Preparedness for Surgical Practice: A Framework to Understand Differences Between Training Paradigms

A study of the differences in preparedness for independent surgical practice of the graduates of two different vascular surgery training paradigms, the integrated vascular surgery residency (0+5) and the traditional vascular surgery fellowship (5+2) was carried out using a constructivist, case-study approach. Interviews were completed with 9 0+5 graduates, 7 5+2 graduates, and 6 program directors. Four interconnected themes emerged as influencing graduates’ preparedness for practice: structural, individual, relational and organizational factors. Participants discussed how the structure of the training program, including overall time spent in training and vascular surgery-specific time, impacted preparedness. Factors related to the individual trainee, such as innate technical skills and confidence, were felt to impact the efficacy of the different training models. Faculty-trainee relationships were emphasized as important for development of trust and granting of autonomy. Finally, features of the local organization, including patient population, case volume, and case mix, further influenced preparedness. There is a complex interplay between structural, individual, relational and organizational factors, all of which influence trainees’ perceptions of their preparedness for independent practice. If efforts to re-structure graduate surgical training models are to be successful, the influence of individual, relational, and organizational factors must also be considered.