Educational Schemes for the New Vascular …Dept. for Cardiovascular Surgery, University Hospital Bern, Switzerland Eiger North Face Education in Vascular Surgery / Strasbourg May

Educational Schemes for the New Vascular Specialist – a Surgeon‘s Perspective

Jürg Schmidli, MD Regula S von Allmen, MD Florian Dick, MD

Department of Cardiovascular Surgery, University Hospital Bern, Switzerland

Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 2

Dept. for Cardiovascular Surgery, University Hospital Bern, Switzerland

Disclosures

• Chairman ESVS Education and Training Committee

• Vascular International Foundation and School (Switzerland) – Member of Board of Trustees – Convenor – Tutor – www.vascular-international.org



Vascular Surgery Education: where to go?

Eiger Mönch Jungfrau


Dept. for Cardiovascular Surgery, University Hospital Bern, Switzerland Eiger North Face



1938 Heckmair-Route 2.5d

2008 Steck 2h47‘



Dependency on resources and material, local culture Interdependency between partners



New vascular specialist?

• Historical • General surgeon abdominal

orthopedic

thoracic

……

vascular

upper GI

hepatobil

breast

??

Cycles of specialization

Endovascular revolution

biology



Widening of vascular surgery focus ? • Vascular specialist

– Vascular surgery – Endovascular surgery – Vascular medicine





• risk management • Conservative treatment • coagulability disorders • venous thromboembolism, • chronic venous insufficiency • lymphedema • non-invasive studies





• risk management • Conservative treatment • coagulability disorders • venous thromboembolism, • chronic venous insufficiency • lymphedema • non-invasive studies

generalist

Schmidli & Dick, EJVES 2010



Trends in vascular surgery training?

• Less general surgery training

• Less open vascular procedures

• More endovascular procedures

• More women in training

• Working time restrictions

• Shorter training time

• Less case load for trainee



Current state of Vascular Surgery as a specialty in Europe

Liapis CD et al EJVES 2009

4.5

M x

Hungary S



Career planning: as early as possible • Engage interest of trainees (students or graduates) as early as possible

• Decision making: •  Training time •  TEAM •  Skills •  Goal oriented?



Career planning: as early as possible

Academic 8 y. Career

Non Academic Career 6 y.



National training programs for vascular surgeons have to be adapted •  integrated training programs

– Open surgical techniques – Endovascular techniques – Vascular Medicine

• Non-invasive studies: Ultrasound

• Academic vascular surgery fellowship – Basic laboratory research – Comprehensive clinical research



Possible European training model

M. Jacobs: Best practice in vascular procedures EVC 2010



Which is the ideal curriculum in VS? • Structured modular training program from basic to

advanced procedures in open and endovascular procedures

•  ‚Ideal‘ institution – Case load – Expertise – Academic environment – „godfather“/tutor/trainer/superviser/teacher – network

• Career planning – Time schedule – Repeat meetings – Rotation in network



Interdisciplinary endovascular training?

Case load and

expertise

Available: NO

Not available:

YES



Interdisciplinary endovascular training?

Case load and

expertise

Learn from each of the specialities

Not available: Specific 6-12 mts rotation

available: Continuous

training parallel to open surgery

Is this enough?



How can trainees improve skills ? • Modular workshops and courses

– Virtual Training models • Open surgical models (AAA, carotid endarterectomy, peripheral bypass, vascular access)

• Virtual simulators or real simulators for endovascular procedures – Non-invasive diagnostic

• Duplex ultrasound • Pletysmography

•  „shift the learning curve from the patient to the model“

• Weekly/monthly training programs on open surgical modles or simulators in own institution





Program of ESVS Workshops 2013

•  January Measuring and Sizing WS for EVAR, Athens 12, recommended •  March ESVS Vascular Trauma, London, 04-05 •  April ESVS TAAA Course London, 04-05

ESVS 5th Vascular Access Workshop Bern 29-30 •  May ESVS Vascular Ultrasound, Barcelona 09-10

ESVS Focus on Carotid Workshop Mallorca 23-24 ESVS Type IV Aneurysm WS, LIVES, Athens 23 ESVS Management of Venous thrombosis, LIVES, Athens 23 ESVS Vascular Trauma Workshop Stockholm 27-28

•  June ESVS Carotid and peripheral reconstruct. Poland, Zakopane 06-07 ESVS Introduction to open Surgery and endovasc Techniques Workshop Hamburg 27-28

•  September ESVS 3rd Vascular Access Workshop Budapest 05-06 ESVS Advanced Ultrasound Course, Copenhagen 26-28

•  October ESVS Head and Neck Surgery, Amsterdam 03-04 ESVS Vascular Trauma, Istanbul 27-30

•  December ESVS Introduction to open Surgery and endovasc Techniques WS Hamburg ESVS Management of Aortic Rupture, Zurich











Summary for TRAINEES

Trainee should… • Decide early on specialisation • Decide early on Academic career • Plan training and career in ‘good volume’ Vascular Center or Network

• Tight skills monitoring by a superviser • Visit modular courses and workshops • Orient on

– National training requirements – EBVS



Summary for TRAINERS

Trainee needs… • Less common trunk surgery • Less open vascular training • More endovascular training • More training for diagnostics • More open and virtual simulation training

Integrated training model would

be best !







Conclusion

VASCULAR SURGERY • Ongoing irresistible trend towards independent

specialisation across Europe • Depends on interdisciplinary collaboration! • Comprehensive vascular centers provide sufficient work

load and staffing levels with least biased care • Shortened but intensified training curricula will benefit from

harmonization across national boarders • Training simulators and workshops are needed • Vascular ‘generalist’ far from reality



Documents

Educational Schemes for the New Vascular …Dept. for Cardiovascular Surgery, University Hospital Bern, Switzerland Eiger North Face Education in Vascular Surgery / Strasbourg May