December 12, 2008

Endovascular Training Fellowships: Results of a National Survey

Rabih A. Chaer, MD¹, Daniel Clair, MD², K Craig Kent, MD³, Kim J. Hodgson, MD⁴, Edward B. Diethrich, MD⁵, Pragatheeshwar Thirunavukarasu, MD¹, Ellen Dillavou, MD¹, Michel S. Makaroun, MD¹.
¹University of Pittsburgh, Pittsburgh, PA, USA, ²Cleveland Clinic Foundation, Cleveland, OH, USA, ³New York Presbyterian Hospital, New York, NY, USA, ⁴Southern Illinois University, Springfield, IL, USA, ⁵Arizona Heart Institute, Phoenix, AZ, USA.

OBJECTIVES: Endovascular fellowships offer training for physicians wishing to acquire basic and advanced endovascular skills. The purpose of this study is to assess the impact of this training on practice patterns.
METHODS: a 22 question online survey was sent to 116 physicians who completed an endovascular fellowship between 1995 and 2007 at 5 institutions. Fellowships most commonly lasted 3 months (range 6 weeks-12 months). Replies were anonymous.
RESULTS: The response rate was 59% (68). 75% of respondents were board certified vascular surgeons, with general and cardiothoracic surgeons comprising the rest. 52% had been in practice >10 years, and 17% for <5.
88% of respondents were very satisfied with their training, but 57% thought carotid stenting exposure was suboptimal and 42% wished for better hands on exposure. Only 10% however sought additional endovascular training.
35% of respondents had limited endovascular privileges prior to training, but 75% acquired expanded privileges afterwards. Overall, 87% acquired new or additional endovascular privileges after training. While 28% did no endovascular work prior, all developed basic or advanced endovascular practices later. 82% currently perform their endovascular procedures in the operating room.
Endovascular procedures increased by>50% in most individual practices after training, and are currently performed independently by 95% of respondents. Training exposure was satisfactory in most organ systems but appeared to be deficient in dialysis access, venous interventions, and thrombolysis. While the pre-fellowship endovascular load consisted mainly of EVAR, the majority of respondents expanded their endovascular cases to include most peripheral interventions.
CONCLUSIONS: Endovascular training fellowships are effective and cause a significant shift in clinical practice. They can be used for privileging and impart basic and advanced endovascular skills to trainees.

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