Self-Perceived Comfort Performing Vascular Surgery Procedures Among Senior Vascular Surgery Trainees and Recent Graduates.

ABSTRACT Objective : In the last two decades, vascular surgery training evolved from exclusively learning open skills to learning endovascular skills in addition to a functional reduction in training duration with 0+5 residency programs. The implications for this on trainee evolution to independence are unknown. We aimed to assess self-perceived comfort performing open and endovascular procedures and to identify predictors of high comfort among senior vascular surgery trainees and recent graduates. Methods : Junior and senior 0+5 vascular surgery residents, traditional fellows, and attendings in their first 4 years of practice were asked to complete a survey assessing the number of vascular procedures performed to date, comfort performing these procedures on a Likert scale, and validated scales of self-efficacy and grit. Groups were then matched by training level and age. Logistic regression identified independent predictors of the top quartile of self-perceived comfort performing procedures. Results : Surveys were completed by 92 trainees and 71 attending surgeons in their first 4 years of practice. After matching, completing ≥7 open juxtarenal aortic repairs (OR=4.73, 95% CI=1.59-14.07) and a higher self-efficacy score (OR=3.24, 95% CI=1.20-8.76), were independent predictors of top quartile comfort performing open vascular procedures. 0+5 residency training inversely correlated with top quartile comfort performing open vascular operations (OR=0.12, 95% CI=0.03-0.47). Completing ≥7 complex EVARs (OR=3.94, 95% CI=1.61-9.59) and a higher self-efficacy personality score (OR=2.76, 95% CI=1.09-7.02) were predictors of top quartile comfort performing endovascular procedures. Conclusion : In this nationally representative survey, both trainees and junior attendings completed a paucity of complex open vascular cases, which corresponded to reduced comfort performing these procedures. Furthermore, 0+5 residency training was associated with lower self-perceived comfort performing open vascular surgery, a trend that persisted through the first years of practice. Endovascular comfort did not show a similar correlation.