Structure and Administration
The University of Virginia Vascular Surgery residency program is designed to provide advanced education in the diagnosis and treatment of vascular diseases. The program is a one- (1) year educational experience focused on providing advanced knowledge and technical skills in the area of vascular surgery. The training program includes the components of knowledge in the fundamental sciences, Interventional Angiography techniques, non-invasive vascular studies, operative experiences, total patient care management, and exposure to the ongoing vascular research being conducted in departmental research laboratories. This program will follow either the general surgery and/or thoracic residency programs well established at the University of Virginia or accept individuals following general surgical training from other programs.
Our vascular surgery residency program was approved February 22, 1996 with an estimated follow-up visit for February 1998. Approval of the program was not received in time to participate in the NRMP nor to find a resident who would be able to fill the position for 1996. The following year, we participated in the National Residency Match program (NRMP) for 1997 and the program has its first vascular surgery resident who began July 1997. The program will continue to use the NRMP yearly for selection of a vascular surgery resident.
Program Director and Teaching Staff
Irving L. Kron, M.D. is the program director for the Section of Vascular Surgery at the University of Virginia. He is certified in the subspecialty of general vascular surgery, and fulfills the qualifications of the program director as defined by the ACGME (see CV). Dr. Kron is responsible for the coordination, direction, and administration of the training program and of the vascular surgery service.
The teaching staff is comprised of three (3) additional vascular surgeons and several collaborating services (Cardiology, Interventional Radiology, Neuroradiology). These attending faculty participate in the care of vascular surgery patients, and the education and training of the vascular resident. Dr. Kron is also the Vice-Chair of the Department of Surgery and Chief of Thoracic Cardiovascular Surgery Service, which helps to provide clear communication and connection with the Department of Surgery and the Division of Thoracic Cardiovascular Surgery. These roles provide additional authority as the program director to develop, determine, and enforce policy and assign/appoint personnel to the vascular surgery service as needed.
Vascular Surgery Service Organization
Continuity of care for vascular surgery patients is paramount in their recovery. Each vascular surgery patient is followed continuously by the vascular surgery service. Every patient admitted to the Vascular Service will be assigned to a member of the attending staff who will be responsible for supervising and guiding the resident. The senior residents change quarterly and in combination with the vascular resident's year long training, provide the patients' benefit of continuity of care delivery from residents who know their cases. Outpatient clinics are located in the hospital complex, which assists in vascular surgery resident participation in outpatient vascular follow up. Each of the vascular surgery attending's runs a clinic, supervises all activities that take place, provides an environment for teaching and overseeing the therapeutic medical management of the patients.
The vascular surgery service patient volume continues to grow. The vascular surgery service has 65 - 90 admissions per month with an average of 55 - 85 operative cases per month. Of those operative cases, the vascular surgery resident averages 30 cases per month (33% as teachng assistant and 64% as surgeon). The general surgery residents on the vascular service average 7 - 12 cases per month for the junior resident, with 25 to 40 cases per month for the senior resident. There have been 675 - 800 outpatient visits per year which provides more than adequate opportunities for the continuing resident education. The general surgery support of two interns, a junior (PGY 3) resident, and a senior (PGY 4) resident on the vascular surgery service is significant.
Resident Educational Program
There are several hours of conferences each week, some of which are conducted by the vascular resident staff and overseen by the faculty. All major vascular journals are available in the Health Sciences library, which is physically integrated with the Medical Center, subscribes to over 2800 journals, provides on-line computer services, and is open 7 days/week. The program provides office space, specialty textbooks, computer support, administrative support, and both supports and encourages each vascular chief resident to attend 1 national and 2-3 regional educational conferences during the year.
Adequate Supervision
The vascular team includes general surgery housestaff, one vascular chief resident and attending faculty, all of who care for the patients on the vascular surgery service. There is a graded chain of command that allows increasing responsibility from the junior housestaff to the chief resident with the ultimate authority for patient care being held by the attendings. The junior house staff report directly to the chief resident, who organizes the service, triages the patients, and delegates responsibility to various members of the team. He or she performs these functions under the auspices of the attending to which the team reports to on a regular basis all aspects of patient care. The attendings see their patients daily on the units and are involved in the critical portions of operative procedures performed on their patients.
The work of the service is completed by all members depending on their training level, professional growth and clinical experiences, as well as motivation, self-direction, maturity, and demonstrated problem solving behaviors. The vascular chief resident with a fair amount of delegation to the PGY 4 senior resident directs the flow of work.
Examples of work:
- PGY 1 interns, under directed supervision, monitor and manage vascular surgery patients on the floor units. They attend outpatient clinic to evaluate patients either pre-operatively or post operatively.
- PGY 3 resident is responsible for all initial in hospital evaluations that come to the vascular service, assists in the operating room on vascular cases as assigned by the chief vascular resident, and is closely involved in the post operative management of the patients.
The vascular surgery service makes twice daily rounds of all patients regardless of hospital location. For those patients on the floor units, the interns on the vascular service monitor and manage patient care issues with close supervision provided by the junior, senior, and vascular chief resident. For patients in the postoperative unit, PGY 2 residents assigned to the post operative unit rotation, monitor and manage patient care issues again closely supervised by the senior and vascular chief resident. One of the TCV faculty make daily teaching rounds on the patients in the post operative unit, however, the care of patients is always supervised by the individual attending and resident who are responsible for the patient.
The performance of each resident is evaluated on an ongoing basis throughout their rotation with written evaluations completed each quarter by the teaching staff. The vascular chief resident is formally evaluated quarterly by written evaluation covering areas from technical operative skills to vascular surgery knowledge to interpersonal communication skills. The chief resident also evaluates the Program and teaching staff on a quarterly basis. A group of general surgery residents focused on educational curriculum, meets quarterly, and provides feedback to the Department of Surgery. Any specific concerns or comments on the vascular surgery program would be shared with Dr. Kron.
Optimal Working Enviroment
The program strives to assure an optimal working environment is maintained for all residents as outlined by the Department of Surgery. The hospital provides an efficient, safe, clean and spacious environment in which to carry out patient care responsibilities. There are many support teams which provide care including other health care professionals (nurses, physical therapists, respiratory therapists, social work, nutrition, IV therapy, pharmacy), who provide day to day care for patients; a non -invasive vascular laboratory and staff, who perform needed testing; and vascular care nurses who assist the service in providing continuity of care to patients.
The average duty hours per week vary depending on the level of the resident with the average per week range from 80 hours. The location at which these hours are served varies with level of housestaff:
- PGY 1 interns duty rotation 24 hours ON/24 hours OFF floor unit with participation in outpatient clinic on alternative days;
- PGY 3 junior resident and PGY 4 senior resident are on call during the week/ 24 hours a day with alternative general surgery coverage on the weekends. This is not in house call.
Vascular Chief Resident is available at all times except for time off call and scheduled times off (meetings, educational programs, or vacation). This is also not in house call.
Facilities for the residents include call rooms, shared ones for junior housestaff, and individual ones for senior housestaff. The Vascular chief has an office/call room on the floor where the majority of activities and patient care are provided. There is a surgical library of vascular surgery texts, journals, videos, and a computer with connection to the University Health System library located in the TCV Surgery office in the hospital complex. As well, there is a housestaff lounge and gym in the hospital complex for use by all housestaff. * In addition, there is an established functioning organizational structure of surgical residents that act in advisory groups within the Department of Surgery. These groups provide input and feedback on several issues including Library, resident education, student/resident liaison; space availability, social and survival group, and residency recruitment.
Relationship of Vascular Surgery Residents to General Surgery Residents
The section of Vascular Surgery plays a major role in the educational training of the general surgery residents in vascular surgery. The vascular service is comprised of various levels of general surgery residents; PGY 1, 3, and 4. With the introduction of the subspecialty of vascular surgery training, the mix of general surgery residents was amended by adding a PGY 4 resident and removing a PGY 5 resident. This change removed any potential for general surgery chief residents and vascular surgery resident from having primary responsibility for the same patients. This helps in separating the primary responsibilities of patients among the senior PGY 4, junior PGY 3 and chief vascular residents, as their clinical skill, knowledge, and experience dictate.
The general surgery residency program provides three (3) month rotation to the Salem Veterans Hospital in Salem, VA where the general surgery resident gains operative experience and post operative management of vascular surgery patients. While at Salem VA, the senior surgical resident role encompasses overall responsibility to coordinate and manage the delivery of care to vascular surgical patients. This experience, in combination with PG rotations at the University Virginia Hospital, will meet the training and educative needs of the general surgery residents. This provides an administrative experience for the senior surgical resident yet establishes no conflict with a subspecialty in vascular surgery and the experiences of a chief vascular resident.
As stated earlier, several levels of general surgery residents are assigned to the vascular service for either 1 month or 3 month rotations. This group oversees the total management of the patients with the chief vascular resident coordinating the administration of and clinical care delivered. The chief vascular resident delegates responsibility of patient care across the vascular service depending on the capabilities and experience of the residents. The chief vascular resident also takes a caseload of patients, acts as a resource and teacher, and handles the administrative chores of the service.
Interactions with other general surgery residents while on the vascular service occur as patients have general surgical needs, in the course of daily rounds, and with participation in regular departmental conferences and meetings.
With the first vascular resident just completing his first 6 months, the view is that the vascular surgery volume at University of Virginia continues to grow and more than amply provides the variety of experiences for ALL levels of residency training.
Additional Resources & Application Information
- FREIDA Online (Fellowship and Residency Electronic Interactive Database Access)
- Applications for the Vascular Surgery Residency can be obtained through the:
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