Regional Variation in Vascular Services


This was presented at the Vascular Society ASM 2016 – click here to view the presentation

VERN would like to thank Athanasios Saratzis, David Sidloff, Andy Duncan, Phil Stather, Ayoola Awoopta, Nadeem Mughal, Phil Bennet, Lalit Kumar, Daniel White, Anisha Perera, Lola Eid-Arimoku, Lauren Kennedy, Stella Nikolaou, Guy Martin, Aaron Goh, Tristan Lane, Ankur Thapar, Joseph Shalhoub, Hayley Moore, Shiva Dindyal, Iain Roy, David Ormesher, Femi Oshin, Jennifer Buxton, Nicholas Greaves, Matt Thomas, Craig Nesbitt, Visesh Sankaran, Sandip Nandhra, Emma Scott, Clare Dawkins, Jenny Robson, Frances Kent, Jonny Morrison, Olivia McBride, Jakub Kaczynski, Thomas Hardy, Natasha Chinai, Jonathan Nicholls, Aled Jones, Amy Stimpson, Dave Bosanquet, Rachel Barnes, Graeme Ambler, Dean Godfrey, Gareth Williams, Matt Popplewell, Nikesh Dattani, Ruth Benson and George Smith for their contribution to this study

Introduction

Operative exposure is key to experiential learning in surgery, however, not all units can offer the same operative experience. The aim of this study was to map training opportunities in vascular surgery to assess the feasibility of trialling strategic matching of training placements with trainee identified learning needs.

Methods

An online survey sent to UK vascular surgery trainees was employed to conduct a retrospective audit of ISCP logbook of all vascular procedures performed (01/11/2015-31/01/2016). Data on region and hospital was obtained. Median values of procedures performed were generated for each hospital and region.

Results

Fifty (35.7%) vascular surgery trainees responded to the survey, covering 13 regions and 37 hospitals. Within each region/hospital, trainees experienced varying operative exposures. Nationally, exposure to aortic procedures (open AAA, EVAR) ranged from 3 to 20 procedures with a median of 8. Venous procedures (open varicose vein, foam sclerotherapy, endovenous therapy) varied with a median of 10 with values ranging from 0 to 37 procedures.
As an example of intra-region variation, in the East Midlands, Derby trainees had the highest venous exposure (17 procedures), Northampton trainees had the highest peripheral (18) and renal-access (14) exposure and Leicester had the highest aortic exposure (15).

Discussion

This data demonstrates that hospitals within regions have different training profiles. Strategically matching these profiles with trainee identified needs may improve operative exposure within regions or nationally to improve learning.