Vascular Surgery Residency Program
2008 - 2009
Section I: Vascular Surgery Residency Program Introduction
Program Requirements & Educational Training Program Overview
The goal of the Vascular Surgery Training Program at the Duke University Department of
Surgery is to prepare the trainees to function as qualified practitioners of vascular surgery
at a high level of competence expected of a board-certified specialist. The program provides
educational resources for the development of proficiency in the diagnosis and treatment of
diseases of the arterial, venous and lymphatic circulatory systems exclusive of those
components intrinsic to the heart and intracranial vessels. In addition to developing the
clinical skills listed above, the Vascular Surgery Residents (“VSRs”) will develop skills with
respect to interpersonal and communications skills, professional behavior and delivery
including ethical practice, and the systemic nature of health care in relation to Duke
University Health System. VSRs will be provided adequate time and sufficient facilities for
study and be assured of a rotation schedule that provides an equivalent opportunity for
each. Service responsibilities will not detract from educational activities.
Section II: Vascular Admissions/Selection Criteria
Selection for a residency position in vascular surgery is based on a number of factors. Those
1. As an Independent Program, as described by the ACGME, vascular surgery education in
the independent format for the Duke Vascular Surgery Residency, the incoming vascular
surgery resident must:
a. Successfully complete a general surgery residency program accredited by the
ACGME. During the general surgery residency, up to 1 year of credit toward a
vascular surgery residency can be achieved as long as there is demonstration of
12 months of appropriate vascular surgery education. This would shorten the
subsequent required vascular surgery residency education to 2 years instead of 3
years. In this format, the residents must complete, at minimum, the last two
years of vascular surgery education at the same institution.
2. Eligible for Board Certification from the ABS at the start of Residency – July 1,
3. Graduation from an ACGME Accredited Program in General Surgery, or a Subspecialty
that would further your professional career with a Vascular Surgery Residency
4. Completion of all USMLE Requirements for Licensure
5. Three Letters of Recommendation from ABS Board Certified Surgeons
6. Professional Statement of Goals and Career Objectives for the reason a candidate wants
to be a Vascular Surgery Resident at Duke
7. Completed Application to the Program Director no later than February 15 annually
8. Personal interview with Program Director and Faculty members upon completion of initial
review for admission – all materials must be up-to-date prior to interview for
consideration or the residency will be denied (if graduating from a residency program,
you must be eligible for ABS by the time you enter our Vascular Surgery Residency –
verification must be in the Residency Office no later than 10 days prior to the first day of
Section III: Specific Vascular Policies and Schedules:
The Vascular Surgery Residency Work Environment and Supervisory Lines of
The Duke University Residency in Vascular Surgery is designed to provide consistent and
outstanding didactic, clinical and technical education to the Vascular Surgery Resident.
Attaining these goals enables the Resident to effectively provide superior health care to
In addition, the Duke Residency in Vascular Surgery prepares the Resident to independently
manage the preoperative, operative, and postoperative care of patients with arterial,
venous and lymphatic disease(s).
A. Resident Appointment, Reappointment, Promotion & Dismissal
All Employment Agreement letters are for one year. Contracts are prepared and signed by
the Program Director, Resident and Designated Institutional Officer (DIO).
Completion of the program is based on several factors. Those factors include:
a Outcome assessment through various formats
b Operative case experiences in both open and endovascular
c Out-patient imaging
d Accurately and timely log all surgical case operative experiences via the
ACGME case log entry system and ensuring that the minimum requirements
are met before the end of the residency.
e Formal and informal evaluations from Program Director and faculty members
f Commitment and interest in scholarly activities
g Commitment and interest in teaching of junior residents, medical students
and other health care providers
In addition, at any time during the Resident’s training, a written or verbal report to the
Program Director of inappropriate behavior or actions by the Resident is received, it will be
discussed with him/her. After investigation and evaluation of the allegations appropriate
actions may be taken which may include, but are not limited to: advice, warnings,
counseling, psychological support, change in rotations, or recommendation to the Institution
that the Resident be given a leave of absence or be dismissed using the appropriate due
process policies of Duke University Hospital.
Reappointment and/or graduation for individual Residents depends upon their ongoing
clinical skills evaluation by each attending surgeon, evidence of ethical behavior, and
professional characteristics of an individual capable of independent practice in vascular
If it is decided that the Resident should take a leave of absence or be dismissed, the
Resident, the Chairman of the Department and the DIO will be notified in writing. Final
decisions are subject to Duke University GME House Staff policies and shall always be in
Vacation, Leave of Absence and Academic Conference Policies**
VSRs will be allotted two (2) one week paid vacations, which must be scheduled at least one
month in advance. In addition, VSRs are permitted to attend one meeting per academic
year. All travel must occur in the U.S. VSRs are encouraged to be academically productive
and will be granted additional meeting time for approved meetings where they have had an
abstract accepted. VSRs should check with the Program Director prior to submitting
abstracts to determine if the meeting is an approved meeting.
Maternity / Disability Leave: 6 weeks leave following an uncomplicated delivery (8 weeks
following a Caesarean section). The Family and Medical Leave Act (FMLA) entitles a covered
employee to take up to 84 days of unpaid leave in a 12-month period for the birth or
adoption of a child, or the "serious health condition" of the employee or the employee's
child, spouse, or parent.
Paternity Leave: 5 days of paid leave
Absences in excess of the ABS Requirements for Vascular Surgery must be made up by
extension of the fellowship training.
**Fellows requesting any type of leave are required to notify the Program Director as early
as possible to arrange for adequate coverage during your absence. These policies are
subject to change without notice.
Overall Policies for Duke University Hospital and Medical Center (Please see the
Duke University Hospital GME Policy Manual and Benefits Guide for Further
All Duke University Hospital graduate medical trainees will receive compensation according
to the Graduate Medical Education training level.
Additionally, Residents are required to comply with the Federal Drug Free Workplace Act –
form more information please refer to this website at:
Also outlined in the benefit guide is the Duke University Policy for House Staff Grievance and
the Duke University Harassment Policy.
All trainees in the Vascular Surgery Residency are required to have a full an unrestricted
North Carolina State Medical License and must be registered with the North Carolina Medical
Duke University is committed to maintaining a bias-free environment for all members of the
University community including freedom from harassment. Harassment is defined as the
creation of a hostile or intimidating environment in which verbal or physical conduct
because of its severity and/or persistence is likely to interfere significantly with an
Sexual coercion consists of unwelcome sexual advances, request for sexual favors, or other
verbal or physical conduct of sexual nature when submission of such conduct is made
explicitly or implicitly a term or condition of an individual's employment or submission to or
rejection of such conduct is used as a basis for employment decisions affecting an
Such conduct has the purpose or substantially interfering with an individual's work
performance or environment. The conduct alleged to constitute harassment under this
policy should be evaluated from the perspective of a reasonable person similarly situated to
the complainant and considering all the circumstances.
The goal of our educational program is to provide an environment that allows for the full
development of skills as described above. This requires a balance between observation and
performance both in the operating room, on the ward, and in the out patient setting. This
balance is determined by the individual attending, Resident’s skills and patient preferences.
It is expected that during this program a graduated process of supervised performance will
Attending Physician: A licensed independent practitioner who holds admitting and/or
attending physician privileges consistent with the requirements delineated in the Bylaws,
Rules and Regulations of the Medical Staff of Duke University Hospital or with the
requirements delineated in the governing regulations of the assigned and approved off-site
Trainee: A physician who participates in an approved graduate medical education (GME)
program. The term includes interns, residents, and fellows in GME programs approved by
the Duke Institutional Committee on Graduate Medical Education. (A medical student is
never considered a graduate medical trainee.)
B. Attending Physician Responsibilities:
In hospitals participating in a professional graduate medical education program(s), the
medical staff has a defined process for supervision of each participant in the program(s) in
carrying out patient care responsibilities. Such supervision will be provided by an attending
physician with appropriate clinical privileges, with the expectation that the graduate medical
trainee will develop into a practitioner who has the knowledge, skills and experience and
abilities to provide care to the patients with the disease states applicable to his/her training
The medical staff has overall responsibility for the quality of the professional services
provided by individuals with clinical responsibilities. In a hospital, the management of each
patient's care (including patients under the care of participants in professional graduate
medical education programs) is the responsibility of a member of the medical staff with
appropriate clinical privileges. Therefore, the medical staff assures that each participant in
a professional graduate medical education program is supervised in his/her patient care
responsibilities by a member of the medical staff who has been granted clinical privileges
through the medical staff process.
The position of attending physician entails the dual roles of providing quality patient care
and effective clinical teaching. Although some of this teaching is conducted in the
classroom setting, the majority of it is through direct contact, mentoring, and role modeling
with trainees. All patients seen by the trainee will have an assigned attending physician.
The attending physician is expected to:
• Exercise control over the care rendered to each patient under the care of a resident,
either through direct personal care of the patient or through supervision of medical
trainees and/or medical personnel.
• Document the degree of participation according to existing hospital policies.
• Effectively role model safe, effective, efficient and compassionate patient care and
provide timely documentation to program directors required for trainee assessment
and evaluation as mandated by the program’s Residency Review Committee (RRC),
• Participate in the educational activities of the training programs, and as appropriate,
participate in institutional orientation programs, educational programs, performance
improvement teams, institutional and departmental educational committees.
• Review and co-sign the history and physical within 24 hours,
• Review progress notes, and sign procedural and operative notes and discharge
In general, the degree of attending involvement in patient care will be commensurate with
the type of care that the patient is receiving and the level of training, education and
experience of any medical trainee(s) involved in the patient’s care.
The intensity of supervision required is not the same under all circumstances; it varies by
specialty, level of training, the experience and competency of the individual trainee, and the
acuity of the specific clinical situation. An attending may provide less direct personal care of
a patient seen for routine care when supervising a senior level trainee, and may provide
more direct personal care of a patient receiving complex care when supervising a junior
level trainee. An Attending physician may authorize the supervision of a junior trainee by a
more senior level trainee based on the attending physician’s assessment of the senior level
trainee’ experience and competence, unless limited by existing or future hospital policies,
such as the use of lasers.
Medical care teams frequently are involved in the management of patients and many
different physicians may act as the attending physician at different times during the course
of a patient’s illness. However, within the medical care team, the faculty attending
physician must provide personal and identifiable service to the patient and/or appropriate
medical direction of the trainee and when the trainee performs the service as part of the
training program experience.
The following are specific instances in which involvement of the attending physician is
For Inpatient Care:
• Review the patient’s history, the record of examinations and tests, and make
appropriate reviews of the patient’s progress;
• Examine the patient within 24 hours of admission, when there is a significant change
in patient condition, or as required by good medical care;
• Confirm or revise the diagnosis and determine major changes in the course of
treatment to be followed;
• Either perform the physician’s services required by the patient or supervise the
treatment so as to assure that appropriate services are provided by trainees or
others, and that the care meets a proper quality level;
• Be present and ready to perform any service that would be performed by an
attending physician in a non-teaching setting. For major surgical or other complex,
high-risk medical procedures, the attending physician must be immediately available
to assist the trainee who is under the attending physician’s direction;
• Make decision(s) to authorize or deny elective and urgent admissions, discharge
from an inpatient status or release from observation or outpatient status
1. When an in-patient is to be transferred to another service, the attending
physician or a designee of the referring service shall inform the patient of the
change in service as soon as possible prior to the transfer. The receiving
service shall assign a new attending physician who shall accept responsibility
for patient care. Confirmation of the transfer to another level of care or
acceptance of patients in transfer is the responsibility of the attending
2. An attending physician’s decision shall be required to authorize an in-patient’s
discharge, or release from observation or outpatient status.
• Issue all “No Code” or DNR orders. “No Code” or DNR orders shall be issued only by
an attending physician. In extenuating circumstances the order may be issued by
the attending physician verbally, by telephone, while the responsible registered
nurse and trainee listen to and witness the verbal-telephone order; such verbal-
telephone order shall be signed within twenty-four hours of issuance by the
• Assure a completed history and physical and a completed, appropriately signed, and
witnessed consent form is placed in the patient’s record prior to the performance of
an operative or invasive procedure involving substantial risk.
• Assure appropriate documentation is made immediately in the medical record when a
procedure is completed on a patient
For Outpatient Care:
The extent and duration of the attending’s physical presence will be variable, depending
upon the nature of the patient care situation, the type and complexity of the service. The
responsibility or independence given to trainees depends on their knowledge, manual skills
and experience as judged by the responsible attending physician. The attending physician
supervisor must be designated and available to all sites of training in accordance with
Accreditation Council for Graduate Medical Education (ACGME) institutional and program
requirements and specific departmental policies.
C. Graduate Medical Trainee Responsibilities:
Each graduate medical trainee physician must meet or may exceed the qualifications for
appointment to Associate member of the Medical Staff of Duke Hospital, whether in an
Accreditation Council for Graduate Medical Education (ACGME) or non-ACGME graduate
medical education program.
Graduate medical trainees are expected to
• Participate in care at levels commensurate with their individual degree of
advancement within the teaching program and competence, under the general
supervision of appropriately privileged attending physicians
• Perform their duties in accordance with the established practices, procedures and
policies of the institution and those of its programs, clinical departments and other
institutions to which the trainee is assigned.
• Adhere to state licensure requirements, federal and state regulations, risk
management and insurance requirements, and occupational health and safety
• Fulfill all institutional requirements, such as attending the Graduate Medical Trainee
Orientation, maintaining BLS/ACLS certification, completing required instructional
exercises, as detailed in their annual Agreement of Appointment.
The Vascular Surgery Residents and General Surgery Chief Residents are never assigned to
the same service nor do they have the same responsibility for the patients on his/her
The Vascular Surgery Resident is responsible for the preoperative management of the
patients with the help of the junior residents assigned to the Vascular Service and nurse
practitioners under the supervision of the attending surgeon. The VSR will have first seen
the patient in the surgical outpatient experience/clinic, Emergency Room, attending
surgeons’ office, or upon admission to the hospital. He/she is assigned to those operations
where he/she can assume the most senior role commensurate with his/her experience and
abilities. Preoperatively, a dialogue is established between the VSR involved and the
responsible faculty member to determine the specifics of therapy and the options for
management. No patient can be taken to the operating room for any surgical procedure
without the faculty member present in the operating room. Anesthesia cannot be induced
until the faculty member has related to the patient. The faculty member must remain
physically within the operating room area throughout the entire procedure until the patient
is transferred to the post-operative care unit. All attestation sheets are signed by the
faculty member of record, as are the operative notes. Under the supervision of the
attending surgeon, the VSR is responsible for the postoperative in-hospital management of
the patient and when possible will see the patient during postoperative visits.
The faculty members of Vascular Surgery share the responsibility of “on call.” There is one
faculty member responsible each day for consultation and emergencies at night and on the
weekends. Faculty presence in the hospital can be requested by the VSR at any time, and
faculty attendance is mandatory for any operative procedure.
Vascular Surgery Fellow and Attending On-Call Schedules are made monthly, are available
at all times, and are provided to the following:
All Vascular attending(s)
All Vascular Residents
All Interventional radiologist attendings and residents
Nurses on Vascular service
General Surgery Residency Office
This policy is consistent with the Duke University Hospital GME Supervision Policy. Please
refer to the GME House Staff Manual and Benefits Guide at:
Grievance Policy for House Staff*
The purpose of the Grievance Policy is to provide an additional, nonexclusive system of
communication, exchange of information, and confidential concerns of individual Graduate
Medical Trainees regarding their educational programs. Graduate Medical Trainees may
contact their Fellow or faculty representative on the Institutional Committee for Graduate
Medical Education, who has full access to the committee and any ad hoc committees
necessary to explore and address Trainee’s concerns, complaints, or grievances not covered
under the Corrective Action and Hearing Procedures for Associate Medical Staff of Duke
University Hospital. Failure to resolve these issues at this level can be referred, in writing, to
the Director of Graduate Medical Education (Designated Institutional Official) for further
consideration and final resolution. The names of the Graduate Medical Trainee and Faculty
representatives will be made available to all Graduate Medical Trainees on an annual basis.
Any records regarding these issues will have protected status of peer review.
ICGME Approval: August 12, 1998
ECMS Approval: September 21, 1998
*The Grievance Policy is replicated verbatim from the 2008 GME Trainee Manual.
Graduate Medical trainees are at risk for all the health problems seen in the general
population and are expected to function at a superior level as trainees in medicine and as
health care providers. The supervision of their care provision and evaluation of their
learning is complicated by the fact that their supervisors and evaluators are health care
providers. Role confusion can occur which interferes with both clear evaluation of
performance and appropriate health care intervention for the trainee.
The policy, procedure and training program below are designed to enhance the quality of
the Duke Graduate Medical Education program by providing guidance for handling issues of
impairment of performance.
The Duke Office of Graduate Medical Education will address all cases of impaired
performance among trainees in order to assure the safety of trainees and the safety of
patients and co-workers. Impairment may result from physical and mental/behavioral health
problems. Services to support confidential and constructive intervention to resolve
impairments will be made available.
Supervisors of trainees will utilize the impairment checklist to evaluate trainees as
appropriate. Concerns arising out of the evaluation will be brought to the Graduate Medical
Education Program Directors (Program Directors).
Performance and/or behavioral concerns will be addressed with the trainee. Trainees will be
encouraged to utilize the Personal Assistance Service (Employee Assistance) or Dean of
Medical Education Counseling on a voluntary basis. PAS is a free and confidential resource
available to house staff and immediate family members. PAS provides assessment, short-
term counseling and referral. Clear expectations for improvement will be established in
writing and evaluation will occur periodically.
Impairment concerns will be reviewed with Duke Employee Occupational Health (EOH) and/
or the NC Physicians Health Program (NCPHP). With the concurrence of EOH and/or NCPHP
the trainee will be referred by Program Director for mandatory evaluation and removed from
patient care responsibilities.
EOH and/or NCPHP will evaluate the trainee and make recommendations for return to work
to the Program Director and the Office of Graduate Medical Education.
Any trainee removed from any aspect of their training program for any reason must be
returned to work through EOH and the Office of Graduate Medical Education must be
Most trainees are eager, productive learners and colleagues; however, some experience
difficulties in learning and/or performance and may demonstrate behaviors that are
How these issues are addressed can have a substantial effect on a trainee's career and
Duke's mission as an educational institution. The following suggestions can enhance
• Consult with PAS. PAS is also a consultative resource for supervisors of trainees
regarding how concern might be addressed.
• Do not ignore, "push under the rug", or dismiss as a "bad day" inappropriate behavior.
Address issues promptly to improve the outcome.
• Document behaviors and incidents that create concern. Request co-observation with a
colleague when possible.
• Do not try to diagnose, do not argue. Rather, discuss concerns i.e. specific behavioral
terms and expectations for improvement.
• Offer and encourage trainee to use available resources.
• Establish clear, written expectations for improvement and an evaluation plan.
V. Manifestations of Impairment
• Dramatic decrease in performance
• Persistent or repetitive absenteeism/lateness
• Mood swings
• Interactional difficulties
• Patient/colleague complaints
• Disruptive behaviors
• Medications missing from work area
• Disappearances from work
• Disordered thought
• Alcohol on breath, other stigmata of drug use
• Diminished physical appearance
Personal Assistance Service
2200 West Main Street, Ste 700
Durham NC 27705
Personal Assistance Service (PAS) is the faculty/staff assistance program of Duke
University. The staff of licensed professionals offers assessment, short-term counseling, and
referrals to help resolve a broad range of personal, work, and family problems. There are no
charges for any service provided by the PAS staff.
Employee Occupational Health Services
2200 West Main Street, Ste 600A
Durham NC 27705
Employee Occupational Health (EOH) provides evaluation of health issues that involve the
safety of the work force and the safety of patients, visitors, and products of Duke
University. EOH services faculty and staff.
The North Carolina Physicians Health Program
The North Carolina Physicians Health Program (NCPHP) was established in 1988 by a
collaborative effort of the North Carolina Medical Society and the North Carolina Medical
Board to help impaired physicians. The NCPHP is set up to identify troubled physicians, get
them the appropriate treatment and return them to the productive practice of medicine'
Impairment can be caused by alcoholism/chemical dependency, psychiatric disorders,
disruptive behavior, professional sexual misconduct and severe stress. Anyone who feels
that they themselves or a colleague possibly has an impairment problem can seek
assistance anonymously and confidentially by calling the NCPHP at 1- 800-783-6792.
B. Rotation Schedule(s) and Information
VASCULAR SURGERY RESIDENCY ROTATION STRUCTURE
6 months 3 months 3 months
Duke university Research ir
3 months 1 month 2 months 6 months
IR Vascular non- elective (hem, card, ir, DUKE UNIVERSITY
invas lab research or imaging)
Duke University Vascular Service Rotation: The first six months of the year is spent on
the busy clinical service at Duke North where the VSR actively participates in the
management of a wide spectrum of major vascular cases. The vascular service consists of
the VSR, a fourth year/SAR2 (clinical) resident, a second year/JAR and an intern, with the
VSR in charge of the service. This insures that each senior resident can participate in both
in-patient and out-patient activities.
During the Duke University Vascular Service Rotation, the VSR will be exposed to the full
spectrum of in-patient vascular disease and their operative and non-operative management
including cerebrovascular disease, aortic and other aneurysms, peripheral arterial occlusive
disease, venous thromboembolism and visceral ischemic syndromes. Involvement,
participation and proficiency in the care of the vascular patient with these disorders will
progress from demonstration to mastery during the course of the residency.
The program provides an educational environment that allows the VSR to develop
competencies in patient care, practice-based learning and improvement, interpersonal and
communication skills, professionalism and systems based practice. They are expected to be
compassionate in patient and family relationships, accurate in the interpretation of tests,
knowledgeable in the choice of treatment, skillful in performing interventions (both open
and endovascular), cooperative with ancillary services, organized in the overall
management and in control during emergencies. They must possess pertinent biomedical
knowledge; understand new and evolving clinical knowledge as well as the epidemiology of
the various disease processes. An understanding of the statistical methodologies of clinical
trials is expected as well. Communication skills are developed during the presentation of
clinical information in the conference setting.
Interventional Radiology Rotation: During the final two months, the goals of the
Interventional Radiology rotation are 1) to understand the principles of diagnostic
percutaneous interventions, 2) to understand the principles of radiation safety, 3) to
become familiar with the various types of radiological contrast agents, 4) to achieve
competence in percutaneous arterial access via retrograde femoral, antegrade femoral,
contralateral “up and over” femoral and antegrade brachial approaches, 5) to achieve
competence in venous access via femoral, subclavian, bracilic, popliteal and jugular veins,
6) to develop competence in balloon angioplasty of iliac, renal and superficial femoral artery
stenoses, 7) to understand and employ arterial and venous stents in appropriate clinical
circumstances, and 8) to develop expertise in evaluating patients for endovascular aortic
grafting. These skills will be complementary to those developed in the previous three
rotations, and will be learned from the interventionalists’ perspective.
Vascular Non-invasive Laboratory Training: A critical part of the vascular surgeon’s
practice is the vascular non-invasive laboratory. The trainee will:
• Acquire knowledge of ultrasound physics as it applies to current established techniques
of vascular diagnosis. The trainee will become familiar with all major forms of
instrumentation associated with routine noninvasive vascular diagnosis, including
continuous-wave and pulsed Doppler, and Color-flow duplex ultrasound scan technology.
• Learn to perform, supervise, and interpret the results of noninvasive testing modalities
performed for major non-cardiac vascular disorders.
• Learn the applications of noninvasive vascular testing in the development of practice
guidelines, surveillance, outcome assessment, and clinical research in vascular
• Learn the administrative skills necessary to serve as a medical director of a noninvasive
It is expected that each would qualify to take the RVT examination although RVT
certification is not required.
MRA/CTA: VSRs will receive education in the special diagnostic techniques for the
management of vascular disease (angiography, MRA, CTA, CT, MRI and MRA) throughout
the course of their residency. This will be accomplished through formal rotations,
conferences and formal settings. While rotating on IR, VSRs will receive formal training
from radiologists in angiography, CTA, CT, MRA and MR. During Friday concerns, additional
didactic learning will take place through the regular participation of radiologists in this
General Principles: The VSRs are expected to create a portfolio of clinical information
regarding the variety of patients seen including demographic information and relevant
images pre and post treatment whenever possible. Our environment emphasizes respect
and sensitivity for patient demographics as well as responsiveness and responsibility to their
needs. VSRs are expected to understand the cost implications of care and concepts of
resource allocation. VSRs are instructed on the variety of economic systems that effect the
delivery of care as well as the CPT coding system that determines compliance and
reimbursement. VSRs are expected to analyze their outcomes in a systematic way and
provide a one summary report within 8 months of starting that confirms their understanding
of Systems-Based Practice and Practice-Based Learning and Improvement in Vascular
Surgery. Access to on-line medical information is provided.
Our program emphasizes one-to-one relationships between faculty and VSRs. There is a
daily assessment of cognitive knowledge and patient care skills. There is constant feedback
from Nurse Leaders on our clinical floor and our nurse practitioner. Our weekly Friday
conferences allow for an evaluation and testing of cognitive knowledge and communication
skills through didactic lecture, oral examination, and supporting documentation. Our daily
working rounds allow for evaluation of patient care and family interaction.
Adverse outcomes of all patients are discussed and documented at Quality Assurance
meetings. Additionally, a Death and Complications (M & M) conference is required weekly of
all faculty and house staff/fellows in General Surgery (including the Vascular Surgery faculty
and residents). This conference is an integrated approach to practice-based learning and
improvement as well as patient care and medical knowledge.
In addition to the Death and Complications conferences, the faculty and key nursing
personnel are asked to objectively report their impressions of the VSRs’ progress on an
extensive evaluation form quarterly. The faculty has an opportunity to discuss these
evaluations at quarterly meetings. The program director meets with the VSRs to discuss the
faculty evaluations quarterly and on an ad hoc basis when deficiencies or problems are
VSRs are expected to take the qualifying and certifying examination of the Board of
Vascular Surgery of the American Board of Surgery within 12 – 18 months following the
successful completion of the Duke VSR program.
Because graduate medical education is a full-time endeavor, the Program Director must
ensure that moonlighting does not interfere with the ability of the trainee to achieve the
goals and objectives of the educational program. Internal moonlighting (Temporary Special
Medical Activity) must be counted toward the 80-hour weekly limit on duty hours and may
be only approved on a case-by-case basis by the Program Director. Requests for TSMA
activity must include documentation of duty hours.
VSRs are required to attend and sign in legibly at all Grand Rounds, Conferences and Journal
Clubs. Attendance of 75% of Grand Rounds, Conferences and Journal Clubs will be considered
as part of the promotion/graduation process.
Operative Case Logs
Annual Operative Case Logs must be submitted on-line via the ACGME. Annually, each VSR
must submit cumulative reports the Program Coordinator. The Program Director will
carefully monitor this data on a quarterly basis. If a VSR falls behind or fails to meet the
minimum RRC requirements, the Program Director will identify appropriate cases to perform
in order to bring the number of surgical cases in-line.
Failure to maintain the operative log on a monthly basis may result in suspension of clinical
privileges until the log is updated.
Duty Hour Policy
All VSRs must maintain a log of their daily duty hours. Each week, the VSR will enter their
duty hour data via e*Value. At the end of each week, the Program Director and Coordinator
will review the data submitted. A monthly calculation will be tabulated and tracked to
ensure ACGME compliance as follows:
1. Duty hours are defined as all clinical and academic activities related to the residency
program; i.e., patient care (both inpatient and outpatient), administrative duties
relative to patient care, the provision for transfer of patient care, time spent in-house
during call activities, and scheduled activities such as conferences. Duty hours do not
include reading and preparation time spent away from the duty site.
2. Duty hours must be limited to 80 hours per week, averaged over a four week period,
inclusive of all in-house call activities.
3. Residents must be provided with 1 day in 7 free from all educational and clinical
responsibilities, averaged over a four week period, inclusive of call. One day is
defined as 1 continuous 24-hour period free from all clinical, educational, and
administrative duties. Each VSR is must take their arranged day off.
4. Adequate time for rest and personal activities must be provided. This should consist
of a 10-hour time period provided between all daily duty periods and after in-house
Any VSR who fails to comply with the ACGME rules place the program at risk. Failure to
adhere to program requirements may include administrative leave or a corrective action
plan. If a VSR fails to adhere to the corrective action plan, as a last resort, termination
from the program will be considered.
Each VSR will be assessed each work day by supervising faculty regarding their previous
night work hours, alertness and well being after night of taking call at home. If the VSR
shows signs of lack of alertness or well being, the VSR will be sent home early the next day.
If a resident has failed to obtain at least four (4) hours of sleep, the VSR will be required to
leave no later than 12:00 p.m. (noon) that day. VSRs and faculty are required to review a
one hour video annually on alertness and well-being and duty hour assessment.
Safety Training and HIPAA
Safety Training includes ACLS, BCLS, HIPAA, etc., and must be updated on-line annually.
Reminders will be sent via email by the GME Office. You are required to maintain
compliance at all times. Failure to comply includes Hospital mandated administrative leave
and temporary loss of training privileges. This can result in a negative listing with the
Physician Central Data Computer.
As a Vascular Surgery Resident, you will be required to participate in the Division’s
1. Rotation Evaluation/Form – to provide the Program with continual feedback on
the value/educational merit of each rotation.
2. Faculty Evaluation/Form – to provide the faculty with valuable feedback
a. Teaching abilities
b. Commitment to the Educational Program
c. Research/Scholarly Activity
d. Clinical Acumen/Knowledge
3. Resident Evaluation Form – per rotation – to provide the Resident with
appropriate feedback concerning his/her abilities related to the six General
Competencies which includes:
a. Medical Knowledge
b. Patient Care
c. Interpersonal & Communication Skills
e. Practice-Based Learning & Improvement
f. Systems-Based Practice
4. Semi-Annual Evaluation Form – to provide the Resident with a semi-annual
review for promotion/graduation purposes.
5. Anonymous Program Evaluation – to provide the program with feedback related
to continual improvement for. If deficiencies are found, the Residency Education
Group will prepare an explicit plan of action which will be approved by the faculty
and documented in the minutes of the meeting.
6. 360 Degree Evaluation – Midpoint during the year, a 360 Degree Evaluation will
be distributed to vascular surgery faculty, peers, medical students, nursing staff and
patients. The results of the evaluation will be anonymously tabulated and discussed
by the Program Director and vascular surgery resident.
7. Speaker/Objectives Evaluation Form – to provide the Resident or speaker with
feedback concerning his/her didactic delivery related to:
a. Medical Knowledge
c. Interpersonal & Communication Skills
d. Practice-Based Learning & Improvement
8. Program Director Evaluation Form – to provide feedback to the Program Director
a. Teaching abilities
b. Clinical acumen/knowledge
c. Commitment to the educational program
d. Research/Scholarly Activities
e. Over-all Management/Supervision of the Program
9. Final Evaluation - The program director must provide a final evaluation for each
VSR who completes the program. This evaluation must include a review of the VSR’s
performance during the final period of education, and should verify that the VSR has
demonstrated sufficient professional ability to practice competently and independently. The
final evaluation must be part of the VSR’s permanent record maintained by the institution.
Section V: Department of Surgery Vascular Surgery Residency Specific Curriculum:
(The following information was adapted to the Vascular Fellowship from the Association of
Program Directors in Surgery Curriculum, 4th Edition, 2002, ASE publication.)
DUKE VASCULAR SURGERY RESIDENCY CURRICULUM
Basic Science Curriculum
• Embryology of the Vascular System
• Molecular Biology
• Physiology and Pathophysiology of Blood Vessels
• Hemodynamics and Atherosclerosis
• Peptide Growth Factors
• Endothelial Cells
• Vascular Smooth Muscle Cells
• Response of the Arterial Wall to Injury and Intimal Hyperplasia
• Atherosclerosis: Theories of Etiology and Pathogenesis
• Histopathologic Features of Nonarteriosclerotic Diseases of the Aorta and Arteries
• Regulation of Vasometer Tone and Vasospasm
• Venous System of the Lower Extremities: Physiology and Pathophysiology
• Structure and Function of the Lympatic System
• Diabetic Vascular Disease
• Plasma Lipoproteins and Vascular Disease
• Cigarette Smoking and Vascular Disease
• Coagulation and Disorders of the Hemostasis
• Blood Rheology and the Microcirculation
• Drugs in Vascular Disease
• Scientific Basis for Balloon Embolectomy
• Basic Principles Underlying the Function of Endovascular Devices
• Vascular Grafts
• Statistics for the Vascular Surgeon
• Aneurysmal Disease of the Abdominal Aorta
• Cerebral Blood Flor
• Basic Science of Renovascular Hypertension
• Basic Mechanisms in Mesenteric Ischemia
• Hemodynamic Basis of Portal Hypertension
• Anatomy and Physiology of Normal Erection
• Skeletal Muscle Ischemia and Reperfusion: Mechanisms of Injury and Intervention
• Spinal Cord Ischemia Associated with High Aortic Clamping: Methods of Protection
• Arteriovenous Hemodialysis Access
• Arterial and Vascular Graft Infection
• Neuropathic and Biomedical Etiology of Foot Ulceration in Diabetics
• Diagnosis and Management of Aneurysmal Disease
• Diagnosis and Management of Extremity Arterial Occlusive Disease
• Diagnosis and Management of Renal Artery Occlusive Disease
• Diagnosis and Management of Visceral Ischemia
• Diagnosis and Management of Carotid Artery Occlusive Disease
• Diagnosis and Management of Innominate, Subclavian and Vertebrobasilar Arterial
• Diagnosis and Management of Thoracic Outlet Syndrome
• Diagnosis and Management of Acute Arteral Occlusion
• Diagnosis and Management of Diabetic Foot Problems
• Diagnosis and Management of Complications of Vascular Therapy
• Diagnosis and Management of Vascular Trauma
• Diagnosis and Management of Venous Thromboembolic Disease
• Diagnosis and Management of Chronic Venous Insufficiency
• Diagnosis and Management of Lymphedemia
• Indications and Techniques for Extremity Amputation
• Techniques for the Diagnosis of Peripheral Vascular Disease
• Use of Endovascular Therapy in the Management of Peripheral Vascular Disease
• Risk Stratification in Patients with Peripheral Vascular Disease
• Diagnosis and Management of Coagulation Disorders in Patients with Peripheral
• Diagnosis and Management of Miscellaneous Vasculogenic Problems
• Diagnosis and Management of Non-Atherosclerotic Vascular Diseases
• Diagnosis and Management of Arterial Venous Malformations
• Indications for and Techniques of Vascular Access
• Indications for and Results of Sympathectomy in Patients with Peripheral Vascular
• Diagnosis and Management of Portal Hypertension
By the end of this Vascular Surgery Residency, the trainee will be able to:
• Demonstrate knowledge of the anatomy, physiology and pathophysiology of the vascular
system, including congenital and acquired diseases.
• Demonstrate the ability to surgically manage the preoperative, operative, and
postoperative care of patients with arterial, venous, and lymphatic disease(s).
• Practice independently and competently as a Vascular Surgeon.