title: Vascular Trauma Operative Experience is Inadequate in General Surgery Programs.
abstract: BACKGROUND
  Vascular injuries may be challenging, particularly for surgeons who have not received formal vascular surgery fellowship training. Lack of experience and improper technique can result in significant complications. The objective of this study was to examine changes in resident experience with operative vascular trauma over time.
  
  
  METHODS
  A retrospective review was performed using Accreditation Council for Graduate Medical Education (ACGME) case logs of general surgery residents graduating between 2004 and 2014 at 2 academic, university-affiliated institutions associated with level 1 trauma centers. The primary outcome was number of reported vascular trauma operations, stratified by year of graduation and institution.
  
  
  RESULTS
  A total of 112 residents graduated in the study period with a median 7 (interquartile range 4.5-13.5) vascular trauma cases per resident. Fasciotomy and exposure and/or repair of peripheral vessels constituted the bulk of the operative volume. Linear regression showed no significant trend in cases with respect to year of graduation (P = 0.266). Residents from program A (n = 53) reported a significantly higher number of vascular trauma cases when compared with program B (n = 59): 12.0 vs. 5.0 cases, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Level 1 trauma center verification does not guarantee sufficient exposure to vascular trauma. The operative exposure in program B is reflective of the national average of 4.0 cases per resident as reported by the ACGME, and this trend is unlikely to change in the near future. Fellowship training may be critical for surgeons who plan to work in a trauma setting, particularly in areas lacking vascular surgeons.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Huan
authors.initials: H
authors.lastname: Yan
authors.affiliation: Department of Surgery, University of California-Irvine Medical Center, Orange, CA.
authors.forename: Steven
authors.initials: S
authors.lastname: Maximus
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Koopmann
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Keeley
authors.affiliation: Department of Surgery, University of California-Irvine Medical Center, Orange, CA.
authors.forename: Brian
authors.initials: B
authors.lastname: Smith
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Christian de
authors.initials: Cd
authors.lastname: Virgilio
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA. Electronic address: dekim@dhs.lacounty.gov.
authors.forename: Dennis Y
authors.initials: DY
authors.lastname: Kim
mesh_terms: D000046:Academic Medical Centers; D002140:California; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D000071938:Fasciotomy / Q000193:education; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D016014:Linear Models; D015397:Program Evaluation; D011996:Records; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000193:education*; D057772:Vascular System Injuries / Q000175:diagnosis / Q000601:surgery*; D016526:Workload