Latest / European Society for Vascular Surgery / Trainee Perspective in Vascular Surgery Across Europe with M. Golian, C. Chwila, D. van den Hondel, and D. Wippel

Transcript

Trainee Perspective in Vascular Surgery Across Europe with M. Golian, C. Chwila, D. van den Hondel, and D. Wippel · European Society for Vascular Surgery

• 0:12
  Hello and welcome back to the ESVS podcast. Today
• 0:15
  we are flipping the perspective. In the previous
• 0:17
  episode, we talked to the trainers, the mentors,
• 0:20
  the consultants, the people who shape the system
• 0:22
  from the top. Now it's time to hear from the
• 0:26
  ones living it every single day. The trainees,
• 0:28
  the residents who move between night shifts and
• 0:30
  morning rounds, between textbooks and real patients,
• 0:33
  between confidence and self -doubt. This episode
• 0:36
  is about what training really feels like from
• 0:39
  the inside, what works, what doesn't, and what
• 0:43
  young vascular surgeons across Europe wish their
• 0:45
  trainers and the system understood a little better.
• 0:48
  I'm a trainee myself, so this conversation is
• 0:51
  close to my heart. It's honest, sometimes uncomfortable,
• 0:54
  but deeply important. So let's hear it directly
• 0:58
  from the next generation of the vascular surgeons.
• 1:01
  Hi everyone, it's really great to have you here.
• 1:04
  Thanks so much for joining me. For our listeners
• 1:06
  who are meeting you for the first time, could
• 1:09
  you each briefly introduce yourselves, tell us
• 1:11
  where you're training, what stage of residency
• 1:13
  you're at and what first pulled you toward vascular
• 1:16
  surgery? Hi, my name is Michael Golian and I
• 1:22
  am a fourth year vascular surgery resident in
• 1:25
  Poland. In total, this is a six -year program.
• 1:29
  And I already knew more or less from fourth year
• 1:33
  in medical school that this was the field that
• 1:36
  I wanted to get into. What really drove me to
• 1:39
  pursue this career, this career path, was not
• 1:45
  only the topic of vascular surgery, the ability
• 1:48
  to treat patients surgically and vascularly,
• 1:58
  led these classes that they really infected me
• 2:02
  with this interest in vascular surgery. So later
• 2:05
  on, during medical school, I was able to come
• 2:08
  into surgeries in my off time, and see what is
• 2:12
  about so that that also helped me decide. Hi,
• 2:15
  everyone. My name is Claudia Chwila. I'm a third
• 2:18
  year vascular surgery resident from Linz, Austria.
• 2:21
  And I'm also participating in the ESVS aortic
• 2:25
  fellowship programme. I never really thought about
• 2:28
  vascular surgery until my final year of medical
• 2:30
  school. During my clinical rotation at the University
• 2:34
  Hospital in Halle, Germany, I worked with this
• 2:37
  amazing team and that's when I became really
• 2:40
  interested. One of the consultants there told
• 2:44
  me, every surgeon is afraid of bleeding except
• 2:47
  vascular surgeons. And at that time, I found
• 2:50
  that really convincing, even though now I know
• 2:53
  that it's not always true. I felt like vascular
• 2:56
  surgeons were always friendly, calm and unshakable.
• 2:59
  And that's exactly the kind of surgeon I wanted
• 3:02
  to become. And before we move on, we actually
• 3:05
  have one more voice to add to this conversation.
• 3:08
  Joining us is someone who's stepped to the other
• 3:10
  side of the training, Desiree van den Hondel,
• 3:13
  a young consultant from Rotterdam. Desiree has
• 3:16
  just finished her training, so she brings very
• 3:18
  unique perspective, fresh, honest, and still
• 3:20
  very close to the trainee's experience. So Desiree,
• 3:24
  looking back now, what made you choose this particular
• 3:28
  field? What made you choose vascular surgery?
• 3:31
  At the start of my training, I was actually focused
• 3:33
  on gastrointestinal surgery. But in my second
• 3:36
  and third year, I came into contact with Vascular
• 3:38
  and suddenly everything clicked. I love the combination
• 3:41
  of anatomically beautiful open procedures and
• 3:44
  a technical challenge of minimal invasive surgery.
• 3:47
  Also, the immediate results you get after an
• 3:49
  operation, for example, seeing the CFA pulsate
• 3:51
  after an endoterectomy, is really satisfying.
• 3:55
  Also, to be honest, I just really enjoy working
• 3:57
  with vascular patients. They're often complex,
• 3:59
  but very grateful. During my training, one of
• 4:03
  the senior surgeons I worked with, a young female
• 4:05
  vascular surgeon named Rose Marijn van der Vijver,
• 4:07
  noticed how excited I was becoming about the
• 4:10
  field. She and others really supported me in
• 4:12
  making the decision to specialize into vascular,
• 4:15
  and I'm still very grateful for that. Since you're
• 4:18
  all training in different countries across Europe,
• 4:20
  this is really interesting. What do you think
• 4:22
  works well in your national training system?
• 4:24
  Are there any specific structures or teaching
• 4:26
  approaches that you feel are particularly effective?
• 4:30
  It really depends on the hospital in Austria,
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  but in my clinic residents get to operate a lot
• 4:36
  and surgeries are often equally distributed among
• 4:40
  the consultants and the residents and also within
• 4:43
  the residents. we also have regular journal clubs
• 4:46
  case presentations updates on guidelines and
• 4:50
  research meetings and the hierarchy is quite
• 4:52
  flat you can basically ask anything even questions
• 4:56
  that might feel simple so what's nice about poland
• 5:01
  in terms of training is that there is a good
• 5:03
  proportion of open to endo procedures so we can
• 5:08
  do a triple a repair open we do evars a lot of
• 5:14
  different bypasses, both anatomic and extra anatomic
• 5:18
  bypasses. It's a very well -rounded system in
• 5:20
  the sense of open and endo procedures. How about
• 5:24
  the Dutch system? There are two things I really
• 5:27
  appreciate about the Dutch system. First is the
• 5:30
  fact that we all do four years of general surgery
• 5:33
  before specializing. I truly believe this is
• 5:36
  a strength. It helps you keep the bigger picture
• 5:37
  in mind and not to get lost in your own super
• 5:40
  specialized corner. Second, especially in vascular
• 5:43
  surgery, the training is well structured. We
• 5:46
  have regular national training days for all vascular
• 5:48
  residents, where we are challenged with theoretical
• 5:50
  cases, guideline discussions and lots of simulation
• 5:53
  training, often in collaboration with the industry
• 5:55
  partners. It really helps you grow. So obviously,
• 6:00
  every training has its limitations. Are there
• 6:03
  any aspects of your training that you find particularly
• 6:06
  challenging or limiting? And if you had a power
• 6:10
  to change one thing, what would make the biggest
• 6:13
  difference for trainees? If I could change one
• 6:16
  thing, I'd shift the balance from 4 years of
• 6:18
  general surgery and 2 years of vascular surgery
• 6:21
  into 3 and 3. 2 years is just a bit too short
• 6:24
  in my opinion to become fully confident in both
• 6:27
  open and endovascular techniques. In fact, during
• 6:29
  my last year of general surgery, I was already
• 6:32
  focusing a lot on vascular cases. And many of
• 6:35
  my colleagues do the same. So the biggest challenge
• 6:38
  in terms of the training system here in Poland
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  is that this program is very individual and we
• 6:46
  have to be driven as residents in order to acquire
• 6:50
  new skills, new information, because that doesn't
• 6:54
  come by itself from anywhere. What do you think,
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  Claudia? I think we could benefit from a more
• 6:59
  centralized system. with clear yearly goals for
• 7:03
  every resident, a national training curriculum
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  with opportunities for national and international
• 7:08
  rotations in university centres but also in smaller
• 7:12
  community hospitals and more structured feedback.
• 7:16
  And within the clinic I'd really love to see
• 7:19
  more time dedicated to just regular bedside teaching
• 7:22
  and also soft skill training. Let's end this
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  part with a bit of imagination. If you had a
• 7:28
  magic wand and could change just one thing about
• 7:31
  your training in your country, what would it
• 7:33
  be? If I had a magic wand, I would improve how
• 7:36
  we train the residents in open aortic surgery.
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  In the Netherlands, the number of open aortic
• 7:41
  cases is declining so rapidly that it's becoming
• 7:44
  rare for the residents to assist, let alone perform
• 7:46
  these operations. What I'd love to see is more
• 7:49
  structured collaboration between hospitals, so
• 7:52
  that every open aortic case includes a vascular
• 7:54
  resident, either assisting or performing part
• 7:57
  of the procedure. That way we can make sure that
• 7:59
  we don't lose essential surgical skills in the
• 8:02
  next generation. As funny as this may sound,
• 8:05
  but paperwork, there could be less paperwork.
• 8:09
  I find that I spend a lot of time just doing
• 8:12
  this sort of paperwork in front of a computer.
• 8:16
  And this really reduces the amount of time that
• 8:19
  I have with patients. So if there's one thing
• 8:23
  to change, it'd be for sure a lot less paperwork.
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  If I could change one thing. it would be micro
• 8:31
  teaching every single day and making sure it
• 8:35
  really happens because i feel like in our daily
• 8:38
  clinical work sometimes teaching just gets lost
• 8:41
  along the way many of us will become trainers
• 8:44
  one day so based on your experience as trainees
• 8:47
  what does it ideal trainer look like what should
• 8:50
  we absolutely keep and what should we leave behind
• 8:53
  maybe to put it shortly a great tutor or or mentor
• 8:58
  would be somebody who is able to gauge what you
• 9:03
  need and give just enough of what you need to
• 9:07
  keep you going and to help you continue to develop
• 9:11
  to give more space or less space to spend more
• 9:15
  time less time maybe giving a little bit more
• 9:19
  more room to perform a procedure or a certain
• 9:23
  skills junior procedure so it's this is this
• 9:27
  is this is a very tough question to answer and
• 9:29
  i feel like this is very individualized that
• 9:31
  the trainer has to has to recognize the individual's
• 9:34
  needs and be able to adapt to that claudia What
• 9:41
  makes a good trainer? At the beginning you need
• 9:44
  a very patient trainer, someone who explains
• 9:46
  a lot and guides you step by step. And then later
• 9:50
  on, I think it's about slowly growing into being
• 9:53
  an independent surgeon and that has to happen
• 9:57
  gradually. That's why you need trainers who trust
• 10:00
  you and who are genuinely interested in helping
• 10:03
  you reach the point where you don't need them
• 10:06
  anymore. but at the same time give you the feeling
• 10:09
  that they're still there to support you and ready
• 10:12
  to step in whenever you need them. That's a tough
• 10:15
  question. For me, the most important aspect of
• 10:17
  being a great trainer is to give honest, constructive
• 10:20
  feedback in a way that builds your confidence
• 10:22
  and not breaks it down. That kind of support,
• 10:25
  I think, helps you grow, not only in the operating
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  theater, but also how you will carry yourself
• 10:29
  as a future consultant. Let's talk about something
• 10:32
  we all know is important but isn't always taught
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  very explicitly. Soft skills. In your training,
• 10:40
  how are things like communication, leadership
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  or teamwork actually handled? Are these skills
• 10:47
  formally taught or is it more a learn by osmosis
• 10:52
  situation? We had a few sessions on communication
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  and teamwork, and it's definitely becoming more
• 10:58
  of a hot topic right now. Structured programs
• 11:00
  are being developed, but there's still room for
• 11:02
  improvement. Right now, a lot is still learned
• 11:04
  by observation. To be honest, there's not a lot
• 11:08
  of focus on soft skills like communication or
• 11:12
  leadership. So this is something that we... pick
• 11:17
  up by osmosis, eventually just learning about
• 11:21
  it outside of work. We're expected to learn it,
• 11:26
  but on our own. Soft skill training isn't really
• 11:29
  embedded in the curriculum in a systematic way
• 11:32
  yet. I'd love to ask each of you this. What advice
• 11:36
  would you give a medical student who's thinking
• 11:38
  about vascular surgery? In terms of advice for
• 11:41
  medical students, I'd probably say that this
• 11:43
  is a tough field for sure. It can be unforgiving
• 11:48
  at times. However, there are also other times
• 11:50
  where it's very rewarding. Probably the best
• 11:54
  piece of advice that I can give is to really
• 11:57
  see for yourself how this specialty looks like.
• 12:01
  It's best to find a specialist or somebody who
• 12:04
  works in this field and just shadow them and
• 12:07
  see for yourself if this is a good fit for you.
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  I'd like to share two pieces of advice I got
• 12:13
  from my head of department. He actually gave
• 12:15
  me the first one during my job interview. It
• 12:19
  was go and see for yourself, which basically
• 12:22
  meant get involved, assist in the OR, ask all
• 12:26
  the questions, really immerse yourself in the
• 12:29
  world of vascular surgery. And then you decide
• 12:32
  whether vascular surgery is right for you or
• 12:35
  not. And you can do that with every specialty.
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  And the second one was always be patient with
• 12:42
  yourself. Because if you are, everyone else will
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  be too, especially in the OR. My advice would
• 12:49
  be to follow your heart and choose a specialty
• 12:51
  that truly excites you. Don't let stories about
• 12:54
  difficult working hours scare you away. Things
• 12:56
  are changing quickly with the new generation
• 12:58
  of doctors. When I started, it was still quite
• 13:01
  normal to work from 7 .30 in the morning until
• 13:04
  10 at night. These days, that's no longer acceptable
• 13:07
  and we're seeing real improvements in the work
• 13:09
  -life balance. Also, try to expose yourself to
• 13:12
  different specialties as much as possible during
• 13:14
  your clinical rotations. And if something catches
• 13:17
  your interest, don't be afraid to ask questions
• 13:19
  or ask to scrub in. Vascular surgery might not
• 13:22
  be as visible as some other fields, but once
• 13:24
  you get involved, you might discover a whole
• 13:26
  new passion that you didn't expect. And finally...
• 13:29
  Even on the hardest days, when training feels
• 13:32
  heavy, what still inspires you about vascular
• 13:35
  surgery? What keeps you going? What gives you
• 13:37
  the small spark of motivation and pride? What
• 13:40
  keeps me going is seeing the immediate impact
• 13:42
  we can make. For example, when a patient has
• 13:44
  severe rest pain and hasn't slept in days or
• 13:46
  even weeks. We perform the procedure, the food
• 13:49
  is warm again, and the next morning they tell
• 13:51
  you, I finally slept again. That kind of immediate
• 13:54
  result gives me such a rush. It really reminds
• 13:56
  me why I do this. As cheesy as it sounds, but
• 13:59
  the satisfaction that you feel in a job well
• 14:05
  done. So, for example, if a patient came in with
• 14:07
  a rupture at AAA, you perform EVAR, and the patient...
• 14:15
  comes back into the apartment after one, two
• 14:18
  days stay in the ICU with a big smile on their
• 14:22
  face. That's something that brings a lot of satisfaction.
• 14:26
  Also, I also need to mention my fiancé helps
• 14:31
  to keep me going, provides a lot of support,
• 14:33
  and especially in those tougher days. For me,
• 14:39
  the goal is to become a really good surgeon.
• 14:43
  not only in the OR but also in diagnostics and
• 14:46
  decision making and in communication with patients
• 14:49
  and with my colleagues and on tough days what
• 14:52
  I think motivates me most is the patients themselves
• 14:56
  when they're thankful because you explained something
• 14:59
  clearly you were honest with them you gave them
• 15:02
  the time they needed for their questions and
• 15:05
  in the end it's also my team in Linz that inspires
• 15:08
  me and keeps me going So a big thank you and
• 15:12
  shout out to all of them. Thank you all for sharing
• 15:15
  these beautiful perspectives. So for our listeners,
• 15:20
  we've just heard from trainees and young vascular
• 15:22
  surgeons sharing what they love about training
• 15:25
  and what they find most challenging. But now
• 15:28
  I'd like to zoom out for a moment. What does
• 15:30
  the data actually say? Joining us, one more special
• 15:33
  guest, David Whippel, who has been studying the
• 15:36
  training experience of young vascular surgeons,
• 15:38
  including burnout, fulfillment, and professional
• 15:41
  development. David, you recently presented some
• 15:44
  of your findings during the ESVS session, and
• 15:47
  they really caught my attention. Could you briefly
• 15:49
  introduce your project? What did you look at,
• 15:51
  and what have you found so far? Yes, thank you
• 15:55
  very much for this opportunity to talk about
• 15:58
  this important subject on this platform. As you
• 16:02
  said, my name is David Whippel and I work as
• 16:05
  a vascular surgery resident in Innsbruck, Austria,
• 16:09
  in my fifth year now. And based on a discussion
• 16:13
  I had with Ryan Melo from Portugal last year,
• 16:17
  where he did a study among his residents, among
• 16:22
  the Portuguese residents, We came up with the
• 16:26
  idea of conducting this survey about training,
• 16:30
  satisfaction and well -being on a European scale
• 16:34
  to get a better understanding and where are the
• 16:38
  strengths of the systems and where are the weaknesses
• 16:41
  and where can we step in to change things. That's
• 16:45
  where we started the EVEST survey. And we are
• 16:49
  in our final phase of recruiting. We plan to
• 16:52
  publish the results at the beginning of next
• 16:54
  year. What we've seen so far is that fulfillment
• 16:57
  is very high. People really care deeply about
• 17:00
  this work and about what they're doing. So what
• 17:04
  I've also seen is that we are, on the one hand,
• 17:06
  they care deeply about their work and what they're
• 17:08
  doing, but the workload and the pressure is also
• 17:13
  really high. What was really surprising is that
• 17:16
  over a third of the Chinese have actually considered
• 17:20
  leaving vascular surgery. This leads us to the
• 17:23
  impression that we are at a bit of a tipping
• 17:25
  point in the system where we have to decide which
• 17:29
  way we want to go. Do we want to keep young talents
• 17:32
  and young people in the field? And for that,
• 17:35
  we have to change something. So what do you think?
• 17:38
  Is there still hope or are we doomed? The older
• 17:42
  generation... they care about training they care
• 17:45
  about our future and they want to improve it
• 17:47
  and they give us the opportunity to make changes
• 17:51
  so we as the younger generation the next generation
• 17:55
  vascular surgery should really take this offer
• 17:58
  the resonance in within our community is very
• 18:02
  positive and we we should go along with this
• 18:05
  can you share with us what are the three most
• 18:08
  important things that you have so far learned
• 18:11
  from this project I think the three most or three
• 18:15
  of the most important points that both trainers
• 18:19
  and trainees agreed on on the survey is that
• 18:22
  for one we need a structured curriculum second
• 18:26
  we need mentorship and and third we need simulation
• 18:31
  training and most importantly to achieve all
• 18:34
  three of these we need time to do it and the
• 18:38
  big question is how do we get time because this
• 18:41
  This seems to be the major bottleneck from both
• 18:44
  a trainee's perspective and trainer's perspective,
• 18:47
  that there's not enough time during the daily
• 18:50
  storm in the work life for mentorship, for simulation
• 18:55
  training. And this is something we should definitely
• 18:59
  work on to create protected time zones during
• 19:03
  the day. Thank you, David, for being here with
• 19:06
  us today. And just quickly, if someone listening
• 19:08
  wants to participate in your survey, what's the
• 19:11
  best way to get involved? Yes, thank you very
• 19:14
  much for bringing this up, because recruitment
• 19:17
  is actually still ongoing. And if you are interested,
• 19:21
  please just follow the link or the QR code. It
• 19:24
  will lead you straight to the trainer survey
• 19:27
  or trainee survey, respectively. Thank you, David,
• 19:31
  for all your work. And I just wanted to add that
• 19:34
  this conversation brings together two very important
• 19:37
  perspectives. On one side, the lived experience
• 19:40
  of trainees and young vascular surgeons. On the
• 19:43
  other, the data that helps us understand, name
• 19:46
  and measure those experiences. What becomes clear
• 19:49
  is that passion and exhaustion can coexist. That
• 19:53
  loving specialty doesn't mean that the system
• 19:56
  can or shouldn't improve. Training in vascular
• 19:59
  surgery is at the turning point. The next generation
• 20:02
  needs not only excellent technical education,
• 20:06
  but also structure, mentorship and an environment
• 20:09
  that allows curiosity and well -being to survive
• 20:13
  alongside ambition. Thank you to all our guests
• 20:17
  for their honesty, openness and time. And thank
• 20:20
  you to our listeners for being part of this conversation.
• 20:24
  You'll find links to David's research and to
• 20:27
  the trainees survey in the show notes. And if
• 20:30
  you're eligible, we truly encourage you to take
• 20:33
  part. Until the next time.