2) = 0.98). Similarly, elective open aortoiliac aneurysm repairs decreased from 7.4 ± 5 (4 ± 4 chief, 3.4 ± 4 junior) in 1999 to 1.3 ± 2 (0.4 ± 1 chief, 0.8 ± 1 junior) in 2012 (R(2) = 0.98). The number of lower extremity bypasses decreased from 21 ± 12 (9.5 ± 7 chief, 11.8 ± 9 junior) in 1999 to 7.6 ± 2.6 (2.4 ± 1.3 chief, 5.2 + 1.8 junior) in 2012 (R(2) = 0.94). Infrapopliteal bypasses decreased from 8.1 ± 3.8 (3.5 ± 2.2 chief, 4.5 ± 2.9 junior) in 2001 to 3 ± 2.2 (1 ± 1.6 chief, 2 ± 1.6 junior) in 2012 (R(2) = 0.94).
  
  
  CONCLUSIONS
  General surgery resident exposure to open vascular surgery has significantly decreased. Current and future graduates may not have adequate exposure to open vascular operations to be safely credentialed to perform these procedures in future practice without advanced vascular surgical training.
authors: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors: Brianna M
authors: BM
authors: Krafcik
authors: Division of General Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors: Teviah E
authors: TE
authors: Sachs
authors: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors: Alik
authors: A
authors: Farber
authors: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors: Mohammad H
authors: MH
authors: Eslami
authors: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors: Jeffrey A
authors: JA
authors: Kalish
authors: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors: Nishant K
authors: NK
authors: Shah
authors: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
authors: Matthew R
authors: MR
authors: Peacock
authors: Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass. Electronic address: jeffrey.siracuse@bmc.org.
authors: Jeffrey J
authors: JJ
authors: Siracuse
mesh_terms: D001014:Aortic Aneurysm / Q000601:surgery; D002983:Clinical Competence; D003479:Curriculum; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000379:methods* / Q000639:trends; D004521:Educational Measurement; D016894:Endarterectomy, Carotid / Q000193:education; D013502:General Surgery / Q000193:education* / Q000639:trends; D006801:Humans; D007396:Internship and Residency; D016491:Peripheral Vascular Diseases / Q000601:surgery; D066231:Surgeons / Q000193:education* / Q000639:trends; D013997:Time Factors; D058017:Vascular Grafting / Q000193:education; D014656:Vascular Surgical Procedures / Q000193:education* / Q000639:trends; D016526:Workload