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Establishing a Vascular Surgery Interest Group Kelli Hicks, University of Washington, Seattle, WA

Assessment ABSTRACT: Peripheral Arterial Endovascular Procedures Performed In a Non-Hospital Based Facility by Vascular Surgery Fellows Keith D. Calligaro, MD, Danielle Pineda, MD, Sam Tyagi, MD, Matthew J. Dougherty, MD, Douglas A. Troutman, DO, and Lou Domenico, Jr, MD, Pennsylvania Hospital, Philadelphia, PA ABSTRACT: Resident Venous Case Volumes Compared to VSITE Exam Answers Robyn A. Macsata, MD1, Michael Siah, MD1, Steve Abramowitz, MD1, John Ricotta, MD1,and Paul Haser, MD2 Georgetown University Hospital/Washington Hospital Center, Washington, D.C. 1 and The Moncton Hospital, Moncton, New Brunswick, Canada2

ABSTRACT: The State of Venous Education In Vascular Residency Programs: A Resident Questionnaire Caitlin Hicks, MD, Christopher Abularrage, MD, James Black, MD, Ying Wei Lum, MD, and Jennifer Heller, MD, Johns Hopkins Hospital, Baltimore, MD

Transition to Practice ABSTRACT: Career Planning for the Vascular Surgery Trainee Susanna Shin, MD and Niten Singh, MD, University of Washington, Seattle, WA ABSTRACT: Fellow and Resident Mentoring in the Senior Year Ash Mansour, MD, Grand Rapids Medical Education Partners/Michigan State University, Grand Rapids, MI ABSTRACT: Mentorship in Surgery – A Perspective from Graduating Vascular Trainees Matthew R. Smeds, MD1, Kwame S. Amankwah, MD2, Cindy Huynh, MD2, Carol R. Thrush, EdD1, and Mohammed M. Moursi, MD1. 1University of Arkansas for Medical Sciences, Little Rock, AR; 2Upstate Medical University, Syracuse, NY.

ESTABLISHING A VASCULAR SURGERY INTEREST GROUP

Kelli Hicks, MS2University of Washington School of

Medicine

THE BEGINNING

Meeting Dr. Julie Freischlag and Dr. Parodi at VAM!

VSIG BEGINS

1. Toolkit on SVS website• https://vascular.org/sites/default/files/vsig-toolkit.pdf

2. Drafting a constitution

3. Accepted to student activities

4. Appointing officers

5. University of Washington Leadership Training

6. Student activities fair

Faculty support

• Article I: General

• Article II: Membership and Impeachment

• Article III: Officers

• Article IV: Meetings

• Article V: Financial

• Article VI: Bylaws

• Article VII: Amendments

• Article VIII: Advisors

First Meeting &

Curriculum Setting

CURRICULUM

• Quarterly meetings with entire group and discuss topics members requested• Discussing the match and interview process• Careers options after residency• Expectations for 3rd year clerkships• Lifestyle of a Vascular Surgeon

• Hands-on skills workshops

CURRENT ACTIVITIES

• Hands-on clerkship training opportunities

• One-on-one mentoring

• Template for shadowing opportunities both in clinic and in OR

• Quarterly speaker events

• envivo project

envivoProject

Research Internship

Opportunities

Local Society Membership Benefits

FUTURE DIRECTIONS

• Expansion of curriculum currently offered

• Video training sessions

• Pre-clinical years curriculum

• Online presence

CONCLUSION

• Expose more students in first and second year to vascular surgery

• Faculty support and student interest• Toolkit supplied by SVS on website• Curriculum setting

Questions – [email protected]

MANY THANKS

• Dr. Sherene Shalhub

• Dr. Niten Singh

• Dr. John Arthur

• Dr. Susanna Shin

Peripheral arterial endovascular procedures performed in a non-hospital

based facility by vascular fellowsKeith Calligaro, MD,

Danielle Pineda, MD, Sam Tyagi, MD, Doug Troutman, DO, and Matthew Dougherty, MD

Pennsylvania Hospital/Philadelphia, PA

APDVSChicago, IL. April 1, 2016

APDVS 2-Year Training Program Survey

# days/week vascular fellows assigned to:1) Procedures

Open vs. endovascular

2) Clinic3) Research4) Non-invasive vascular laboratory (NIVL)

Our ProgramEndovascular Procedures in Hospital

(done same day in same room as open cases)

days/week1st year fellow 12nd year fellow 4

Our Program – 1st Year Fellow

Mixed open/endo (hospital) 1 day/wkEndo (outside facility) 1 day/wkVenous Clinic (out-pt procedures) 1 day/wkArterial Clinic 1 day/wkNIVL 1 day/wk

APDVS 2-Year Training Program Survey

Programs with at least 1 day/week…Mixed open/endo 100%Pure endovascular days

In hospital 42%Outside facility 16%

Traditionally vascular fellows perform endovascular procedures in hospital setting

Approached by non-hospital based facility to perform out-patient dialysis procedures

Capture facility-fee revenuesBegan to perform PAD endo casesSurprise!!! Most patients found this site more

convenient, less hassle and preferred non-hospital based setting

Endovascular procedures in non-hospital based facility

Under supervision of attending VSLocal anesthesia + moderate conscious sedationCardiac monitoringNursing support staff ACLS certified Fluoroscopy - portable GE OEC 9900 C-armClosure devices generally used (Mynx)


2012 -2015: 211 procedures (180 pts)40 dx’ic agrams

171 interventions

claudication 113 * iliac 48rest pain/tissue loss 56 * femoral 112failing grafts 41 * popliteal 28

* tibial 14


171 interventions

Balloon alone = 7% (12) Balloon + stent = 30% (51)Balloon + covered stents = 20% (34) Atherectomy + balloon/stent = 65% (112)Mechanical thrombolysis = 1% (1)

Anterior tibial: stenotic proximally, occluded distally

Occluded mid -AT

Re-constituted dorsalis pedis

Post-atherectomy and balloonangioplasty


1st year fellowsWould loss of endovascular cases from hospital setting impact fellowship endovascular volume?

YesFirst year: 2012-13 = 0% (0/49) done by fellow

Spoke to administration – out-patient site approved for fellow after negotiated malpractice coverage


1st year fellows

Performed increasing percentage of procedures

2012-13 = 0% (0/49)2013-14 = 31% (17/54)2014-15 = 93% (56/60)2015-16 = 93% (57/61) (after nine months)

Was it safe to have 1st year fellows perform these procedures

without anesthetists or other medical specialists present

patency/lesion standpoint? patient health (cardiopulmonary) standpoint?

emergency complication (bleeding, occlusion) standpoint?


1st year fellows98% (206/211) pts d/c’ed 2-6 hrs of bed-rest

No 30-day adverse outcomes

2% (5/211) patients had complications4 immediately transferred to PH(2 - oxygen desaturation; 1 – groin hematoma observe only; 1- arterial occlusion –tibial stent unavailable at site)

1 returned to PH next day(rest pain after femoral atherectomy and balloon angioplasty - required stent graft)

Conclusion

PAD endovascular procedures can be performed safely by 1st year vascular fellows in out-patient, non-hospital based setting

Valuable from learning and technical standpoint for fellows (they love it!)

Vascular surgery training programs will need to adapt to these changing care delivery models

Evaluation of Venous Case Volume in Vascular Surgery Training

Michael Siah MD1,2, Steven Abramowitz MD1, Paul Haser MD3, John Ricotta MD4,5, Robyn Macsata MD1,2

Medstar Washington Hospital Center/Georgetown University¹Veterans Affairs Medical Center²

Moncton City Hospital³George Washington University Hospital4

Residency Review Committee5

Background• Increasing recognition and treatment of venous disease in the US

• 2014 Society for Vascular Surgery (SVS) membership survey results showed 18.8% of vascular surgeons practice was venous

• True for practicing vascular surgeons, but given the ability for many of these treatments to be office based as well as current reimbursement rates, other specialties have started treating venous disease

Background• American Board of Phlebology

– American Board of Venous and Lymphatic Medicine• Not yet part of the American Board of Medical Specialists

– Establish qualifications for certification in the practice of phlebology

– Establish educational standards for training programs in phlebology• 250 venous procedures/fellow/year, must include

– Endovenous ablations (thermal/radiofrequency)– Ambulatory phlebectomy– Ultrasound guided sclerotherapy– Perforator therapies

– Examine candidates for certification and maintain a registry

Background• Society for Vascular Surgery

– American Venous Forum• Education

– Annual Meeting– Venous Forum, West Coast Venous Forum– Biannual Fellows Course

• Initiatives– Classification system for chronic venous disease (CEAP)– National screening program– On-line registry– Promote public awareness– Promote academic research– Publish evidence based practice guidelines– Promote cross-specialty collaboration

– Journal of Vascular Surgery: Venous and Lymphatic Disorders

Background• Despite this, there remains a lack

of venous operative objectives for vascular surgery (VS) trainees

• No case requirements

• Though VS trainees record their venous cases with CPT codes, they are reported as:

“minor vascular procedure”

• Concern for VS trainees to enter workforce with insufficient venous case volume or inability to be “certified”

Objective

• Examine the current venous surgical training experience of graduating VS trainees

Methods• Medstar Washington Hospital Center Institutional Review Board

(IRB) waiver and Association of Program Directors in Vascular Surgery (APDVS) and Residency Review Committee (RRC) approval

• Summarized (venous) results of– 2014 APDVS educational needs assessment survey– 2015 & 2016 vascular surgery in-training examination (VSITE) results– 2012-2015 case logs using RRC database

• Compared 2012-2015 venous case logs using RRC database of 0/5 residents and 5/2 fellow VS graduates – Student t-test (p<0.05 statistically significant)

MethodsCPT Code Description Group34401 Thrombectomy, IVC, iliac, abdominal incision Open Thrombectomy

34421 Thrombectomy, IVC, iliac, fem/pop, leg incision

34451 Thrombectomy, IVC, iliac, fem/pop, abdominal & leg incision

34471 Thrombectomy, subclavian, neck incision

34490 Thrombectomy, axillary, subclavian, arm incision

34502 Reconstruction IVC, any method Reconstruction IVC

34520 Cross-over vein graft Vein bypass

36468 Sclerotherapy, spider veins, limb/trunk Sclerotherapy

36470 Sclerotherapy, single vein

36471 Sclerotherapy, multiple veins, leg

36475 Radiofrequency ablation, first vein Venous ablation

36476 Radiofrequency ablation, subsequent vein

36478 Laser ablation, first vein

36479 Laser ablation, subsequent vein

MethodsCPT code Description Group37187 Percutaneous mechanical thrombectomy, initial Percutaneous thrombectomy

37188 Percutaneous mechanical thrombectomy, follow-up

37238 Venous angioplasty/stenting, initial vessel Venous angioplasty

37239 Venous angioplasty/stenting, subsequent vessel

37260 Interruption IVC, filter, clip, suture ligation Interruption IVC

37700 Ligation and division long GSV at SPJ Ligation/Phlebectomy

37722 Ligation and stripping long GSV from SPJ to knee

37735 Ligation and stripping long or short SV with ulcer resection

37766 Stab phlebectomy, 1 extremity, >20 incisions

37780 Ligation and division SSV at SPJ

37785 Stab phlebectomy, 1 cluster

ResultsAPDVS Educational Training Needs Assessment Survey

• Please identify any training gaps you have encountered after completing a vascular fellowship/residency.– 15.91% venous lysis– 15.15% venous procedures

• Please identify any areas where additional training would be beneficial.– 16.67% venous lysis– 15.48% venous procedures

• Why do you think these training gaps occurred?– 53.79% a gap in fellowship/residency training– 43.18% evolution of technology

Results2016 Vascular Surgery In-Training Examination

68% vs. 71%

Results2015 Vascular Surgery In-Training Examination

74% vs. 71%

Results2012-2015 Case Logs

Description Fellow(497)

Resident(58)

Total(555)

/Fellow /Resident /Total

Open thrombectomy 452 45 497 0.91 0.78 0.90

Reconstruction IVC 615 57 672 1.24 0.98 1.21

Vein bypass 186 15 201 0.37 0.26 0.36

Sclerotherapy 685 229 914 1.38 3.95 1.65

Venous ablation 7274 1267 8541 14.64 21.84 15.39

Perc thrombectomy 1637 255 1892 3.29 4.40 3.41

Venous angioplasty 221 48 269 0.44 0.83 0.48

IVC interruption 5572 1130 6702 11.21 12.08 12.08

Ligation/Phlebectomy 2856 917 3773 5.75 15.81 6.80

Total 19498 3963 23461 39.23 68.33 42.27

p<0.01

Results2012-2015 Case Logs

Description FellowTotal

FellowMin

FellowMax

ResidentTotal

ResidentMin

ResidentMax

Open thrombectomy 0.91 0 7 0.78 0 1

Reconstruction IVC 1.24 0 12 0.98 0 7

Venous bypass 0.37 0 6 0.26 0 4

Sclerotherapy 1.38 0 55 3.95 0 62

Venous ablation 14.64 0 80 21.84 0 69

Perc thrombectomy 3.29 0 35 4.40 0 18

Venous angioplasty 0.44 0 13 0.83 0 7

IVC interruption 11.21 0 68 12.08 0 88

Ligation/Phlebectomy 5.75 0 50 15.81 0 77

Total 39.23 1 188 68.33 11 264

ResultsPercentage(%) of Case Volume

Fellow Resident

Total cases (2012-2015 graduates) 832.0 838.5

Venous cases (2012-2015 graduates) 39.2 68.3

% 4.7 8.1

Conclusion• Current VS operative experience is highly variable and

not consistent with future VS clinical practice

• VS trainee fund of knowledge does not appear affected

• Trainees will not meet the “standards” established by American Board of Phlebology

• PDs should consider developing a better defined venous curriculum which includes venous case minimums in defined categories

The State of Venous Education in Vascular Residency Programs:

A Resident Questionnaire

Caitlin W. Hicks MD, MSJames H. Black III MDChristopher J. Abularrage MDYing Wei Lum MDJennifer A. Heller MD

APDVS Meeting April 1, 2016

Disclosures

• None

Background/Objective

• Vascular surgery training comprises a heterogenous and broad scope of knowledge

• Arterial disease is more prevalent than venous disease, and the natural history and associated treatment paradigms for arterial disease dominate vascular education programs

Objective: To determine if current vascular surgery trainees consider their training in venous disease to be sufficient.

Methods

• IRB approval obtained

• Survey-based study• 13 questions pertaining to venous disease emailed out via

Survey Monkey

• Distribution facilitated by APDVS office

• All trainee information de-identified

• Distributed to all vascular surgery trainees in the U.S.• Traditional 5+2 trainees

• Integrated 0+5 trainees

• 80% 25-34 years of age• 60% male• 72% Caucasian• 91% from academic training

program• 57% integrated vascular

surgery residency

104 of 464 vascular trainees responded (22%)

Results: Demographics

Results: Venous case experience overall

• Vascular resident training experience with venous disease was relatively low

How many of each of the following procedures would you estimate you have completed during your vascular surgery training?

Answer Options <10 10-20 21-50 51-100 >100

Endothermal ablations 47% 28% 15% 7% 4%IVC stent placement 63% 22% 6% 8% 1%Iliac stent 51% 29% 14% 3% 3%Stripping and ligation 65% 25% 10% 1% 0%Venous bypass 95% 3% 1% 0% 1%

Results: Venous cases by PGY year

• Case volumes increased progressively by clinical training year among integrated vascular residents (p≤0.02), but were relatively stable for classic 5+2 vascular fellows (p=NS)

Results: Venous cases by PGY year

• Case volumes increased progressively by clinical training year among integrated vascular residents (p≤0.02), but were relatively stable for classic 5+2 vascular fellows (p=NS)

• There were no differences in overall reported venous procedure volumes between groups (all, p=NS)

Results: Venous disease didactics

• Integrated residents reported more didactic time related to venous disease than classic 5+2 vascular surgery fellows (p<0.01)

Results: Trainee views on venous disease

• The majority of trainees (82%) acknowledged that treating venous disease is part of a standard vascular surgery practice

• 39% of trainees indicated a desire for more venous insufficiency during their training

• The majority of responders (75%) reported plans to dedicate <25% of their vascular surgery practice to venous disease

Conclusions

• Increased exposure to venous disease didactics and procedures during vascular surgery training is needed

• By increasing exposure to venous disease, perhaps this will motivate trainees’ interest in venous disease after completion of training

Limitations & Discussion

• Low survey response rate (22%)• Consistent with other academic surveys

• ? Low available venous disease exposure due to emphasis on arterial practice in many hospital settings

• ? Many academic vascular practices do not have faculty dedicated to venous disease, so energy not present

Future Directions

• Use VSITE scores to assess trainees' aptitude with venous disease

• Re-evaluate vascular surgery trainee curriculum to promote venous clinical education• Consider adding a minimum number of venous procedures to

AGCME requirements for vascular surgery training

• Communicate opportunities for venous education to vascular surgery trainees • AVF Fellows Course

Acknowledgements

• Emily Kalata

• APDVS

Thank You

Career Planning for the Vascular Surgery Trainee

Finding a First Job

Susanna Shin, MDAssistant Professor

University of Washington

Career Planning

• Why? – First “real” job – Not Medical School, Residency or Fellowship

• Different kind of “Match” process

– Integrated Vascular Resident vs Vascular Fellow

– Avoid pitfalls– Formalize/Organize what we already do

Career Planning

• Meet bimonthly June/July prior to graduation

• Additional faculty mentors

• Timetable to achieve signed contract by March 1 in order to start reasonably after graduation– Licensing & Credentialing– Moving– Qualifying Exam (September)

Career Planning

• Identify “Dream Job”

• Job Search

• Interviews

• Contract Negotiation

Career Planning

• Identify “Dream Job”– Academic vs Private

• Academic – Different models• Hospital Employee – Why or why not?

– Geographic Location– Urban vs Rural– Size of Practice

– Absolutes vs Negotiables

Career Planning


• Job Search

• Interviews


Career Planning

• Job Search – What Jobs are available?– SVS Job Website – Faculty connections– VAM– VEITH meeting– Letters of Interest– Previous graduates

Career Planning


• Job Search

• Interviews


Career Planning

• Interviews– 1st Interview

• Gauge compatibility– 2nd Interview

• House hunting• Bring spouse?

– Red Flags– Tour the facility

• OR: Block time, Hybrid room– Meet with Administration, Partners

Career Planning


• Job Search

• Interviews


Career Planning

• Contract Negotiation– What can you ask for?– What is important?– Guarantee?– Incentive?– Red Flags

Career Planning

• Timeline and Important Dates to Consider

June Vascular Annual Meeting: Meet with prospective employers

July-August 1. Review criteria for trainee’s “ideal” job 2. Search for available job opportunities

September-December

1. Interviews2. VEITH Meeting: Meet with prospective employers

January-March

1. Receive/Negotiate contracts2. Review contract with lawyer

February-March

State License Application

April-June 1. Hospital Credentialing2. Relocation

September Vascular Surgery Qualifying Board Exam

Career Planning

• Thank you

Fellow and Resident Mentoringin the Senior Year

Ash Mansour, M.D., RPVI, FACSProfessor of Surgery

Disclosures

• None

Background

• SVS: founded in 1947• Vascular surgery as a specialty• Fellowship programs• Specialty certificate• Vascular Board (VSB)• Changing training paradigms:

– 0-5, 3+3, 4+2, 5+2

Historical Perspective

• Early fellowships:– UCSF: Jack Wylie 1962 (Mac Perry 1st fellow)– Northwestern University– Baylor in Dallas– Henry Ford

Training Model

• One-year fellowship• Two-year fellowship• Fellowships: 106• Residencies: 51

Goal of Training

• Competent vascular surgeon• Wide exposure to vascular disease• Academic surgeons• Address the shortage of specialists

Opinions of 5+2 Fellows

Opinions of Integrated Residents

Mentorship - Apprenticeship

mentor• noun men·tor \ˈmen-ˌtor, -tər\ : someone who

teaches or gives help and advice to a less experienced and often younger person

apprentice• a person who learns a job or skill by working for a

fixed period of time for someone who is very good at that job or skill

Our Model

• Started in 2008• Last 6 months of fellowship/residency• Spend one month with each attending• Focus on acquiring additional skills:

– Coding & billing– Outreach clinics– Admin duties

Our Model

• Dictate letters to referring docs• Vascular Lab• Quality meetings• Hospital functions

Results

• Near unanimous: positive experience• Learnings:

– Time management– Coding & billing– Outreach– Vein Center– Industry relations

SUMMARY

• Senior trainees benefit from shadowing• Learn some non-clinical skills• Time management• Administrative responsibilities• Elective available for trainees

1Matthew R. Smeds, MD, FACS

Mentorship in Surgery – A Perspective from Graduating Vascular Trainees

1Division of Vascular and Endovascular Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas

2Kwame S. Amankwah, MD, 2Cindy Huynh, MD, Carol R. 1Thrush EdD, 1Mohammed M. Moursi, MD

2 Division of Vascular Surgery, State University of New York –Upstate Medical University, Syracuse, New York

Disclosures

ØNone.

Definitionsmen·tor/ˈmenˌtôr,ˈmenˌtər/• an experienced and trusted adviser.• synonyms:

Advisor, guide, guru, counselor ,consultant, confidant

• an experienced person in a company, college, or school who trains and counsels new employees or students.

• synonyms:• Trainer, teacher, tutor, instructor

A Mentor in Surgery…• Numerous roles: advisor and consultant, friend , teacher , coach and leader.

Mentoring Surgeons for the 21st Century:

“Support and facilitate, listen, teach by example, encourage and motivate, promote independence and balance, and rejoice in the success of their mentees.”

-S. Eva SingletaryPresidential address at the 2005 annual meeting of Society of Surgical Oncology

“Mentorship is more than just about technical surgery, but also about life.”

-Irving Kron, MD, FACSPresidential address at the 2011 annual meeting of the American Association for Thoracic Surgery

“Role Model”

Versus

“Mentor”

There maybe no explicit supervisory relationship

An exchange of communication and guidance

May not have an explicit role in relation to the learner , yet his/her actions and attitudes may be unconsciously or consciously observed by the mentee and can lead to emulation of approaches and practices

Act as a coach active role in guiding a student, resident , peer or junior colleague

Not Engaged in the personal and professional successes and growth of the mentee.

Engaged in the personal and professional successes and growth of the mentee.

Benefits of MentorshipØBenefits of mentorship in academic

medicine have demonstrated an impact on:– Career progression– Personal development– Career guidance– Specialty choice– Academic career choice – Faculty retention

Sambunjak et al. 2006 JAMA 296:1103-1115

Benefits of MentorshipØ 24 US medical school: faculty members with

mentors had a higher career satisfaction scores (p<0.03).ØGraduates of a general surgery program: identified

mentor guidance important in their personal development J.Ped.Surg.2001;36;1802ØCanadian OB/GYN fellows: those with mentors

were more likely to be promoted following completion of their training. J.Ob/gyn Can. 2004; 26;127Ø In a study of maternal/fetal medicine fellows in the

United States, the presence of a mentor was associated with satisfaction with their fellowship

Sambunjak et al. 2006 JAMA 296:1103-1115

Goals of StudyØTo examine mentorship experiences in

current graduating vascular trainees-Academic achievement-Operative skill-Career opportunities

ØTo examine program directors in vascular surgery attitudes towards mentorship

Methods

ØAnonymous electronic survey (www.surveymonkey.com) sent to all U.S. vascular surgery trainees (VT) 2015 (n = 141) and 2016 (n = 144)-Current mentor relationships-Ideal mentor/mentee characteristics-Academic productivity-Operative comfort level

Does mentorshipRelations affect?

Methods

ØParallel survey sent to all current program/associate program directors (PD)of US training programs (n = 169)-Current mentor relationships-Ideal mentor/mentee characteristics-Benefits of mentorship relationship for trainee

Results

ØSurveys completed by 65 (38%) of PD and 62 (22%) VT

Attending Geographical Locations Trainee Geographical LocationsCurrent Training

VascularResidentVascularFellow

Results

Ø43/62 (69%) identified having a mentor-Vascular Surgeon: 41/43 (95%)-Program Director: 9/43 (21%)-Assigned: 10/43 (23%)

0%20%40%60%80%

100%

Mentor?

VascularResidencyVascularFellowship

p = .05*

Results

ØMajority met their mentor during their surgical training-Met during vascular training: 25/43 (58%)

0%10%20%30%40%50%60%70%80%

Medical School Residency Fellowship

Vascular ResidentsVascular Fellows

When did you meet your mentor?

p = .07

Results

0%20%40%60%80%

Face toFace

Email Texting Phone Other

How do most interactions occur?

0%

20%

40%

60%

80%

Asneeded

Weekly Monthly Daily Other

When do most interactions occur?

ResultsAreas of Guidance Mentor Provides Percent Responded “YES”

Clinical Knowledge 88%

Career Guidance 86%

Operative Skills 83%

Act as a “Role Model” 60%

Clinical Research 58%

Career Enabling (help with getting jobs) 49%

Stimulate Interests 49%

Advise on “Life Issues” 47%

Improve Exam Performance 33%

Basic Science Research 12%

Educational Research 12%

Results

Ø60/65 (92%) PD identified being a mentorØ48/65 (74%) PD identify having had a

mentor in vascular surgery

Results

ØProgram directors:-29% believe mentorship training is required to be a “good” mentor-18% have undergone formal mentorship training

Results – Ideal Mentor AttributesAttribute Vascular

TraineesSimilar Ethnicity 1.13

Similar Age 1.5Same Gender 1.56

Undergone Mentorship Training 1.82

Leader in the field 2.39Similar Region 2.56

Someone Mentee Selected 2.56Organized 2.95

Similar Profession 3.06Guidance in "Life Issues" 3.1

Collaborative 3.15Compassionate 3.42

Confidential 3.52Loyal 3.55

Ethical 3.56Committed to Relationship 3.61

Enthusiastic 3.66Accessible 3.74Supportive 3.76

Approachable 3.94

Attribute Program Directors

Similar Ethnicity 1.22Same Gender 1.26

Similar Age 1.42Undergone Mentorship

Training 1.95

Similar Region 2.35Someone Mentee Selected 2.44

Leader in the field 2.54Similar Profession 2.74

Guidance in "Life Issues" 2.79Organized 2.88Accessible 3

Collaborative 3.11Compassionate 3.17

Loyal 3.32Confidential 3.41Enthusiastic 3.55

Committed to Relationship 3.58Approachable 3.66

Supportive 3.67Ethical 3.77

Results – Ideal Mentee AttributesAttribute Program

DirectorsSimilar Ethnicity 1.16Similar Gender 1.16


Training 1.53

Someone Mentor Selected 1.77Similar Geographical Region 2.34

Similar Profession 2.52Compassionate 2.89Collaborative 3.08Confidential 3.11Organized 3.16Accessible 3.23

Loyal 3.26Approachable 3.39

Committed to Relationship 3.63Ethical 3.66

Enthusiastic 3.74

Attribute Vascular Trainees

Similar Ethnicity 1.29Similar Gender 1.34


Training 1.6

Someone Mentor Selected 2.08Similar Geographical Region 2.31

Similar Profession 2.55Compassionate 3.24Collaborative 3.29Confidential 3.37Organized 3.29Accessible 3.37

Loyal 3.39Approachable 3.61

Committed to Relationship 3.45Ethical 3.69

Enthusiastic 3.79

Results – Benefits of Mentorship

0%10%20%30%40%50%60%70%80%90%

100%

Vascular TraineeProgram Directors*

p = .006

*p = .0004

Results – Benefits of Mentorship

VT with Mentor VT without Mentor p - Value

Involved in Research 43/43 (100%) 18/19 (95%) .31

Basic Science 9/43 (21%) 7/19 (37%) .22

Clinical Science 42/43 (98%) 16/19 (84%) .08

Educational Research 10/43 (23%) 3/19 (16%) .74

Case Reports 24/43 (60%) 12/19 (63%) .78

> 2 Abstracts Presented 26/43 (60%) 9/19 (47%) .41

> 2 Papers Published 15/43 (33%) 5/19 (26%) .57

Results – Benefits of MentorshipAll VT with Mentor

(n = 40)VT without Mentor

(n = 19)p - Value

Angiogram with SFA Stent 59/59 (100%) 40/40 (100%) 19/19 (100%) 1.0

Fem-pop bypass (above knee) 58/59 (98%) 39/40 (98%) 19/19 (100%) 1.0

Fem-pop bypass (below knee) 56/59 (95%) 38/40 (95%) 18/19 (95%) 1.0

Angiogram with Iliac stent 59/59 (100%) 40/40 (100%) 19/19 (95%) 1.0

Aortobifemoral bypass 53/59 (89%) 36/40 (90%) 17/19 (90%) 1.0

Carotid Stent 26/59 (44%) 19/40 (48%) 7/19 (37%) 0.58

Carotid Endarterectomy 58/59 (98%) 40/40 (100%) 18/19 (95%) 1.0

EVAR 55/59 (93%) 39/40 (98%) 16/19 (84%) .09

Fenestrated EVAR 21/59 (36%) 15/40 (38%) 6/19 (32%) .77

Open AAA 49/59 (83%) 32/40 (80%) 17/19 (90%) .48

Juxtarenal AAA 32/59 (54%) 21/40 (53%) 11/19 (58%) .78

Fistulogram 55/59 (93%) 37/40 (93%) 18/19 (95%) 1.0

AV Fistula 58/59 (98%) 39/40 (98%) 19 (100%) 1.0

Mesenteric Stent 48/59 (81%) 33/40 (83%) 15/19 (79%) 0.73

Aorto-mesenteric bypass 25/59 (42%) 17/40 (43%) 8/19 (42%) 1.0

Vascular trauma 40/59 (68%) 27/40 (68%) 13/19 (68%) 1.0

ResultsFellows Vascular Residents p - Value

Angiogram with SFA Stent 3.86 3.87 0.67

Fem-pop bypass (above knee) 3.82 3.80 1.0

Fem-pop bypass (below knee) 3.64 3.47 0.61

Angiogram with Iliac stent 2.80 2.07 0.14

Aortobifemoral bypass 3.84 3.87 0.67

Carotid Stent 2.41 2.07 0.30

Carotid Endarterectomy 3.70 3.67 1.0

EVAR 3.61 3.53 0.38

Fenestrated EVAR 2.14 2.20 0.87

Open AAA 3.32 2.73 0.04

Juxtarenal AAA 2.80 2.07 0.14

Fistulogram 3.70 3.60 0.79

AV Fistula 3.82 3.60 0.10

Mesenteric Stent 3.23 3.27 0.82

Aorto-mesenteric bypass 2.57 1.93 0.03

Vascular trauma 3.02 2.73 0.55

Conclusions

ØThe majority of vascular trainees identify a mentor within vascular surgeryØVascular residents are more likely than

fellows to have a mentorØ Ideal mentors are: approachable and

supportive (as well as accessible and ethical)Ø Ideal mentees are: enthusiastic, ethical,

committed, and approachable

Conclusions

ØBenefits of mentorship may include: professional networking and increased job opportunities, but not academic productivity or case comfort levelØVascular fellows are more comofortable

with open AAA and mesenteric bypass than vascular residents and neither are comfortable with carotid stenting, FEVAR, or juxtarenal aneurysm repair

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