Scope of Vascular Training

The vascular resident is an integral part of the surgical health care team which includes faculty, the vascular resident, senior and junior general surgery residents and medical students. Educational advantages such as didactic training and investigative insight accrue from interaction with all members of the surgical service team. General surgery residents and medical students are assigned to the vascular surgical service and the vascular resident is a key influence in their educational experience.

The training of vascular surgeons encompasses education in basic sciences, training in cognitive and technical skills, development of clinical knowledge and maturity, and acquisition of keen surgical judgment. Our program provides the opportunity for vascular residents to learn the fundamentals of basic science as applied to clinical vascular surgery. The program provides experience in preoperative, operative and postoperative care for patients in all areas of vascular surgery.

The goals of our vascular surgical residency program are to prepare the resident to function as an expert practitioner of vascular surgery at the high level of performance expected of a board certified specialist. Residents are provided adequate time and sufficient facilities for study. Operative skill is essential for the vascular surgeon and can be acquired only through personal experience and training. The program provides for extensive operative experience more than sufficient to train qualified vascular surgeons. Graduate education in vascular surgery requires a commitment to continuity of patient care.

Residency training in vascular surgery is a full-time responsibility; activities outside the educational program must not interfere with the vascular resident’s performance in the educational process. The establishment of an inquiring and scholarly environment is the primary responsibility of the teaching staff. The teaching staff is well qualified to create and maintain such an environment and are willing to devote the necessary time and effort to the educational program, and permit vascular residents to participate actively in the management of patients under their care. The attending physician has both an ethical and legal responsibility for the overall care of the individual patient and for the supervision of the vascular resident involved in the care of that patient.

A chain of command exists emphasizing graded authority and increasing responsibility as experience is gained, with the vascular resident having more authority and responsibility than the general surgery residents. Judgments on this delegation of responsibility are made by the attending surgeon who is ultimately responsible for each patient’s care; they are based on his or her direct observation and knowledge of each vascular resident’s skills and ability. Proper supervision does not conflict with progressively more independent decision-making on the part of the vascular resident; thus, the degree of supervision may vary with the clinical circumstances and the stage of the vascular resident.

The vascular resident spends over 95% of the available time at the Hospital of the University of Pennsylvania. Occasionally the resident will visit another institution.

As in past years, last year, the vascular resident performed over 400 major vascular procedures as operating surgeon. They were distributed across the breadth of vascular surgery. These cases do not include transplants, portacaval shunts or access surgery. Interested residents may choose to involve themselves in the activities of the multi-organ transplant service and provide coverage for a few vascular access cases. Training in endovascular techniques is excellent. We are currently performing angioplasty and stenting procedures in the operating room with digital subtraction angiography and road-mapping. We have an ongoing program in endovascular aortic stent graft surgery for the treatment of aortic aneurysms. We have placed over 400 endo grafts. We are a training center for both Ancure and AneuRx Endovascular aortic grafts and demonstrate placement of these to outside physicians. In addition, we have multiple aortic stent graft device trials, and carotid stenting trials and other protocols ongoing. HUP is designated as a Level I Trauma Center and has an active service, which provides ample opportunity for trainees at all levels to participate in vascular trauma care.