Vascular surgery training in the United States: a half-century of evolution.

The purpose of this report is to succinctly review the history, evolution, and accreditation process of postgraduate surgical training programs in the United States, with emphasis on recent dramatic changes in vascular surgery training. Vascular surgery became a distinct specialty of surgery on March 17, 2005, when the American Board of Surgery (ABS) received approval from the American Board of Medical Specialties (ABMS) to offer a Primary Certificate in Vascular Surgery. The traditional requirement for 5 years of training and certification in general surgery was eliminated. Effective July 1, 2006, the ABS converted its certificate in vascular surgery from a subspecialty certificate to a specialty (primary) certificate. These landmark changes allowed the simultaneous development of new training paradigms. Multiple flexible training pathways leading to either dual certification (Traditional 5-2; Early Specialization Program 4-2) or vascular surgery certification alone (Integrated 0-5; Independent 3-3) now exist. New pathways require a minimum of 2 years of core surgery training and 3 years of advanced vascular training. There are currently 96 accredited traditional 5-2 programs, five 4-2 programs, and 11 0-5 integrated programs, with multiple additional institutions in the process of submitting 0-5 applications. The main obstacle preventing more rapid transition to the new pathways seems to be difficulty in obtaining funding for additional resident positions. Multiple flexible training paradigms are likely to coexist as vascular surgery continues to evolve.