Message from the Chair
The Vascular Surgery Board (VSB) of the American Board of Surgery (ABS) has continued to fulfill its stated mission to serve patients, society, and the specialty of surgery by providing leadership in surgical education and practice. The ABS ensures excellence through: building a diverse, equitable and inclusive culture; rigorous evaluation and assessment; and promoting the highest standards for professionalism, lifelong learning, and continuous certification of surgeons in practice.
- Examination Preparation and Administration
- Entrustable Professional Activities
- Blueprint Redesign
- Diplomate and Candidate Education
- Diplomate Engagement
Examination Preparation and Administration
The process of certification remains the core of the VSB's efforts. Initial certification requires successful completion of the written Qualifying Examination (QE) and oral Certifying Examination (CE) after completion of an ACGME-accredited vascular surgery training program, while Continuous Certification requires completion of the Continuous Certification Assessment (CCA) every two years. Notably, the latter is an open-book, formative test designed to establish a national standard documenting a commitment to lifelong learning. The Vascular Surgery In-Training Examination (VSITE) is administered to vascular trainees annually during their training.
The QE was administered on Sept. 13, 2022. A total of 218 candidates took the exam with an overall pass rate of 92.2% and a failure rate of 7.8%. Notably, the failure rate was higher for the re-examinees (19.2%) when compared to the first-time candidates (6.2%). The failure rate was consistent with the past few years (2021 - 16%, 2020 - 5.2%, 2019 - 5.2%).
The 2022 CE was administered virtually from May 16-17, 2022. A total of 182 candidates took the exam. The pass rate was 91.8% and was slightly lower than the past two virtual exams (2020 – 97.6%, 2021 - 94.7%), but consistent with historical results. All candidates successfully completed the examination and none opted to invalidate their exam due to technology-related issues. The overall virtual process continues to improve from all perspectives including technology, scoring, exam content and both the candidate and examiner experience. The post-exam survey results were consistent with past results, showing that the candidates favor the virtual format while the examiners favor the in-person alternative. The 2023 CE is scheduled for May 15-17, 2023. The results of the initial two virtual CEs were recently published in the Journal of Vascular Surgery.
The CCA was available from Aug. 29 - Nov. 7, 2022. A total of 564 vascular surgery diplomates took the exam. The overall pass rate was 100% with 47% of the diplomates passing on their first attempt and 57% passing on their second attempt.
The 2023 VSITE was just administered from Feb. 10-11, 2023. The ability of the VSITE to predict performance on the QE was also recently published in the Journal of Vascular Surgery.
Entrustable Professional Activities (EPAs)
The VSB and the Association for Program Directors in Vascular Surgery (APDVS) continue to move forward on developing EPAs for vascular surgery. EPAs are the essential components of our discipline that an individual can be trusted to perform and represent a form of workplace-based assessment that integrates with the ACGME milestones and competencies. The EPA Advisory Council (VSB/APDVS) held a retreat with the Writing Group in September 2022. At this meeting, the list of EPAs was formalized and the various milestones were assigned. The workgroup has been charged with drafting the behavior templates by the APDVS annual meeting, March 17-18, 2023. The functional documents and behavior templates will ultimately be released for public comment prior to implementation. The general surgery EPAs will be implemented on Jul. 1, 2023, at the start of the academic year 2023-2024. The VSB will delay implementation of the vascular surgery EPAs until the start of the following academic year, but it is anticipated that a pilot study will be started at the onset of the 2023-2024 academic year.
The current vascular surgery exam blueprint has been extensively reviewed by the VSB Research and Education Committee along with its directors. The scope of vascular surgery has been refined to reflect contemporary practice incorporating newer technologies (e.g. TCAR) and eliminating several historic components (e.g. portal hypertension). VSB directors need to further define the scope and spectrum of these defined components. A tentative timeline has been developed with the anticipated completion date of a draft blueprint by the start of the 2023-2024 academic year. The draft will need to be reviewed by the various stakeholders including the members of the APDVS and leadership of VSCORE prior to implementation. Note that the blueprint will comprise the elements of all future VSB testing.
Both the VSITE and virtual CE manuscripts have been published in the Journal of Vascular Surgery. Additionally, the Presidential Address (Huber) from the 2022 Florida Vascular Society Annual Meeting entitled "The Vascular Surgery Board of the American Board of Surgery: Our Independent Board" was published in the Annals of Vascular Surgery.. There are several research projects in various stages of development with targeted abstract submission dates for the Vascular Annual Meeting (submission January 2023). Notably, the VSB has received a data use agreement from CMS to look at the impact of board certification and outcomes.
Diplomate and Candidate Education
The VSB would like to expand the educational opportunities and focus for both candidates and diplomates. The VSB has had some initial discussions with the APDVS and the SVS about a possible CE preparatory course. It is the impression that the commercially available courses are both expensive and misleading. Note that the there is a similar course sponsored by the ABS and the American College of Surgeons (ACS) for general surgeons. One proposal is to have the course prior to the CE in May, likely at the time of the APDVS meeting in Chicago.
While all new oral examiners attended a training session in April 2022, the existing vascular CE examiners have requested additional training. For the first time in September 2022, an in-person retreat was held by the ABS for general surgery CE examiners to allow for more robust discussion of the current processes, suggested improvements, exam feedback, and other details related to the oral exam process. It has been proposed that a similar retreat could be arranged to correspond with the fall VSB retreat. This would allow for some in-person contact with the examiners and the directors. It has also been proposed that all oral examiners be placed on a schedule such that they would be afforded the opportunity to train or retrain every set number of years.
In addition, podcasts are planned with the SVS's Audible Bleeding to address the format of the CE and the EPAs.
The VSB would like to continue to expand communications with the diplomates, specifically, engaging more on Twitter (@VSB_ABS). As part of this communications effort, the ABS communications team will frequently share on Twitter articles selected for the CCA. In addition, the ABS will continue to encourage diplomates to log in to their ABS portal periodically to report on any requirements that are out of date, as well as maintain current mailing and email addresses.
Diversity is among the core values of the VSB and this emphasis expands all missions. There is currently a VSB representative on the ABS Diversity, Equity and Inclusion Committee (Aulivola). The nomination and selection process for new VSB directors is based upon desired competencies within the context of diversity. Notably, the most recent additions to the VSB (Motaganahalli, Smith) reflect this emphasis.
The care of venous disease across the country is problematic, with more than 35 specialties performing superficial procedures. The American Vein and Lymphatic Society and the American Board of Venous and Lymphatic Medicine (AVLM) are working toward their own separate board and training certification. The American Venous Forum (AVF) is in the process of developing a Focused Practice Designation (FPD) to allow vascular surgeons additional training and certification. The VSB does not believe that vascular surgeons need additional training or certification to care for patients with venous and lymphatic disease since it already comprises a large component of our exam blueprint and curriculum. Furthermore, ABS diplomates certified in vascular surgery did not express any interest in a separate venous module during a recent survey administered following the 2022 CCA. The VSB has sent a position statement to the American Board of Medical Specialties (ABMS) opposing the development of a new board.
VSB Membership Selection
The VSB has moved to a competency-based nomination process rather than an organizational-based process. Drs. Raghu Motaganahalli and Brigitte Smith officially joined the VSB at the time of the fall retreat based upon the identified competencies of alternative practice settings and experience with EPAs. The VSB will be soliciting nominations for four new directors in the spring to replace the individuals that will complete their terms in September 2023. The desired competencies of those who will fill those positions have not yet been identified.
The Vascular Summit between the VSB, APDVS, Residency Review Committee (RRC), APDVS, and Accreditation Council for Graduate Medical Education (ACGME) was held on Dec. 12, 2022. Each group provided an update of their education-related issues, and common concerns were discussed. The RRC is currently in the process of rewriting the program requirements for vascular surgery. It was suggested that the leadership of this effort from the RRC and the leadership of the EPA and blueprint redesign efforts from the VSB all meet to align efforts. The organizations were supportive of a CE educational course and suggested that the leaders for the various vascular societies that conduct mock oral exams be contacted.
Family Leave Policy
An updated family leave policy for vascular surgery independent residents has been implemented for the 2022-2023 academic year to align with the policy that was implemented for integrated residents in the previous academic year. Independent residents are expected to complete 96 weeks of training, but may take off an additional four weeks as required for a total of 92 weeks.
Thomas S. Huber, M.D., Ph.D.
VSB Chair 2021-2023