1. Members
   
   
2. Introduction to the Committee
   
   
3. Terms of Reference
   
   
4. Training in Vascular Surgery
   
   
5. Vascular Society’s Position Statement on Specialist Training
6. Publications - Vascular Training Requirements
   
   
7. Publications - Training in Interventional Radiology
   
   
8. Educational grants
   
   
9. Carotid Procedure Based Assessment forms
   

Members

Professor C Shearman (Chairman)
Mr G Gilling-Smith (until Nov 2009)
Mr D C Mitchell (until Nov 2008)
Mr R Chalmers (until Nov 2008)
Professor A R Naylor (until Nov 2009)
Mr L Williams (until Nov 2008)
Mr W Yusuf (until Nov 2010)
Dr A Odurny
Mr M J Gough
Mr R Holdsworth
Mr P R Taylor

[ menu ]

Introduction to the Committee

The Vascular Society Training and Education Committee was established in 2001 with the remit for training, education, and related matters. Since its establishment, the Committee has produced a document on training in vascular surgery, and focused on the following:

• Changes to the SAC Curriculum
• Development of a Vascular Training Registry and a Registry of Vascular Training Centres
• Competency Assessment
• Continuing Medical Education(CME)/Continuing Professional Development(CPD)
• Current issues under discussion include:
• The future of vascular surgery
• The Intercollegiate Examination
• Vascular courses
  

[ menu ]

Training in Vascular Surgery

Download Printer Friendly Version - PDF File (46Kb)

Approved at the The Vascular Society AGM on November 8 2001
Valid until November 2004

Introduction

The past few years have seen a fragmentation of General Surgery into the four main areas of Upper GI, Lower GI, Breast/Endocrine and Vascular Surgery. Within this confederation of specialist interests, Vascular Surgery in Great Britain and Ireland remains a major component of General Surgery and the majority of surgeons continue to work as General Surgeons with a Vascular Interest. Core training in General Surgery during SpR years 1-3 remains the foundation upon which a specialist knowledge of Vascular Surgery is built.

Increasing numbers of Consultants are now choosing to become specialist Vascular Surgeons with little or no involvement in General Surgery, particularly as the number of dedicated Vascular Surgery emergency rotas increase. Nevertheless, it remains important at the current time to ensure that Vascular Surgeons have sufficient core training to be able to cope competently with General Surgery emergencies. Likewise any non-Vascular General Surgeon should either be able to cope with the common vascular surgical emergencies, or at least know when to refer on to a specialist Vascular Surgeon.

Vascular surgery includes areas of low volume, high complexity surgery and it may prove difficult for many trainees to achieve sufficient competence in some vascular surgical procedures in just two years. Trainees are therefore encouraged to use their flexible year in a clinical post gaining additional experience in Vascular Surgery. Reductions in working hours with consequent reduction in clinical experience mean that the majority of trainees should now aim to spend six clinical years in SpR training. Only those trainees with a demonstrable commitment to enter Academic Surgery should consider using their flexible year in research.

This is not to say that the The Vascular Society would discourage a trainee from taking the time to undertake a period of research training. There is immense value of such training to a future Consultant Vascular Surgeon, whether it be a year spent on a formal MSc course or a two year period of original research leading to a higher degree. The majority of trainees now undertake such research training before entering higher surgical training. Whilst a period in research is considered to be desirable by the The Vascular Society, it is not an essential part of Vascular Surgical training.

The assessment of vascular trainees and vascular training centres has most recently been the responsibility of the Postgraduate Deans and the SAC in General Surgery. These assessments may be handicapped because not every vascular trainee will have a Vascular Surgeon present at their annual RITA assessment. Likewise not every SAC visiting team will have vascular expertise, although the The Vascular Society do have representation on the SAC in General Surgery through the auspices of the Association of Surgeons of Great Britain and Ireland.

As defined areas of General Surgery become increasingly specialised, so it becomes more difficult for surgeons to address the needs of training outside their own special interests. There is thus increasing reliance on the Specialist Societies to provide advice and guidance on issues of specialist training to the Colleges and the SAC. Many Regional Training Committees nowadays see the value of having a lead member in each speciality area of General Surgery to give advice. The newly revised SAC Curriculum in General Surgery has purposely omitted any details of specialist training and has instead encouraged the Specialist Societies to produce their own guidelines to which the SAC visitors may refer.

The The Vascular Society has formed a new Training and Education Committee to move these issues forward. In addition, the role of the Vascular Advisor has been expanded to include a more direct responsibility for the supervision of Vascular Surgical Trainees in their geographical area (Appendix A). Direct feedback on these issues to the The Vascular Society Council is offered through the Vascular Advisory Committee, which comprises the Vascular Advisors, the Vascular Surgical members of the SAC in General Surgery and members of the The Vascular Society Council.

In view of the close relationship between Vascular Surgeons and Vascular Interventional Radiologists, the The Vascular Society also has a liaison group with the Royal College of Radiologists. This group has worked, among other things, towards definitions of training in interventional radiology for vascular trainees and their recommendations are included in this document (see Appendix B).

The The Vascular Society also has representation on the European Board of Vascular Surgery, which examines training issues in Vascular Surgery across Europe on behalf of the Division of Vascular Surgery of the UEMS (Union of European Medical Specialities). The Board also administers the European Board of Vascular Surgery Qualification (EBSQ-Vasc), which attempts to ensure consistency of vascular training standards across Europe. Successful candidates for this qualification must first obtain the training and examinations pertinent to the award of a CCST from the country where they trained. Further information on applying for this qualification can be obtained from the The Vascular Society Office.

Definition of a Vascular Surgeon

A surgeon with an interest in Vascular Surgery should have:

• A sound training in General Surgery
• The necessary clinical and surgical skills relating to the management of relevant diseases of arteries, veins and lymphatics.
• The necessary clinical and surgical skills to maintain an emergency surgical service in General Surgery (where appropriate) and in Vascular Surgery.
• A sound knowledge of the role of interventional radiology in the management of vascular disease.
• A sound knowledge of the role of angiology in the management of vascular disease.
• Knowledge of relevant diagnostic imaging investigations.
• Knowledge of the role of a Vascular Laboratory in diagnosis and management of vascular disease.
• Knowledge of the relevant aspects of basic sciences and critical care as applied to vascular disease.

Vascular Surgery Units

A three surgeon unit might have two SpRs in any year of training, but would be most suited to year 5/6 trainees for a one year period or to year 3 trainees for a six month period. Two year 5/6 trainees may be attached to a unit at the same time, provided they rotate to work for all of the surgeons during the course of a year and are exposed to appropriate volumes of operative cases. A two surgeon unit would have only one SpR. All SpRs training in Vascular Surgery should spend both year 5 and year 6 attached to a Specialist Vascular Unit.

A three surgeon unit might have two SpRs and a two surgeon unit would have one SpR. These SpRs would not necessarily be committed to a speciality interest in Vascular Surgery. These posts would only be suitable for year 1-3 SpRs.

Both types of unit will have:

• At least two consultants who are members of the The Vascular Society and regularly attend its meetings
• A vascular surgical workload sufficient for training. This need not be fully comprehensive in each unit, provided the overall SpR programme gives full coverage.
• A ward with nursing staff experienced in looking after Vascular Surgery patients
• Appropriate investigative facilities, including access to comprehensive angiology, CT scanning, MR scanning and Duplex ultrasound.
• Close collaboration and weekly clinical meetings with Vascular Interventional Radiologists.
• A multidisciplinary approach to vascular disease incorporating close links to related specialities, including care of the elderly/rehabilitation, limb fitting, neurology, cardiology, diabetology, nephrology, haematology and dermatology.
• An ITU and an HDU facility
• Regular Postgraduate meetings and a climate which encourages health promotion and clinical risk management
• A regular audit programme of vascular surgical caseload and outcomes with submission of data to the National Outcome Audit run by the The Vascular Society.
• A climate which encourages clinical research.

In addition, a specialist vascular unit will have:

• A workload sufficient to provide personal operative experience for each trainee to achieve competence by year 6 in the index procedures of aortic aneurysm repair (elective and emergency), carotid endarterectomy and infra-inguinal bypass.
• Non invasive vascular laboratory facilities, including teaching of techniques and familiarity with Duplex ultrasound.
• A dedicated Vascular Emergency rota.
• Twenty four hour access to Vascular Radiology
• The opportunity to obtain training in Vascular Interventional Radiology.
• A programme of prospective vascular research projects, which are presented regularly at National Societies and which are published in peer-reviewed journals.

Vascular Surgery Trainees

• All Vascular Surgery trainees will have completed basic surgical training and will have passed the MRCS examination or equivalent.
• Training in General Surgery must be sufficient to ensure that trainees are competent to manage the full spectrum of Emergency General Surgery. This will require involvement in the rota for unselected General Surgical emergencies for a minimum of four years of Higher Surgical Training.
• Training in Vascular Surgery must be sufficient to ensure that trainees are competent to manage all vascular surgery emergencies.
• Vascular surgical trainees must pass the Intercollegiate Examination or equivalent and would normally submit Vascular Surgery as a Speciality interest.
• Year 6 vascular surgery trainees in possession of the Intercollegiate Examination or equivalent may wish to sit the EBSQ-Vasc.
• Training in SpR years 1-3 should be in General Surgery and should include at least one six month attachment to a General Vascular Unit.
• The flexible year should normally be spent in a clinical post relevant to Vascular Surgery, either in the UK or abroad. Only those trainees with a demonstrable commitment to a career in academic surgery should use their flexible year in research.
• SpR years 5 and 6 must be spent on a Specialist Vascular Unit.
• All Vascular Surgical trainees must keep a logbook of operative experience, including assisted, personal assisted and personal cases.
• By the end of year 6, all vascular trainees should have been involved in at least 200 arterial reconstructions. This experience must include as principal operator a minimum of 20 elective aortic aneurysm repairs, 5 ruptured aortic aneurysm repairs, 20 carotid endarterectomies and 10 infra-popliteal bypass grafts. At least 50% of each of these procedures should be personal assisted cases.
• Failure to obtain the operative experience detailed above by the end of year 6 should be addressed by an extra period of focused training on a Specialist Vascular Unit.
• The future development of effective competency assessments may allow the above targets to be modified according to individual SpR progress and achievement.
• There should be sufficient training in interventional radiology to perform the basic range of intra-operative interventions (arteriography and thrombolysis) as specified at level 2 in Appendix B.
• By the end of year 6, vascular surgery trainees should have obtained exposure to the majority of procedures specified in the Vascular Surgery Specialist Curriculum (see page 14)
• Trainees in Vascular Surgery are encouraged to become Affiliate Members of the The Vascular Society and attend its AGM. They are also encouraged to join the Rouleaux Club and to attend courses and workshops relevant to Vascular Surgery.
• Trainees in Vascular Surgery should show evidence of original thinking in the subject, either through the award of a Higher Degree in a vascular topic or through the publication of papers relevant to vascular surgery in peer-reviewed journals.
• Trainees in Vascular Surgery will have an annual appraisal by their The Vascular Society Vascular Advisor. The advisor will make recommendations to the local Surgical Training Committee regarding future attachments on the SpR programme to ensure an adequate training in Vascular Surgery according to the above parameters.

Curriculum

Core Curriculum

The core curriculum describes the training compulsory for all General Surgeons by the completion of General Surgical Training and outlines the syllabus for the general surgery part of the Intercollegiate examination. These are the areas to which all trainees should be exposed, both to provide core skills and to assist in the choice of specialisation.

Specialist Curriculum

This defines training in areas of specialist interest not required for all General Surgeons, which will be examined in the specialist part of the Intercollegiate examination. Trainees will be expected to have gained exposure to a majority of these procedures by the end of year 6. They will be required to exhibit competence in the procedures of aortic aneurysm repair (elective and emergency), carotid endarterectomy and infra-inguinal bypass.

CORE CURRICULUM VASCULAR SURGERY

SPECIALIST CURRICULUM VASCULAR SURGERY

APPENDIX A

The Role of Vascular Advisors

General

The role of the Vascular Advisor should be to represent the The Vascular Society in service, training and education matters relevant to vascular surgery within their Deanery, primarily reporting to the The Vascular Society Council via the Vascular Advisory Committee (VAC).  The Vascular Advisor should develop close links with the Regional Speciality Advisor in General Surgery.

The Vascular Advisor should:

• Have responsibility within their Deanery for implementing the recommendations of the The Vascular Society on training and education, and for advising their Regional Training Committee on these matters.
• Liaise with the Regional SpR Programme Director on matters related to vascular surgical training and advise on the most appropriate placement for individual vascular surgical trainees according to their specific training needs in Vascular Surgery.
• Serve on the Regional Training Committee, wherever this is possible.
• Keep an up to date record of SpRs in their Deanery with a vascular surgical interest.
• Be responsible for mentoring vascular surgical trainees in their Deanery, including the assessment of their log books/competency, and a yearly appraisal of their training in vascular surgery.

• The Vascular Advisor should:
• Provide advice for the Regional Speciality Advisor in General Surgery, and other interested parties, on the content of job descriptions for consultant appointments with a vascular surgical interest.  They should liaise with the The Vascular Society over any points of concern.
• Provide local advice on vascular services, liaising with the The Vascular Society as required.
• Assist The Vascular Society Council, through the VAC, on matters relating to manpower planning.

Liaison with the Secretariat

The The Vascular Society secretariat aims to assist the Vascular Advisors as much as possible.  Specific and regular assistance might include:

• Scanning of the BMJ to inform Vascular Advisors immediately of any advertisement for consultant posts with a vascular interest in their Deanery.
• Circulation of minutes of committees (Vascular Advisory Committee and the Education and Training Committee).
• Early circulation of briefing notes from the Honorary Secretary following Council meetings.

Advisors will be asked if they would inform the secretariat about vascular surgeons in their Deanery who might be suitable candidates for A and B awards, either directly or through the offices of a more senior nominee in their Deanery.  They should encourage such surgeons to submit ACDA CVs to the secretariat well before the November deadline each year.  They will be supplied with a list of A and B award holders by the secretariat.

The VAC will comprise Council together with all the Vascular Advisors.  It will meet at the time of the AGM. 

• Vascular Advisors should serve for a term of five years.
• Election should be by all Ordinary Members of the The Vascular Society in the Deanery. 
• The secretariat will invite nominations and then assist in conducting a postal ballot.
• There will be elections in all Deaneries where Vascular Advisors (formerly VAC Representatives) have served for five years or more.  Thereafter, elections will be conducted when any Vascular Advisor reaches the end of five years of service.

TRAINING IN INTERVENTIONAL RADIOLOGY

Proposal by the The Vascular Society/RCR Liaison Group

There should be four levels of training:

(i) A basic understanding of endovascular techniques and their applications - essential for all vascular trainees

This should include attendance at regular joint vascular surgical/radiology meetings where management decisions are discussed.  Training should also include attendance at vascular radiology sessions.

(ii) Sufficient training to perform a basic range of intra-operative interventions, such as arteriography, thrombolysis, and angioplasty of 'simple' arterial lesions

Skills in simple intraoperative vascular radiology, including angiography and thrombolysis, should be part of normal vascular surgical training.

Surgical trainees may acquire skills in more complex radiological procedures (specifically balloon angioplasty) by regular attendance at vascular radiology sessions in a recognised training unit.  In consultant practice these surgeons would use their radiological skills intraoperatively, working in liaison with vascular radiological colleagues in their hospital, in appropriately equipped operating theatres.  Although such procedures ideally would be conducted in collaboration, it is accepted that this may not always be possible.

(iii) Insertion of endovascular stent grafts for aortic aneurysms

Acquire wire and catheter skills for the insertion and the deployment of stent grafts.  Endovascular stent grafting should normally be a collaborative procedure between vascular radiologists and surgeons.  Specialists who are accredited both in vascular surgery and vascular radiology {(iv) below} may choose to undertake endovascular aneurysm procedures as the sole operator.

(iv) Full training in endovascular radiology to practise as a vascular and endovascular specialist

For vascular surgical trainees this should involve the equivalent of a one year full-time fellowship in a recognised vascular radiology training unit.  Trainees would be required to perform the core number of procedures specified for 'Sub-Specialty Training in Vascular Interventional Radiology', for practitioners with more than one sub-specialty interest, published in 'Structured Training in Clinical Radiology: Curricula for Subspecialty Training'.  Surgeons undertaking endovascular procedures will have to satisfy the training recommendations outlined in the regulations on ionising radiation.

27 July 2001

[ menu ]

Publications - Training in Interventional Radiology

Proposal by the The Vascular Society/RCR Liaison Group

There should be four levels of training:

(i) A basic understanding of endovascular techniques and their applications – essential for all vascular trainees

This should include attendance at regular joint vascular surgical/radiology meetings where management decisions are discussed. Training should also include attendance at vascular radiology sessions.

(ii) Sufficient training to perform a basic range of intra-operative interventions, such as arteriography, thrombolysis, and angioplasty of ‘simple’ arterial lesions

Skills in simple intraoperative vascular radiology, including angiography and thrombolysis, should be part of normal vascular surgical training.

Surgical trainees may acquire skills in more complex radiological procedures (specifically balloon angioplasty) by regular attendance at vascular radiology sessions in a recognised training unit. In consultant practice these surgeons would use their radiological skills intraoperatively, working in liaison with vascular radiological colleagues in their hospital, in appropriately equipped operating theatres. Although such procedures ideally would be conducted in collaboration, it is accepted that this may not always be possible.

(iii) Insertion of endovascular stent grafts for aortic aneurysms

Acquire wire and catheter skills for the insertion and the deployment of stent grafts. Endovascular stent grafting should normally be a collaborative procedure between vascular radiologists and surgeons. Specialists who are accredited both in vascular surgery and vascular radiology {(iv) below} may choose to undertake endovascular aneurysm procedures as the sole operator.

(iv) Full training in endovascular radiology to practise as a vascular and endovascular specialist

For vascular surgical trainees this should involve the equivalent of a one year full-time fellowship in a recognised vascular radiology training unit. Trainees would be required to perform the core number of procedures specified for ‘Sub-Specialty Training in Vascular Interventional Radiology’, for practitioners with more than one sub-specialty interest, published in ‘Structured Training in Clinical Radiology: Curricula for Subspecialty Training’. Surgeons undertaking endovascular procedures will have to satisfy the training recommendations outlined in the regulations on ionising radiation.

27 July 2001

[ menu ]

Educational Grants

A number of grants are available from the ESVS - see each link for details, this will open a new window on the ESVS web site:

• Educational Travel Grants
• Congress Travel Grants
• Research Grant
• Marco Polo Fellowship

[ menu ]

Carotid Procedure Based Assessment forms

• CEA Instructions
• CEA v2
• Global Rating Scale

[ menu ]