The Southern Association for Vascular Surgery Mock Oral Exam Identifies Significant Knowledge Deficiencies in Open Surgical Topics
Christopher G. Carsten, III1, Joseph V. Blas1, Matthew S. Edwards2, David L. Cull1
1Prisma Health/University of South Carolina School of Medicine-Greenville, Greenville, SC, 2Wake Forest University School of Medicine, Winston-Salem, NC
INTRODUCTION: Since 2006, The Southern Association for Vascular Surgery (SAVS) has administered an annual mock oral exam (MOE) to prepare trainees and recent graduates of vascular residency programs for the Vascular Certifying Examination (VCE). A study published in 2015 evaluated the SAVS MOE using surveys of examiners and examinees. Examiners from that study reported pervasive knowledge deficits in open surgical techniques and the management of surgical complications. Although the study authors recommended broad educational efforts by programs and specialty societies to address those deficits, specific areas of deficit were not defined. The purpose of this study is to use MOE grade sheets, feedback comments, and exam summaries to identify topics/themes that will inform program directors of potential curricular deficits that may warrant greater focus. METHODS: The SAVS MOE is comprised of 52 scenarios. The SAVS MOE grade sheets and exam summaries from 2015 to 2020 for all examinees in their final year of or recently graduated from a vascular residency program were reviewed. Grades and comments for each exam scenario and the overall exam grade for each examinee were collected. The SAVS MOE adopted the ABS VCE scoring system in 2017. The revised system scored a grade 3 as a pass, 2 as equivocal, and 1 a fail. The maximum possible exam score was 72. A cumulative score greater than or equal to 56 is designated as ‘pass’ with lesser scores designated as ‘fail’. For consistency, the grades and scoring system for the 2015 and 2016 MOE were changed to the new ABS scoring system. Exam scenarios receiving fewer than 50 grades were excluded from analysis. Scenarios that received a failing or equivocal grade by more than 55% of examinees were deemed low performing scenarios. Comments from these scenarios were reviewed to identify common themes that explain low performance.RESULTS: Between 2015 and 2020, 182 residents participated in the SAVS MOE. Of those, 147 (143 unique) examinees were in their final year of training or recently graduated and comprise data for this study. The majority of examinees attended 5+2 programs (92%). Overall, 41% (60/147) of examinees passed the exam (mean grade 53.7+9.1). Thirty three percent (4/12) of the integrated residents passed (mean grade 52.8+7.0) and 42% of the 5+2 residents passed (mean grade 53.8+9.3). There were 3390 grades recorded. Low performing topics and themes are identified in Table 1. Low performing topics comprised 24% (830/3390) grades.CONCLUSIONS: This study supports the observation of SAVS MOE examiners in a previous publication that there are pervasive knowledge deficits in vascular surgery topics requiring demonstration of open surgical techniques and identifies perennial topics examinees seem to struggle with. This information provides program directors and vascular surgery societies information that may guide their educational curricula.
| Themes | Grades | Pass | Equivocal | Fail | Outcomes |
| Renovascular HTN | 58 | 43% | 29% | 28% | Conduit for renal artery bypass in pediatric patient - 22/58 missed Technique: Wrong procedure or couldn’t describe procedure - 20/50 missed |
| Inflammatory AAA | 100 | 30% | 26% | 44% | Technique: Struggled to describe procedure, tried to dissect duodenum off inflammatory aneurysm, proximal control problems - 32/100 missed |
| Acute Aortic Occlusion | 132 | 41% | 33% | 26% | Technique: Failed to protect renal arteries, difficulty describing procedure, proximal control problems - 40/132 missed Failed to perform fasciotomy - 48/132 missed |
| Acute LE Ischemia, HITT | 60 | 33% | 20% | 47% | Missed HITT diagnosis - 22/60 missed |
| Lower Extremity Trauma | 154 | 43% | 30% | 27% | Technique: Orhto/vascular sequence, use of shunt, exposure of SFA/Pop. - 50/154 missed Failed to consider fasciotomies - 34/154 missed Conduit (ipsilateral GSV, PTFE, cryopreserved vein, arm vein) - 26/154 missed |
| Aortoenteric Fistula | 120 | 42% | 25% | 33% | Technique: Proximal control, aortic stump closure, difficulty describing procedure - 26/120 missed |
| Acute DVT and Pregnancy | 88 | 41% | 32% | 27% | Failed to protect fetus from radiation - 18/88 missed Placed IVC filter below renal veins - 50/88 missed |
| Effort Induced Thrombosis | 118 | 39% | 42% | 19% | Technique: Difficulty describing procedure steps, wrong incision - 36/118 missed |
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