A comparison of the knowledge base and surgical skills of integrated versus independent vascular surgery trainees

Objective: The purpose of this study was to compare the knowledge base and surgical skills of 0/5 integrated resident (IR) and 5/2 independent fellow (IF) vascular surgery trainees using milestones. Methods: An anonymous survey, endorsed by the Association of Program Directors in Vascular Surgery, was sent to all program directors (PDs) of IR and IF training programs. The survey asked PDs to assess their trainees' milestones in postgraduate year (PGY) 4 to 7 pertinent to knowledge base and surgical skills using a 5-point Likert scale. The PDs were then asked to choose their trainees' three strongest and weakest milestones and to select from a list which factors were contributing most to the trainees' strengths and weaknesses. Results were grouped by training paradigm and year, with comparisons made between IR PGY4 and PGY 6 trainees and IF PGY5 and PGY7 trainees. Milestone means and strengths, weaknesses, and contributing factor response rates were compared using a Mann-Whitney U test. Results: Of 166 surveys sent, 56 (34%) PDs replied and evaluated a total of 87 trainees, 12 IR PGY4, 12 IR PGY5, 35 IF PGY6, and 28 IF PGY7. IR PGY4s were found to be lower than IF PGY6s in knowledge of procedural anatomy, and there was a trend that all IR PGY4 milestones were lower than IF PGY6 milestones. There was no difference in ranking of strongest milestones. Open surgical skills were ranked as a weakness of IR PGY4s more than of IF PGY6s. Time spent on vascular surgery call contributed more to the IR PGY4's strengths, whereas time spent on general surgery contributed more to the IF PGY6's strengths. Not enough time spent in outpatient clinics contributed more to the IR PGY4's weaknesses, whereas no factors contributed more to the IF PGY6's weaknesses. IR PGY5s were found to be lower than IF PGY7s in open surgical skills, and there was a trend that all IR PGY5 milestones were lower than IF PGY7 milestones. Open surgical skills were ranked as a strength of IF PGY7s more than of IR PGY5s. Open surgical skills were ranked as a weakness of IR PGY5s more than of IF PGY7s. No factors contributed more to the IR PGY5's strengths, whereas time spent on general surgery contributed more to the IF PGY7's strengths. Not enough time spent in the vascular laboratory and performing open surgical procedures contributed more to the IR PGY5's weaknesses, whereas no factors contributed more to IF PGY7's weaknesses. Conclusions: PDs of IR trainees should consider increasing time on general surgery and performing open surgical procedures.