Vascular access surgery training in the United Kingdom is currently perceived (by trainees) to be inadequate

TL;DR

UK vascular surgery trainees feel they are not adequately trained for vascular access surgery, which is essential for haemodialysis.

Contribution

The study highlights a lack of formal training and perceived competence in vascular access surgery among senior trainees in the UK.

Findings

Only 46% of trainees felt confident to perform access surgery independently after training.

Training experience varied, with 28.6% having fewer than 10 cases of exposure.

There is currently only one access surgery fellowship accredited in the UK.

Abstract

Vascular access surgery (VAS) involves the creation and maintenance of arteriovenous access to facilitate haemodialysis. The prevalence of haemodialysis is rising despite increases in kidney transplants on a yearly basis. There is currently only one access surgery fellowship accredited by the Royal College of Surgeons of England. We aimed to establish the experience and perceived competence in access surgery of senior vascular surgery trainees.

A short questionnaire (SurveyMonkey) was used to survey all senior (ST6–ST8) vascular surgery trainees in Health Education England (HEE) vascular surgery training programmes. The short survey asked trainees to report their: (1) training grade; (2) training deanery; (3) experience of access surgery; and (4) whether senior trainees thought they would be able to independently undertake primary access surgery post-completion of training (post Certificate of Completion of Training). The survey was circulated via HEE deaneries and the vascular surgery trainees' society: the Rouleaux Club.

Twenty-eight senior (ST6–ST8) vascular surgery trainees responded to the survey: 29.6% were ST6 level, 33.3% were ST7 and 37.1% were ST8. Deanery respondence was evenly spread, although London was overrepresented (37.1%). In total, 28.6% had been involved in fewer than 10 cases, 35.7% in 10–25 cases, and 35.7% in more than 25 cases. Almost 54% of senior vascular surgery trainees believed they would not be able to undertake independent access surgery once they had completed training.

Competence in access surgery is an increasing requirement of a consultant vascular surgeon. More formalised training is required to adequately train the next generation of vascular surgeons.