Pub Date : 2025-06-01DOI: 10.1053/j.semvascsurg.2025.03.003
M. Libby Weaver , Brigitte K. Smith
Entrustable professional activity (EPA) assessments are an assessment tool designed to integrate multiple competencies and subcompetencies across all clinical settings and phases of care. These assessments are important in the shift toward competency-based medical education, as they allow for holistic assessment of the core competencies expected of vascular surgery trainees preparing for independent practice. This manuscript serves to describe the process by which vascular surgery EPAs were developed and implemented nationally in a pilot study, and outlines training challenges addressed by EPA implementation, as well as future directions for EPA development and use.
{"title":"Entrustable professional activity assessments in vascular surgery training","authors":"M. Libby Weaver , Brigitte K. Smith","doi":"10.1053/j.semvascsurg.2025.03.003","DOIUrl":"10.1053/j.semvascsurg.2025.03.003","url":null,"abstract":"<div><div>Entrustable professional activity (EPA) assessments are an assessment tool designed to integrate multiple competencies and subcompetencies across all clinical settings and phases of care. These assessments are important in the shift toward competency-based medical education, as they allow for holistic assessment of the core competencies expected of vascular surgery trainees preparing for independent practice. This manuscript serves to describe the process by which vascular surgery EPAs were developed and implemented nationally in a pilot study, and outlines training challenges addressed by EPA implementation, as well as future directions for EPA development and use.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 145-154"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280553","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.2025.03.002
Jeffrey Jim , David A. Rigberg
Applicant interviews remain an integral part of the match process used in graduate medical education. In vascular surgery, in-person interviews of the applicant by program faculty at the institution have been the standard for decades. The COVID-19 pandemic forced a dramatic pivot to virtual interviews. With this unexpected change, there is now insight that interview format can affect equal and fair access, negatively impact the environment, as well as alter financial and administrative burden for both the applicants and programs. Future modifications to the match process will have to be explored to ensure both applicants and programs are able to mutually find their best match.
{"title":"Interview format: Current state and future directions","authors":"Jeffrey Jim , David A. Rigberg","doi":"10.1053/j.semvascsurg.2025.03.002","DOIUrl":"10.1053/j.semvascsurg.2025.03.002","url":null,"abstract":"<div><div>Applicant interviews remain an integral part of the match process used in graduate medical education. In vascular surgery, in-person interviews of the applicant by program faculty at the institution have been the standard for decades. The COVID-19 pandemic forced a dramatic pivot to virtual interviews. With this unexpected change, there is now insight that interview format can affect equal and fair access, negatively impact the environment, as well as alter financial and administrative burden for both the applicants and programs. Future modifications to the match process will have to be explored to ensure both applicants and programs are able to mutually find their best match.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 202-206"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280436","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.2025.03.001
Arash Fereydooni, Michael David Sgroi
Simulation-based training (SBT) has become essential in vascular surgery education, providing a risk-free environment for skill development. This scoping review evaluates the current state of vascular surgery simulation, highlighting validated models, educational impact, and areas for improvement. A systematic literature search was conducted in PubMed, Embase, and Scopus, following PRISMA-ScR guidelines. Studies assessing validated simulation models for open and endovascular procedures, vascular anastomosis, carotid interventions, peripheral vascular interventions, and nontechnical skills training were included. Data extraction focused on fidelity, skill acquisition, procedural efficiency, and accessibility. Validated high-fidelity models, including 3D-printed, virtual reality (VR), and pulsatile cadaveric systems, significantly enhance technical proficiency and confidence. Bench and porcine models improve vascular anastomosis training, while VR-based simulators enhance catheter manipulation and decision-making. However, simulation remains limited by high costs, accessibility challenges, and lack of standardized nontechnical skills training. Simulation improves competency in vascular surgery but requires further integration into training curricula. AI-driven assessments, hybrid simulation models, and expanded cost-effective solutions are needed to bridge existing gaps. Standardization and broader adoption of simulation will enhance competency-based training and improve patient outcomes.
{"title":"The Use of Simulation in Vascular Surgery Education: Current State and Future Directions","authors":"Arash Fereydooni, Michael David Sgroi","doi":"10.1053/j.semvascsurg.2025.03.001","DOIUrl":"10.1053/j.semvascsurg.2025.03.001","url":null,"abstract":"<div><div>Simulation-based training (SBT) has become essential in vascular surgery education, providing a risk-free environment for skill development. This scoping review evaluates the current state of vascular surgery simulation, highlighting validated models, educational impact, and areas for improvement. A systematic literature search was conducted in PubMed, Embase, and Scopus, following PRISMA-ScR guidelines. Studies assessing validated simulation models for open and endovascular procedures, vascular anastomosis, carotid interventions, peripheral vascular interventions, and nontechnical skills training were included. Data extraction focused on fidelity, skill acquisition, procedural efficiency, and accessibility. Validated high-fidelity models, including 3D-printed, virtual reality (VR), and pulsatile cadaveric systems, significantly enhance technical proficiency and confidence. Bench and porcine models improve vascular anastomosis training, while VR-based simulators enhance catheter manipulation and decision-making. However, simulation remains limited by high costs, accessibility challenges, and lack of standardized nontechnical skills training. Simulation improves competency in vascular surgery but requires further integration into training curricula. AI-driven assessments, hybrid simulation models, and expanded cost-effective solutions are needed to bridge existing gaps. Standardization and broader adoption of simulation will enhance competency-based training and improve patient outcomes.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 163-171"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280555","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.2025.04.004
Priscilla Tanamal , Claudie Sheahan , Malachi Sheahan III
Training surgeons poses many unique challenges. In addition to the clinical acumen that must be learned, a minimum threshold of technical competency is a requisite for independent practice. The trends of endovascular interventions and open surgical procedures add another layer of complexity to vascular surgery training. Simulation can provide a solution for both technical skills training and evaluating proficiency. The Education Committee of the Association of Program Directors of Vascular Surgery (APDVS) developed the Fundamentals of Vascular and Endovascular Surgery platform to provide an opportunity for more uniform basic technical skill teaching and assessment across all vascular training programs. Evaluation by experts with standardized scoring of Objective Structured Assessment of Technical Skills (OSATS) Global Rating Score and Global Summary grading systems have demonstrated correlation with participant ability when completing the end-to-side anastomosis, patch angioplasty, and clockface suturing models. Future research should be directed toward developing autonomous and objective methods for technical assessments on these models.
{"title":"Fundamentals of vascular surgery: A plan for the uniform instruction and assessment of basic skills in vascular surgery","authors":"Priscilla Tanamal , Claudie Sheahan , Malachi Sheahan III","doi":"10.1053/j.semvascsurg.2025.04.004","DOIUrl":"10.1053/j.semvascsurg.2025.04.004","url":null,"abstract":"<div><div>Training surgeons poses many unique challenges. In addition to the clinical acumen that must be learned, a minimum threshold of technical competency is a requisite for independent practice. The trends of endovascular interventions and open surgical procedures add another layer of complexity to vascular surgery training. Simulation can provide a solution for both technical skills training and evaluating proficiency. The Education Committee of the Association of Program Directors of Vascular Surgery (APDVS) developed the Fundamentals of Vascular and Endovascular Surgery platform to provide an opportunity for more uniform basic technical skill teaching and assessment across all vascular training programs. Evaluation by experts with standardized scoring of Objective Structured Assessment of Technical Skills (OSATS) Global Rating Score and Global Summary grading systems have demonstrated correlation with participant ability when completing the end-to-side anastomosis, patch angioplasty, and clockface suturing models. Future research should be directed toward developing autonomous and objective methods for technical assessments on these models.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 155-162"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280554","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.2025.04.008
Christina L. Cui , Brandi Tuttle , Dawn M. Coleman
Psychological safety is a critical component of the medical learning environment. While multiple synthesis studies exist for psychological safety within broader medical education, few have focused specifically on surgical training paradigms. This narrative review evaluates psychological safety for surgical trainees. A literature search of PubMed was conducted to identify studies discussing psychological safety within the surgical learning environment. Studies were included if psychological safety was a primary outcome, predictor, or theme. Studies were excluded if surgical trainees were not included or specifically discussed. A total of 53 articles were screened. Of these, 36 were excluded for relevance, and the remaining 17 full texts were reviewed. Reasons for exclusion include: study was conducted internationally; psychological safety was not a critical outcome, predictor, or theme; study focused on nonsurgical medical specialties (ie, anesthesia or psychiatry); and psychological safety of surgical trainees was not discussed despite surgical trainees being within the study cohort. A total of 11 studies were included for comparison. Four studies evaluated the positive impact of psychological safety within care teams that included surgical trainees. Two discussed the importance of building psychological safety as a surgical educator. Five studies evaluated learning environment factors or interventions that predicted psychological safety. Existing literature on psychological safety within the surgical learning environment focuses on educators, surgical teams, and specific aspects of the learning environment. While these studies offer valuable insight, additional studies are needed to identify effective interventions and operationalization of previous recommendations.
{"title":"A narrative review of psychological safety in the surgical learning environment","authors":"Christina L. Cui , Brandi Tuttle , Dawn M. Coleman","doi":"10.1053/j.semvascsurg.2025.04.008","DOIUrl":"10.1053/j.semvascsurg.2025.04.008","url":null,"abstract":"<div><div>Psychological safety is a critical component of the medical learning environment. While multiple synthesis studies exist for psychological safety within broader medical education, few have focused specifically on surgical training paradigms. This narrative review evaluates psychological safety for surgical trainees. A literature search of PubMed was conducted to identify studies discussing psychological safety within the surgical learning environment. Studies were included if psychological safety was a primary outcome, predictor, or theme. Studies were excluded if surgical trainees were not included or specifically discussed. A total of 53 articles were screened. Of these, 36 were excluded for relevance, and the remaining 17 full texts were reviewed. Reasons for exclusion include: study was conducted internationally; psychological safety was not a critical outcome, predictor, or theme; study focused on nonsurgical medical specialties (ie, anesthesia or psychiatry); and psychological safety of surgical trainees was not discussed despite surgical trainees being within the study cohort. A total of 11 studies were included for comparison. Four studies evaluated the positive impact of psychological safety within care teams that included surgical trainees. Two discussed the importance of building psychological safety as a surgical educator. Five studies evaluated learning environment factors or interventions that predicted psychological safety. Existing literature on psychological safety within the surgical learning environment focuses on educators, surgical teams, and specific aspects of the learning environment. While these studies offer valuable insight, additional studies are needed to identify effective interventions and operationalization of previous recommendations.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 176-183"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280433","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.2025.04.002
Clara M Gomez-Sanchez, Curtis Woodford
Trainee unions have been a source of great contention between resident physicians, staff physicians, hospital administrators, and the public since their inception in the 1930s. Resident physicians strike a unique balance between being students learning medicine under the watchful eye of attendings and being employees without whom the healthcare system in the United States would struggle to function. Unions seek to improve the working conditions for residents and to protect them from exploitation by hospital systems but have often been perceived as conflicting with professional ideals, patient care, and the educational environment. The goal of this review was to examine the history of resident physician unions, contextualize the arguments for and against them, and describe the best available evidence on the impact of unions on the lives of resident physicians.
{"title":"A contextual review of trainee unions in the United States","authors":"Clara M Gomez-Sanchez, Curtis Woodford","doi":"10.1053/j.semvascsurg.2025.04.002","DOIUrl":"10.1053/j.semvascsurg.2025.04.002","url":null,"abstract":"<div><div>Trainee unions have been a source of great contention between resident physicians, staff physicians, hospital administrators, and the public since their inception in the 1930s. Resident physicians strike a unique balance between being students learning medicine under the watchful eye of attendings and being employees without whom the healthcare system in the United States would struggle to function. Unions seek to improve the working conditions for residents and to protect them from exploitation by hospital systems but have often been perceived as conflicting with professional ideals, patient care, and the educational environment. The goal of this review was to examine the history of resident physician unions, contextualize the arguments for and against them, and describe the best available evidence on the impact of unions on the lives of resident physicians.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 192-197"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280435","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.2025.04.006
Erica L. Mitchell
Competency-based medical education (CBME) has emerged as a transformative approach to medical and surgical training. Competency-based assessments (CBAs) are assessments associated with a CBME curricula, and drive CBME curricula administration, implementation, and development. This review article provides an overview of CBME, the educational theory behind its underlying principles, and evolving implementation strategies in the United States. The key foundational concepts related to assessment in the era of CBME are discussed, beginning with an historical overview, followed by definitions and rationale for the adoption of differing CBA frameworks for surgical training, and terminating in the current state of CBAs for surgical training in the United States. Finally, the strengths and challenges of CBAs are discussed.
{"title":"Assessment in the era of competency-based surgical education","authors":"Erica L. Mitchell","doi":"10.1053/j.semvascsurg.2025.04.006","DOIUrl":"10.1053/j.semvascsurg.2025.04.006","url":null,"abstract":"<div><div>Competency-based medical education (CBME) has emerged as a transformative approach to medical and surgical training. Competency-based assessments (CBAs) are assessments associated with a CBME curricula, and drive CBME curricula administration, implementation, and development. This review article provides an overview of CBME, the educational theory behind its underlying principles, and evolving implementation strategies in the United States. The key foundational concepts related to assessment in the era of CBME are discussed, beginning with an historical overview, followed by definitions and rationale for the adoption of differing CBA frameworks for surgical training, and terminating in the current state of CBAs for surgical training in the United States. Finally, the strengths and challenges of CBAs are discussed.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 122-131"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280540","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.2025.04.007
Kirran Bakhshi, Peter Kanuika, Ayman Ahmed, Javariah Asghar, Shameem Kunhammed, Tahlia L. Weis
It has been established that there is a shortage of vascular surgeons nationwide. This is attributed partially to an imbalance between the number of vascular trainees, and consequently the number of newly graduated vascular surgeons entering the workforce, and the number of clinically active vascular surgeons approaching retirement age. Concurrently, a “silver tsunami” of an aging population in the United States, and increasing prevalence of morbid obesity, diabetes, and peripheral vascular disease portends a marked increase in the patient population in need of vascular care. This anticipated lack of appropriate vascular care may disproportionately affect specific populations. It is our aim to explore the role community training can serve in addressing this issue.
{"title":"Perspectives in community training in vascular surgery","authors":"Kirran Bakhshi, Peter Kanuika, Ayman Ahmed, Javariah Asghar, Shameem Kunhammed, Tahlia L. Weis","doi":"10.1053/j.semvascsurg.2025.04.007","DOIUrl":"10.1053/j.semvascsurg.2025.04.007","url":null,"abstract":"<div><div>It has been established that there is a shortage of vascular surgeons nationwide. This is attributed partially to an imbalance between the number of vascular trainees, and consequently the number of newly graduated vascular surgeons entering the workforce, and the number of clinically active vascular surgeons approaching retirement age. Concurrently, a “silver tsunami” of an aging population in the United States, and increasing prevalence of morbid obesity, diabetes, and peripheral vascular disease portends a marked increase in the patient population in need of vascular care. This anticipated lack of appropriate vascular care may disproportionately affect specific populations. It is our aim to explore the role community training can serve in addressing this issue.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 198-201"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280551","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 : 2025-03-01DOI: 10.1053/j.semvascsurg.2025.01.004
Michael Hurst , Laura Shin
Charcot neuroarthropathy (CN) is an inflammatory condition affecting the joints of patients with peripheral neuropathy; its prevalence is as high as 7.5%. It is commonly seen in patients with diabetes and poses a significant public health burden. CN often leads to severe morbidity, with complications including ulcerations, infections, and lower extremity amputations, and a 5-year mortality rate of 29.0%. The etiology of this condition is a combination of inflammation, neurotrauma, and altered bone metabolism, necessitating early identification and accurate diagnosis through clinical evaluation and imaging studies. Conservative management, particularly total contact casting, plays a pivotal role in managing midfoot ulcers, demonstrating success in reducing plantar pressure and promoting ulcer healing. Surgical interventions are aimed to stabilize affected joints through techniques like arthrodesis and osteotomy and creating a plantigrade foot. Reconstructive options, including external and internal fixation, play a crucial role in the healing process. Postoperative management, including rehabilitation, is vital for successful outcomes, with surgical success rates varying based on procedures. CN is often misdiagnosed as gout, deep vein thrombosis, cellulitis, or infection, and diagnosis is often delayed in the acute care setting. Early diagnosis and intervention can significantly improve outcomes for these patients.
{"title":"Charcot neuroarthropathy: Surgical and conservative treatment approaches","authors":"Michael Hurst , Laura Shin","doi":"10.1053/j.semvascsurg.2025.01.004","DOIUrl":"10.1053/j.semvascsurg.2025.01.004","url":null,"abstract":"<div><div>Charcot neuroarthropathy (CN) is an inflammatory condition affecting the joints of patients with peripheral neuropathy; its prevalence is as high as 7.5%. It is commonly seen in patients with diabetes and poses a significant public health burden. CN often leads to severe morbidity, with complications including ulcerations, infections, and lower extremity amputations, and a 5-year mortality rate of 29.0%. The etiology of this condition is a combination of inflammation, neurotrauma, and altered bone metabolism, necessitating early identification and accurate diagnosis through clinical evaluation and imaging studies. Conservative management, particularly total contact casting, plays a pivotal role in managing midfoot ulcers, demonstrating success in reducing plantar pressure and promoting ulcer healing. Surgical interventions are aimed to stabilize affected joints through techniques like arthrodesis and osteotomy and creating a plantigrade foot. Reconstructive options, including external and internal fixation, play a crucial role in the healing process. Postoperative management, including rehabilitation, is vital for successful outcomes, with surgical success rates varying based on procedures. CN is often misdiagnosed as gout, deep vein thrombosis, cellulitis, or infection, and diagnosis is often delayed in the acute care setting. Early diagnosis and intervention can significantly improve outcomes for these patients.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 74-84"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600878","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 : 2025-03-01DOI: 10.1053/j.semvascsurg.2025.01.011
Ben Li , Miguel Montero-Baker , Brian D. Lepow
Lower extremity amputation secondary to diabetes and/or peripheral artery disease is a significant health issue globally. Many amputation prevention programs exist in academic settings; however, given the increasing administrative burdens associated with large institutions, it can be challenging to develop and maintain such programs in the modern era. Private amputation prevention clinics may be a viable alternative, allowing for greater control over services provided and better ability to meet patient needs. HOPE Vascular and Podiatry (https://hcic.io/), a private amputation prevention clinic established in 2023 in Houston, Texas, has successfully integrated a clinical, research, and educational program focused on amputation prevention. Key aspects of this program include a multidisciplinary team consisting of vascular/podiatric surgeons, clinical/administrative staff, and interdisciplinary collaborators. Notable advantages include decentralization of care, improvements in clinician satisfaction, and fewer administrative barriers to providing high-quality care. By identifying and quantifying the need for amputation prevention care in the community, establishing a clear mission, building a minimum viable program, and growing responsibly, there is potential to establish private amputation prevention clinics that provide high-quality, accessible, and personalized care for patients with diabetes and/or peripheral artery disease to improve limb outcomes. In this article, we describe the design and flow of HOPE Vascular and Podiatry, including how the clinic was developed, its mission and values, and ongoing clinical, research, and educational activities. We also share logistical, financial, and operational considerations, and provide lessons learned on how to effectively develop, maintain, and run a successful private amputation prevention clinic.
继发于糖尿病和/或外周动脉疾病的下肢截肢是一个全球性的重大健康问题。许多截肢预防项目存在于学术环境中；然而，考虑到与大型机构相关的日益增加的行政负担，在现代发展和维护这样的项目可能是具有挑战性的。私立截肢预防诊所可能是一个可行的选择，可以更好地控制所提供的服务，并更好地满足患者的需求。HOPE Vascular and Podiatry （https://hcic.io/）是一家于2023年在德克萨斯州休斯顿成立的私人截肢预防诊所，成功地将临床、研究和教育项目结合在一起，专注于截肢预防。该计划的关键方面包括一个由血管/足部外科医生、临床/行政人员和跨学科合作者组成的多学科团队。显著的优势包括护理的分散化，临床医生满意度的提高，以及提供高质量护理的行政障碍的减少。通过确定和量化社区对截肢预防护理的需求，建立一个明确的使命，建立一个最小可行的项目，并负责任地发展，有可能建立私人截肢预防诊所，为糖尿病和/或外周动脉疾病患者提供高质量、可访问和个性化的护理，以改善肢体预后。在这篇文章中，我们描述了HOPE血管和足部的设计和流程，包括诊所是如何发展的，它的使命和价值，以及正在进行的临床、研究和教育活动。我们还分享后勤、财务和运营方面的考虑，并就如何有效地发展、维护和运营一家成功的私人截肢预防诊所提供经验教训。
{"title":"On the go with Toe & Flow: Private Clinic Design and Flow","authors":"Ben Li , Miguel Montero-Baker , Brian D. Lepow","doi":"10.1053/j.semvascsurg.2025.01.011","DOIUrl":"10.1053/j.semvascsurg.2025.01.011","url":null,"abstract":"<div><div>Lower extremity amputation secondary to diabetes and/or peripheral artery disease is a significant health issue globally. Many amputation prevention programs exist in academic settings; however, given the increasing administrative burdens associated with large institutions, it can be challenging to develop and maintain such programs in the modern era. Private amputation prevention clinics may be a viable alternative, allowing for greater control over services provided and better ability to meet patient needs. HOPE Vascular and Podiatry (<span><span>https://hcic.io/</span><svg><path></path></svg></span>), a private amputation prevention clinic established in 2023 in Houston, Texas, has successfully integrated a clinical, research, and educational program focused on amputation prevention. Key aspects of this program include a multidisciplinary team consisting of vascular/podiatric surgeons, clinical/administrative staff, and interdisciplinary collaborators. Notable advantages include decentralization of care, improvements in clinician satisfaction, and fewer administrative barriers to providing high-quality care. By identifying and quantifying the need for amputation prevention care in the community, establishing a clear mission, building a minimum viable program, and growing responsibly, there is potential to establish private amputation prevention clinics that provide high-quality, accessible, and personalized care for patients with diabetes and/or peripheral artery disease to improve limb outcomes. In this article, we describe the design and flow of HOPE Vascular and Podiatry, including how the clinic was developed, its mission and values, and ongoing clinical, research, and educational activities. We also share logistical, financial, and operational considerations, and provide lessons learned on how to effectively develop, maintain, and run a successful private amputation prevention clinic.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 1","pages":"Pages 11-19"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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