Credentialing Committee Action for Surgeon Without Vascular Surgery Training
The credentialing committee should request review for approval post-surgeon formal training (Option B), as performing complex vascular surgeries without proper training and certification is risky, contrary to patient welfare, and constitutes poor medical practice.
Rationale Based on Guidelines
The American College of Cardiology explicitly states that "the practice of peripheral angioplasty by the untrained physician should be avoided; it is risky and contrary to patient welfare and good medical practice" and that "responsible leadership of health care institutions offering peripheral angioplasty as part of their health care program should insist on the documentation of accredited training and maintenance of physician skills" 1.
Why Other Options Are Inappropriate:
Option A (Supervised privileges): While supervision might seem reasonable, the guidelines emphasize that formal training programs with hands-on experience are required, not just supervision during actual patient care 1. Complex vascular procedures require specialized knowledge of vascular disease natural history, noninvasive assessment, and alternative therapeutic modalities that cannot be adequately learned through supervision alone 1.
Option C (Brief course): The guidelines explicitly reject the notion that brief courses are sufficient. Although historically some physicians learned through "how-to" seminars, "the complexity of the procedures and the recognized need for hands-on experience dictate that formal training programs in peripheral angioplasty and other vascular interventions become the standard means of learning" 1.
Option D (Approve based on success): Success in other surgical areas does not translate to competence in vascular surgery. Vascular surgery requires specialized skills beyond general surgery 2, and credentialing committees must insist on documented accredited training 1.
Required Training Pathway
For a postgraduate physician without prior vascular training, the guidelines specify 1:
Formal training requirements: Completion of a structured vascular surgery residency program after board certification in general surgery, or a vascular medicine fellowship after board certification in internal medicine 1
Minimum procedural experience: 100 diagnostic peripheral angiograms and 50 peripheral angioplasty procedures under supervision of an experienced interventionist (>50% as primary operator), plus experience in 10 cases of thrombolytic therapy management 1
Educational components: Attendance at peripheral angioplasty seminars including live case demonstrations, learning vascular disease anatomy and natural history, noninvasive patient evaluation, and visiting active laboratories 1
Patient Safety Considerations
The primary concern is morbidity and mortality risk. Without proper training, the surgeon lacks:
- Understanding of vascular disease pathophysiology and natural history 1
- Skills in noninvasive vascular assessment 1
- Knowledge of when conservative management or alternative interventions are more appropriate 1
- Experience managing procedure-specific complications (renal failure, stroke, bleeding, emergency bypass requirements) 1
Common Pitfalls to Avoid
The credentialing committee must not:
- Confuse general surgical competence with vascular surgical competence 2
- Allow institutional financial pressures to override patient safety requirements 1
- Accept brief educational courses as substitutes for formal training programs 1
- Grant privileges based solely on past success in unrelated procedures 3