RS18 - Graduating Vascular Surgery Trainee Competence and Autonomy in Endovascular as Compared to Open Peripheral Revascularization Procedures

Objectives: Endovascular interventions for peripheral artery disease have increased in prevalence over time given the inherent benefits of minimally invasive approaches. While it is essential that vascular surgery graduates are facile with endovascular techniques, the results of the BEST-CLI trial highlight the equivalent importance of ensuring trainee competence in open skills. Recent studies demonstrate increasing case volume of both endovascular and open procedures during vascular surgery training. However, case volume is merely a surrogate marker for competence and true competence attained by the time of graduation is unknown. We sought to investigate operative autonomy and competency of graduating vascular surgery trainees performing endovascular as compared to open peripheral vascular revascularization procedures.

Methods: Operative performance and autonomy ratings for infrainguinal endovascular and open revascularizations from the Society for Improving Professional Learning(SIMPL) application database were collected for all vascular surgery participating institutions from 2018-23. The distribution for autonomy and performance ratings were determined by training level for endovascular and open procedures, respectively. Mixed effects logistic regressions were conducted to estimate the predictive association between procedure type and autonomy and performance assessment adjusting for training level and case complexity. Subsequently, the estimated model was applied to predict the probability of a graduating trainee being rated as meaningfully autonomous or competent while performing endovascular and open procedures across various case complexities.

Results: 69 residents from 21 programs(11 fellowship,10 residency) were assessed 329 times(n=179 endovascular,150 open). In the final year of training, trainees were assessed as ‘autonomous’ for 92% of endovascular and 79% of open peripheral revascularization procedures, and ‘competent’ for 65% of endovascular and 53% of open procedures. When controlling for case complexity, there were no differences in autonomy(OR 1.11,[95% CI: 0.62-1.99]) or competency assessment(OR 0.86,[95% CI: 0.46-1.59]) for endovascular, as compared to open, peripheral revascularization procedures. For average complexity procedures, the predicted probability of a trainee being assessed as competent and autonomous at the time of graduation was high(competent:88% endovascular, 86% open; autonomous:96% endovascular, 97% open). Predicted probability of competence and autonomy for complex procedures was lower, but remained similar between groups(competent:73% endovascular, 70% open; autonomous:92% endovascular, 92% open)(Figures 1 and 2).

Conclusions: There is no difference in the graduating level of autonomy and competence of endovascular as compared to open peripheral revascularization procedures for vascular surgery trainees. These findings suggest vascular surgery trainees enter independent practice with adequate proficiency to utilize the full scope of techniques to care for patients requiring average complexity peripheral revascularization procedures.