Pub Date : 2025-09-01DOI: 10.1053/j.semvascsurg.2025.07.006
Sonia Talathi (Guest Editor) , Yana Etkin (Guest Editor)
{"title":"Vascular surgery in older adults: Looking beyond the number","authors":"Sonia Talathi (Guest Editor) , Yana Etkin (Guest Editor)","doi":"10.1053/j.semvascsurg.2025.07.006","DOIUrl":"10.1053/j.semvascsurg.2025.07.006","url":null,"abstract":"","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 3","pages":"Pages 207-208"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.semvascsurg.2025.06.005
Judy Li, Melissa Kumi, Cassius Iyad Ochoa Chaar
Chronic venous insufficiency (CVI) develops as a consequence of valvular incompetence or venous obstruction over time and can significantly impair quality of life. Its prevalence and burden are highest among older adults, as the physiological changes of aging predispose to the onset and progression of CVI. We present an overview of the evaluation and management of CVI in older adults, with a focus on superficial venous disease. Current treatment modalities for superficial venous disease and their outcomes in older adults are discussed.
{"title":"Management of chronic venous insufficiency in older adults","authors":"Judy Li, Melissa Kumi, Cassius Iyad Ochoa Chaar","doi":"10.1053/j.semvascsurg.2025.06.005","DOIUrl":"10.1053/j.semvascsurg.2025.06.005","url":null,"abstract":"<div><div>Chronic venous insufficiency (CVI) develops as a consequence of valvular incompetence or venous obstruction over time and can significantly impair quality of life. Its prevalence and burden are highest among older adults, as the physiological changes of aging predispose to the onset and progression of CVI. We present an overview of the evaluation and management of CVI in older adults, with a focus on superficial venous disease. Current treatment modalities for superficial venous disease and their outcomes in older adults are discussed.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 3","pages":"Pages 323-331"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.semvascsurg.2025.06.007
Caitlin Dowling , Lucy Chu , Yana Etkin , Alisha Oropallo
Nonhealing wounds are increasingly prevalent, present in 1% to 2% of the global population, with higher incidence in geriatric patients. These chronic wounds pose challenges to older adult patients owing to physiologic changes that hinder healing, common medical comorbidities that promote inflammation and damage microcirculation, poor nutritional status and mobility, and psychosocial barriers to receiving care. In this literature review, the epidemiology, pathophysiology, systems costs, and management of chronic venous leg ulcers, arterial ulcers, and diabetic foot wounds in older adult patients are investigated. Evolving skin structure, pro-inflammatory cellular changes, and propensity for infection place the geriatric population at risk for all wound types. Strategies to differentiate between nonhealing wounds through physical examination, standardized tools, and patient-specific characteristics are outlined. Optimal wound care management principles for each wound type, including wound bed debridement, moisture optimization, biofilm control, and management of edema are addressed. Venous leg ulcers secondary to venous insufficiency are particularly common in older adults and often recur, requiring innovative techniques in compression and tissue substitutes. Emerging therapies, including skin grafts, hyperbaric and topical oxygen, and bedside imaging devices, are discussed. Finally, older adult patients are susceptible to social circumstances that place them at risk for suboptimal wound care and poor healing. The combination of access gaps to regular caretakers, immobility, nociceptive and neuropathic pain, and frailty must be acknowledged and addressed in older adult patients with wounds. The aims of this literature review were to clarify these factors to consolidate awareness and to advocate for a multidisciplinary approach to wound care management.
{"title":"Assessment and management of chronic venous, arterial, and diabetic wounds in older adults","authors":"Caitlin Dowling , Lucy Chu , Yana Etkin , Alisha Oropallo","doi":"10.1053/j.semvascsurg.2025.06.007","DOIUrl":"10.1053/j.semvascsurg.2025.06.007","url":null,"abstract":"<div><div>Nonhealing wounds are increasingly prevalent, present in 1% to 2% of the global population, with higher incidence in geriatric patients. These chronic wounds pose challenges to older adult patients owing to physiologic changes that hinder healing, common medical comorbidities that promote inflammation and damage microcirculation, poor nutritional status and mobility, and psychosocial barriers to receiving care. In this literature review, the epidemiology, pathophysiology, systems costs, and management of chronic venous leg ulcers, arterial ulcers, and diabetic foot wounds in older adult patients are investigated. Evolving skin structure, pro-inflammatory cellular changes, and propensity for infection place the geriatric population at risk for all wound types. Strategies to differentiate between nonhealing wounds through physical examination, standardized tools, and patient-specific characteristics are outlined. Optimal wound care management principles for each wound type, including wound bed debridement, moisture optimization, biofilm control, and management of edema are addressed. Venous leg ulcers secondary to venous insufficiency are particularly common in older adults and often recur, requiring innovative techniques in compression and tissue substitutes. Emerging therapies, including skin grafts, hyperbaric and topical oxygen, and bedside imaging devices, are discussed. Finally, older adult patients are susceptible to social circumstances that place them at risk for suboptimal wound care and poor healing. The combination of access gaps to regular caretakers, immobility, nociceptive and neuropathic pain, and frailty must be acknowledged and addressed in older adult patients with wounds. The aims of this literature review were to clarify these factors to consolidate awareness and to advocate for a multidisciplinary approach to wound care management.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 3","pages":"Pages 281-290"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.semvascsurg.2025.06.003
Christina L. Cui , Arash Fereydooni , Shipra Arya , Laura M Drudi
The surgical management of elderly patients has become increasingly important as the population ages in the U.S. and globally, and the incidence of cardiovascular risk factors continues to rise. Geriatric surgical patients face heightened surgical risks due to age-related physiological changes, which may extend beyond comorbidities, best described as geriatric syndromes. A thorough geriatric evaluation involves examining risk factors for these syndromes, which includes an extensive review of the patient’s medical history, frailty assessment, nutritional evaluation, medication review, and evaluation of social support. The goal of this assessment is not to deem patients “safe” or “unsafe” for surgery, but to evaluate their risk levels and identify opportunities for prehabilitation prior to surgery. This approach necessitates collaboration between surgical teams and a comprehensive perioperative team that includes geriatricians. This narrative review aims to analyze the components of a geriatric evaluation and identify subsequent actions for patients at increased risk of postoperative complications and identify areas for innovation as it relates to vascular care in aging populations.
{"title":"Perioperative Evaluation and Risk Stratification of the Elderly Patient Undergoing Vascular Intervention","authors":"Christina L. Cui , Arash Fereydooni , Shipra Arya , Laura M Drudi","doi":"10.1053/j.semvascsurg.2025.06.003","DOIUrl":"10.1053/j.semvascsurg.2025.06.003","url":null,"abstract":"<div><div>The surgical management of elderly patients has become increasingly important as the population ages in the U.S. and globally, and the incidence of cardiovascular risk factors continues to rise. Geriatric surgical patients face heightened surgical risks due to age-related physiological changes, which may extend beyond comorbidities, best described as geriatric syndromes. A thorough geriatric evaluation involves examining risk factors for these syndromes, which includes an extensive review of the patient’s medical history, frailty assessment, nutritional evaluation, medication review, and evaluation of social support. The goal of this assessment is not to deem patients “safe” or “unsafe” for surgery, but to evaluate their risk levels and identify opportunities for prehabilitation prior to surgery. This approach necessitates collaboration between surgical teams and a comprehensive perioperative team that includes geriatricians. This narrative review aims to analyze the components of a geriatric evaluation and identify subsequent actions for patients at increased risk of postoperative complications and identify areas for innovation as it relates to vascular care in aging populations.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 3","pages":"Pages 209-218"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.semvascsurg.2025.07.002
Maha Haqqani, Hans Boggs, Jordan R. Stern
As the population ages, the rate of identification and repair of complex aortic pathology in patients of advanced age is rising. The older adult patient, defined here as 80 years or older, presents unique challenges for aortic repair due to medical comorbidities, declining functional status and independence, and anatomic changes. In this review, the evidence-based risk assessment and perioperative management are discussed, including the use of geriatric assessment tools, frailty indices, and emerging prehabilitation strategies. Outcomes for both open and endovascular procedures are examined, with a focus on more complex repairs, such as fenestrated and branched repair for paravisceral and thoracoabdominal pathology. Finally, ethical and social considerations, such as shared decision making, expectation management, and cost are addressed. Careful patient selection and individualized optimization is critical for successful aortic repair in this vulnerable patient population, with the goal of minimizing morbidity and loss of independence without compromising outcomes.
{"title":"Complex aortic repair in older adults","authors":"Maha Haqqani, Hans Boggs, Jordan R. Stern","doi":"10.1053/j.semvascsurg.2025.07.002","DOIUrl":"10.1053/j.semvascsurg.2025.07.002","url":null,"abstract":"<div><div>As the population ages, the rate of identification and repair of complex aortic pathology in patients of advanced age is rising. The older adult patient, defined here as 80 years or older, presents unique challenges for aortic repair due to medical comorbidities, declining functional status and independence, and anatomic changes. In this review, the evidence-based risk assessment and perioperative management are discussed, including the use of geriatric assessment tools, frailty indices, and emerging prehabilitation strategies. Outcomes for both open and endovascular procedures are examined, with a focus on more complex repairs, such as fenestrated and branched repair for paravisceral and thoracoabdominal pathology. Finally, ethical and social considerations, such as shared decision making, expectation management, and cost are addressed. Careful patient selection and individualized optimization is critical for successful aortic repair in this vulnerable patient population, with the goal of minimizing morbidity and loss of independence without compromising outcomes.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 3","pages":"Pages 225-233"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.semvascsurg.2025.06.004
Blake E. Murphy, Sara L. Zettervall
Aortic dissection carries significant morbidity and mortality, particularly with involvement of the ascending aorta. The estimated prevalence of aortic dissection in the general population is between 2.0 and 3.5 per 100,000 people; the risk of which increases with age and underlying risk factors, such as hypertension, long-term tobacco use, and genetic aortopathy. The older adult population continues to increase exponentially, with people older than 65 years accounting for nearly 20% of the total population. The unique challenges associated with treating older patients include consideration of reduced physiologic reserve, increased comorbidity profiles, and clinical frailty. Although surgical repair and endovascular repair have notable survival benefits in the setting of acute aortic dissection, older patients are more frequently offered medical management alone. More recently, the proliferation and evolution of endovascular therapies has offered novel and minimally invasive treatment options for older patients with acute and chronic post-dissection thoracoabdominal aortic aneurysms. In this article, the underlying risk factors, pathophysiology, and clinical decision making for patients with acute dissection are described. In addition, the considerations for treatment of both acute and chronic aortic dissection in this unique patient population are outlined.
{"title":"Management and outcomes of thoracic dissection in older adults","authors":"Blake E. Murphy, Sara L. Zettervall","doi":"10.1053/j.semvascsurg.2025.06.004","DOIUrl":"10.1053/j.semvascsurg.2025.06.004","url":null,"abstract":"<div><div>Aortic dissection carries significant morbidity and mortality, particularly with involvement of the ascending aorta. The estimated prevalence of aortic dissection in the general population is between 2.0 and 3.5 per 100,000 people; the risk of which increases with age and underlying risk factors, such as hypertension, long-term tobacco use, and genetic aortopathy. The older adult population continues to increase exponentially, with people older than 65 years accounting for nearly 20% of the total population. The unique challenges associated with treating older patients include consideration of reduced physiologic reserve, increased comorbidity profiles, and clinical frailty. Although surgical repair and endovascular repair have notable survival benefits in the setting of acute aortic dissection, older patients are more frequently offered medical management alone. More recently, the proliferation and evolution of endovascular therapies has offered novel and minimally invasive treatment options for older patients with acute and chronic post-dissection thoracoabdominal aortic aneurysms. In this article, the underlying risk factors, pathophysiology, and clinical decision making for patients with acute dissection are described. In addition, the considerations for treatment of both acute and chronic aortic dissection in this unique patient population are outlined.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 3","pages":"Pages 234-242"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semvascsurg.2025.04.009
M. Libby Weaver (Guest Editors) , Brigitte K. Smith
{"title":"Introduction to Contemporary Issues in Vascular Surgery Education","authors":"M. Libby Weaver (Guest Editors) , Brigitte K. Smith","doi":"10.1053/j.semvascsurg.2025.04.009","DOIUrl":"10.1053/j.semvascsurg.2025.04.009","url":null,"abstract":"","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Page 121"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semvascsurg.2025.04.005
Taylor Carter , M. Libby Weaver
Health disparities occur due to complex interactions of individual and environmental factors in the presence of structural inequities and social determinants of health, and disproportionately impact disadvantaged and vulnerable patient populations. Vascular surgery cares for a diverse patient population who often experience socioeconomic disadvantage. Understanding the complex reasons for differences in presentation, management, and outcomes in vulnerable patient populations is critical to providing optimal vascular surgical care and mitigating health disparities. We outline the need for implementation of health disparities curriculum in graduate medical education and proposes a framework for health disparities curriculum development specific to vascular surgery.
{"title":"Teaching health disparities in vascular surgery training programs","authors":"Taylor Carter , M. Libby Weaver","doi":"10.1053/j.semvascsurg.2025.04.005","DOIUrl":"10.1053/j.semvascsurg.2025.04.005","url":null,"abstract":"<div><div>Health disparities occur due to complex interactions of individual and environmental factors in the presence of structural inequities and social determinants of health, and disproportionately impact disadvantaged and vulnerable patient populations. Vascular surgery cares for a diverse patient population who often experience socioeconomic disadvantage. Understanding the complex reasons for differences in presentation, management, and outcomes in vulnerable patient populations is critical to providing optimal vascular surgical care and mitigating health disparities. We outline the need for implementation of health disparities curriculum in graduate medical education and proposes a framework for health disparities curriculum development specific to vascular surgery.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 172-175"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semvascsurg.2025.04.003
Chelsea Dorsey , Ashley Gordon , Maryam Hashmi , Simi Ogunnowo , Luigi Pascarella , Gabrielle Sutton , Rana Afifi
The decline in diversity in medical education, following the Supreme Court’s 2023 ruling against race-based affirmative action, exacerbates existing health disparities. With decreasing enrollment of underrepresented groups in medical schools, residency attrition, and gaps in diversity, equity and inclusion (DEI) standards, urgent efforts are needed to address systemic inequities in medical training and patient care. Vascular surgery has made important progress in increasing diversity within its training programs, but there is still much work to be done to create a truly inclusive environment. While there has been growth in the representation of women within vascular surgery, the proportion of underrepresented in medicine (UriM) physicians has not kept pace. Addressing the lack of diversity in vascular surgery requires a multi-pronged approach focused on recruitment, retention, and the creation of an inclusive learning and work environment. Establishing an inclusive environment goes beyond recruitment; it requires fostering a culture where all trainees and faculty feel valued and heard. Through targeted initiatives, commitment to transparency, and systemic changes to academic and clinical environments, the field can make substantial strides in workforce diversity and in turn addressing disparities.
{"title":"Diversity, equity, and inclusivity in vascular surgical education","authors":"Chelsea Dorsey , Ashley Gordon , Maryam Hashmi , Simi Ogunnowo , Luigi Pascarella , Gabrielle Sutton , Rana Afifi","doi":"10.1053/j.semvascsurg.2025.04.003","DOIUrl":"10.1053/j.semvascsurg.2025.04.003","url":null,"abstract":"<div><div>The decline in diversity in medical education, following the Supreme Court’s 2023 ruling against race-based affirmative action, exacerbates existing health disparities. With decreasing enrollment of underrepresented groups in medical schools, residency attrition, and gaps in diversity, equity and inclusion (DEI) standards, urgent efforts are needed to address systemic inequities in medical training and patient care. Vascular surgery has made important progress in increasing diversity within its training programs, but there is still much work to be done to create a truly inclusive environment. While there has been growth in the representation of women within vascular surgery, the proportion of underrepresented in medicine (UriM) physicians has not kept pace. Addressing the lack of diversity in vascular surgery requires a multi-pronged approach focused on recruitment, retention, and the creation of an inclusive learning and work environment. Establishing an inclusive environment goes beyond recruitment; it requires fostering a culture where all trainees and faculty feel valued and heard. Through targeted initiatives, commitment to transparency, and systemic changes to academic and clinical environments, the field can make substantial strides in workforce diversity and in turn addressing disparities.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 184-191"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1053/j.semvascsurg.2025.04.001
Christine Kariya, Mina Boutrous, Kwame S. Amankwah
Operative autonomy, entrustment, self-efficacy, and decision-making are fundamental aspects of surgical resident education. Over the past few decades, trainee operative autonomy in surgical subspecialties has been declining. Most retrospective studies evaluating clinical outcomes with increasing levels of trainee independence have found no significant rise in patient morbidity and mortality. To provide more autonomy, attendings assess their relationship with the trainee, along with the trainee's skill level, the complexity of the case, and their own confidence. Identified barriers include a desire for efficiency and expectations from patients and the hospital that the procedure be performed by the attending. Consequently, trainees can enhance their self-efficacy by fostering a relationship with the attending, demonstrating clinical competence to encourage the delegation of clinical responsibilities, and adapting to the attending’s teaching style. Techniques to improve autonomy include longitudinal evaluations of trainee independence with a variety of teaching applications and role reversal. It is essential for patients, hospital administrators, and legislators to recognize the significance of demonstrating operative independence during training to cultivate competent, self-sufficient surgeons.
{"title":"Autonomy, entrustment, self-efficacy, and decision-making: The current state of training independent surgeons","authors":"Christine Kariya, Mina Boutrous, Kwame S. Amankwah","doi":"10.1053/j.semvascsurg.2025.04.001","DOIUrl":"10.1053/j.semvascsurg.2025.04.001","url":null,"abstract":"<div><div>Operative autonomy, entrustment, self-efficacy, and decision-making are fundamental aspects of surgical resident education. Over the past few decades, trainee operative autonomy in surgical subspecialties has been declining. Most retrospective studies evaluating clinical outcomes with increasing levels of trainee independence have found no significant rise in patient morbidity and mortality. To provide more autonomy, attendings assess their relationship with the trainee, along with the trainee's skill level, the complexity of the case, and their own confidence. Identified barriers include a desire for efficiency and expectations from patients and the hospital that the procedure be performed by the attending. Consequently, trainees can enhance their self-efficacy by fostering a relationship with the attending, demonstrating clinical competence to encourage the delegation of clinical responsibilities, and adapting to the attending’s teaching style. Techniques to improve autonomy include longitudinal evaluations of trainee independence with a variety of teaching applications and role reversal. It is essential for patients, hospital administrators, and legislators to recognize the significance of demonstrating operative independence during training to cultivate competent, self-sufficient surgeons.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 132-144"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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