A nationwide survey of vascular surgery trainees reveals trends in operative experience, confidence, and attitudes about simulation

Objective: There is mounting evidence supporting the benefit of surgical skills training in a simulated environment. However, the use of simulation in vascular surgery has been limited, and its value has been poorly understood. Access to simulation is presumed to be a major barrier to its widespread implementation. While a great deal of discussion is taking place at the national level, input from current trainees has not been obtained. Methods: The Association of Program Directors in Vascular Surgery Committee on Education and Simulation sent a survey to all vascular surgical trainees assessing access to vascular simulation, the perceived value of simulation, and expectations for the future. Data were analyzed for junior (postgraduate year <= 4; n = 73) and senior (postgraduate year >= 5; n = 110) level and program type (traditional = 5 + 2/4 + 2; integrated = 0 + 5). Results: A total of 183 of 326 (56%) trainees completed the survey, 72 (0-5), 5 (4+2), 111 (5+2), respectively. Of the respondents, 86% believe there is educational value in simulation. Cadaver dissections, followed by peripheral endovascular simulators and endovascular aortic aneurysm repair simulators, were ranked the most valuable tools by seniors, while anastomotic models are valued most by juniors, followed by cadavers and endosimulators. Fifty-six percent of programs currently offer simulation training, most commonly in the form of peripheral endovascular simulators (70%), anastomotic models (58%), or endovascular aortic aneurysm repair simulation (53%). Senior residents are more likely than juniors to have attended outside simulation courses (37% vs 19%). Overall, 57% of trainees expect that technical skills assessment will be incorporated into the certification process, and 52% endorse skills assessment for certification. Conclusions: Trainees report limited operative experience and confidence, and confidence levels are improved for a number of index procedures among those trainees with access to simulation. Trainees endorse the use of simulation to augment their surgical training, and a significant proportion of them already have access to it. These data support a perceived need and utility for implementation of a standardized simulation curriculum in vascular surgical training.