TRAINEE PERFORMANCE

lower-extremity revascularization has been poorly studied, secondary to limitations of certain large databases and the nature of the patients in this specific vascular subset.

Their dataset offers up insights from 223 revascularizations performed between January 2002 and June 2022. Of these patients 161 (72%) had lower and 62 (28%) upper extremities. The Albany team reports an operative mortality rate of 4.5% (n=10), all involving lower-extremity revascularization. Thirty-day non-fatal complications included immediate bypass occlusion in 11 patients (4.9%), wound infection in 7 (3.1%), graft infection in 6 (2.7%), and lymphocele/seroma in 5 patients (2.2%).

All major amputations (13, 5.8%) were early and in the lower extremity bypass group, the study’s authors report. Late revisions in the lower- and upper-extremity groups were 14 (8.7%) and 2 (3.2%) respectively.

Although the study’s authors are set to report that revascularization for extremity trauma can be performed with excellent limb salvage rates, demonstrating longterm durability with low limb loss and bypass revision rates, they also sound a note of caution over poor compliance with long-term surveillance.

“The poor compliance with long-term surveillance is concerning and may require adjustment in patient retention protocols,”

A NATIONAL COHORT STUDY OF VASCULAR TRAINEES TAKING THE Vascular Qualifying Examination (VQE) and the Vascular Certifying Examination (VCE) found performance during the former is “not predictive” of first-time pass achievement in the latter—but, the findings highlight the “[necessary]” identification of trainee competency measures that may predict certification examination failure.

Speaking to VS@VAM ahead of her presentation on Saturday, Libby Weaver, MD, from University of Virginia Health System in Charlottesville explained that their results may have stemmed from the two examinations testing distinct competencies.

Given board certification is associated with better quality of care, and that training programs must demonstrate high rates of first-attempt pass by their graduate candidates to maintain accreditation, Weaver noted this result indicates we must “find a marker to better identify candidates at risk [of failure]”.

In a follow-up study looking at Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings—a means of formative assessment of trainees—Weaver et al convey how these are seen to be a “highly predictive” indication of ability to pass board certification examinations. Specifically, medical knowledge and patient care competencies strongly predict performance on VQE, whereas interpersonal communication skills emerge as strongly predictive of VCE performance. This suggests we are “certifying well-rounded vascular surgeons and maintaining a high-quality standard within our specialty”, Weaver noted.

To this end, Weaver intends on furthering this research against a backdrop of the emerging evidence which has found a correlation between board certification and quality of care.

The current study’s senior author Brigette Smith, MD, University of Utah Health, Salt Lake City, is presently researching how Milestone ratings ultimately predict quality of care, ensuring outcomes in practice are reflective of assessment of trainees. “If we are able to make that connection it would be a huge advancement in surgical education,” Weaver commented.