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 the public and the specialty of surgery by providing leadership in surgical education and practice, by promoting excellence through rigorous evaluation and examination, and by promoting the highest standards for professionalism, lifelong learning, and its continuous certification in practice over the past year as outlined.
- Examination preparation and administration
- Blueprint redesign
- Entrustable Professional Activities
- Volunteer Recognition
Examination Preparation and Administration
The process of certification remains the core of our 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 exam designed to establish a national standard documenting a commitment to lifelong learning. The Vascular Surgery In-Training Examination (VSITE) is administered to vascular residents annually during their training.
A total of 188 candidates took the 2021 QE in October with an overall pass rate of 84%, consistent with historic performance. The corresponding 2022 CE was just administered in May with an overall pass rate of 92%. Notably, the 2022 CE was given in a virtual format similar to the preceding two CEs, a format that is overwhelmingly preferred by the candidates. However, no decision has been made about the format for future CEs. A total of 585 vascular diplomates completed the CCA in the fall of 2021, with consistent feedback from test-takers that the assessment was appropriate and beneficial. The VSITE was administered this year in February to 713 vascular trainees from 187 different programs.
The Blueprint defines the scope of vascular surgery and the expertise required for certification. The current blueprint is undergoing detailed review and revision to reflect the current scope of practice in the field of vascular surgery. It has been extensively reviewed, and the various components of the individual diagnoses and procedures are being prioritized. A timeline has been developed with the anticipated completion date of a draft by the fall. The draft will need to reviewed by various stakeholders including the leadership of VSCORE and members of the Association for Program Directors in Vascular Surgery (APDVS).
Entrustable Professional Activities (EPAs)
The VSB and APDVS have assembled an EPA Advisory Council to develop Entrustable Professional Activities (EPAs). EPAs are the essential components of a discipline that an individual can be trusted to perform and they serve to define our profession. They represent a form of workplace-based assessment and integrate with the ACGME milestones and competencies. The Advisory Council and Writing Group held a retreat at the APDVS Annual Meeting in March and began drafting the final list of EPAs. A follow up meeting between these two groups is scheduled for the fall, with plans to integrate the VSB efforts with those of the other ABS specialty boards in terms of technology and roll out. It is anticipated that the VSB EPA implementation will not occur until July 2024, but a pilot rollout has been proposed among select centers to begin in July 2023.
There are several ongoing research projects in various stages of development. Abstracts examining the impact of the VSITE performance on passing the QE and CE were presented at the 2021 Vascular Annual Meeting, while the results of the initial two virtual CEs were presented at the 2022 Society For Clinical Vascular Surgery Annual Meeting. The VSITE manuscript is under review for publication, while the virtual CE manuscript has been provisionally accepted in the Journal of Vascular Surgery. Notably, the VSB has received a data use agreement from CMS to look at the impact of board certification and outcomes.
Tthe activities of the VSB and ABS are contingent upon an army of volunteers. It has been appreciated that the transition to virtual CEs has been associated with the loss of the many “intangible” benefits of serving the VSB. A variety of strategies are being investigated to recognize and reward the many volunteers including the members of the writing committees in addition to the examiners.
VSB Director Selection
The VSB has moved to a competency-based selection process rather than an organizational representation-based process. The desired competencies for this year included alternative practice settings, experience with EPAs, and service to the ABS/VSB with an overall emphasis on diversity. Drs. Brigitte Smith and Raghu Motaganahalli were elected as the newest VSB members and will begin their terms in July of this year.
Opportunities to improve communication with the VSB diplomates are being investigated, including a Diplomate Summit, similar to the current educational summit. A podcast was created on the SVS Audible Bleeding channel summarizing several current VSB issues and a follow-up podcast is planned.
An opportunity for the Independent Residents to have an international rotation was approved for the Independent Residents by the RRC and ACGME. This is similar to the opportunity for the Integrated Residents, but noteworthy because of the substantially shorter training timeline. Details will be available on the ABS website this summer.
Diversity, Equity and Inclusion
The ABS developed an ad hoc DEI committee in 2021 with representatives from each of the specialty boards including the VSB. The committee's work reflects the ABS mission to build a diverse, equitable, inclusive culture. Notably, the diplomates of the VSB have become more diverse over the years. There are currently 3,777 board-certified vascular surgeons with 17% of these being women. Among the 156 Diplomates certified in 2022, 31% were women.
It has been an overwhelming pleasure to serve as the chairperson of the VSB during this past year and, collectively, we should all feel very proud of our efforts. The VSB is in very good shape as we move forward to the next academic year, largely as a result of the tireless commitment of the numerous volunteers.
Thomas S. Huber, M.D., Ph.D.
VSB Chair 2021-2022