Educational Schemes for the New Vascular Specialist a Surgeon s Perspective
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1 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
2 Disclosures Chairman ESVS Education and Training Committee Vascular International Foundation and School (Switzerland) Member of Board of Trustees Convenor Tutor Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 2
3 Dept. for Cardiovascular Surgery, University Hospital Bern, Switzerland Vascular Surgery Education: where to go? Eiger Mönch Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli Jungfrau 3
4 Eiger North Face Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 4
5 1938 Heckmair-Route 2.5d 2008 Steck 2h47 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 5
6 Dependency on resources and material, local culture Interdependency between partners Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 6
7 New vascular specialist? Historical General surgeon Cycles of specialization abdominal upper GI orthopedic hepatobil thoracic breast vascular?? Endovascular revolution biology Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 7
8 Widening of vascular surgery focus? Vascular specialist Vascular surgery Endovascular surgery Vascular medicine Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 8
9 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 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 9
10 Widening of vascular surgery focus? Vascular specialist generalist Vascular surgery Endovascular surgery Vascular medicine risk management Conservative treatment coagulability disorders venous thromboembolism, chronic venous insufficiency lymphedema non-invasive studies Schmidli & Dick, EJVES 2010 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 10
11 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 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 11
12 Current state of Vascular Surgery as a specialty in Europe 4.5 x M Hungary S Liapis CD et al EJVES 2009 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 12
13 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? Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 13
14 Career planning: as early as possible Academic 8 y. Career Non Academic Career 6 y. Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 14
15 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 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 15
16 Possible European training model M. Jacobs: Best practice in vascular procedures EVC 2010 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 16
17 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 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 17
18 Interdisciplinary endovascular training? Case load and expertise Available: NO Not available: YES Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 18
19 Interdisciplinary endovascular training? Case load and expertise Is this enough? available: Continuous training parallel to open surgery Not available: Specific 6-12 mts rotation Learn from each of the specialities Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 19
20 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 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 20
21 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 21
22 Program of ESVS Workshops 2013 January Measuring and Sizing WS for EVAR, Athens 12, recommended March ESVS Vascular Trauma, London, April ESVS TAAA Course London, ESVS 5 th Vascular Access Workshop Bern May ESVS Vascular Ultrasound, Barcelona ESVS Focus on Carotid Workshop Mallorca ESVS Type IV Aneurysm WS, LIVES, Athens 23 ESVS Management of Venous thrombosis, LIVES, Athens 23 ESVS Vascular Trauma Workshop Stockholm June ESVS Carotid and peripheral reconstruct. Poland, Zakopane ESVS Introduction to open Surgery and endovasc Techniques Workshop Hamburg September ESVS 3 rd Vascular Access Workshop Budapest ESVS Advanced Ultrasound Course, Copenhagen October ESVS Head and Neck Surgery, Amsterdam ESVS Vascular Trauma, Istanbul December ESVS Introduction to open Surgery and endovasc Techniques WS Hamburg ESVS Management of Aortic Rupture, Zurich Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 22
23 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 23
24 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 24
25 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 25
26 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 26
27 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 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 27
28 Summary for TRAINERS Trainee needs Less common trunk surgery Less open vascular training More endovascular training More training for diagnostics Integrated training model would be best! More open and virtual simulation training Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 28
29 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 29
30 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 30
31 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 Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 31
32 Dept. for Cardiovascular Surgery, University Hospital Bern, Switzerland Education in Vascular Surgery / Strasbourg May 10, 2013 / Jürg Schmidli 32
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