Training Gaps: How to Establish Comprehensive Training in Venous and Lymphatic Medicine

Significant gaps in training in venous and lymphatic medicine have been identified in published articles and data [1-7], as well as in previous articles in Vein Magazine—regardless of whether a physician’s training is in vascular surgery, interventional radiology, dermatology or another specialty. Simply put, there is no single specialty that routinely provides a comprehensive curriculum covering all aspects of this field.

Given that education is at the foundation of quality patient care, an important question is how to ensure that physicians receive the necessary training in venous and lymphatic medicine (VLM), so that high-quality care is provided to patients suffering from these problems.

The goal of comprehensive training in VLM, which should be delivered at the graduate level, is for a specialist to be knowledgeable about the treatment of all aspects of VLM. As is typical across all specialties, comprehensive training does not mean that an individual physician would perform all procedures to which they may have been exposed to during training.

Comprehensive training requires the establishment of a standardized curriculum for teaching programs. A curriculum is the backbone of educational standards, and is built around an understanding of a core content that outlines the areas of essential knowledge. The curriculum includes goals and objectives, instructional methods, assessment and training environment.

With these realities in mind, the American Board of Venous and Lymphatic Medicine (ABVLM) began a three-step collaborative, multispecialty process to develop educational standards in VLM.

Three-step process for establishing VLM standards

Step One: Core Content

The work of more than 70 experts from dermatology, interventional radiology, phlebology, vascular medicine, vascular surgery and other fields led to the publication of the Core Content for Training in Venous and Lymphatic Medicine,8 which has been endorsed by the American College of Phlebology and the American Venous Forum.

Step Two: Program Requirements

Program requirements delineate the knowledge and skills that need to be learned during graduate training. A group of experts from key specialties has developed a draft of the educational objectives of the program requirements for VLM (nearing completion), based on the template used by the ACGME for all approved programs. The program requirements cover the requisites for the program director, faculty, institution, facilities, resources, educational programs and training environment. It is meant to serve as a guide for one-year fellowship training programs in VLM.

Step Three: Curriculum Implementation

The meeting, funded by a generous grant of the ACP Foundation, was used to review and suggest modifications to the program requirements document, and to discuss incorporating the core content and program requirements into one-year training programs in VLM. Step three entails discussion and planning as to how to incorporate the core content and program requirements into VLM graduate training. Toward that end, the ABVLM Curriculum Advisory Council (CAC) met in January 2015 in Ft. Lauderdale, Florida. The CAC is composed of five vascular surgeons, three vascular medicine specialists, three interventional radiologists, two interventional cardiologists and two dermatologists, in addition to members of the multidisciplinary ABVLM board.

Next Steps for ABVLM

The ABVLM is in the initial phase of developing a support structure for VLM fellowships, initially to include a program development committee and a fellowship accreditation process and system. The program development arm is designed to foster interest in offering fellowships and to be an important resource to those considering offering the fellowships. A toolkit is being developed that will delineate and provide support for the steps involved in creating a VLM fellowship, assist in working with the GME office and accreditation process, as well as to help identify and provide funding sources.

The Value of VLM Fellowships

There are a number of important benefits to establishing VLM fellowships. It would provide for more comprehensive and standardized training. Physicians who receive such training will provide better care for patients. Such programs would increase academic development in the field, with a stimulus for scientific inquiry, publication, development of faculty for fellowship programs, and the development of future leaders in the field. Increased credibility, visibility, representation and recognition would be the natural result of such training.


Medical knowledge and treatment methods have evolved rapidly in VLM, and physicians providing care to patients with these disorders come from diverse backgrounds. Given these realities, the availability of comprehensive training at the graduate level can be seen as critically important. Such training is the best way to ensure that patients receive quality care from physicians well trained in the field. Our commitment to medical professionalism demands nothing less.


1. Zimmet SE, Comerota AJ. Venous Disease Care: Improving Training Paradigms. Endovascular Today 2015;14(7):75-77.

2. Lohr JM, Dalsing MA, Wakefield TW et al. Knowledge Deficit in Venous Disease Remarkable in Current Vascular Trainees. J Vasc Surg. 2009;49(5), Supplement:S21.

3. Vascular Surgery Case Logs National Data Report, Accreditation Council for Graduate Medical Education, prepared by the Prepared by: Department of Applications and Data Analysis. Available at: Accessed May 15, 2015.

4. Scurr JR, Oshin OA, Hinchliffe RJ et al. Deficiencies in venous experience in UK vascular trainees: a survey of Rouleaux Club members. Phlebology. 2011 Sep;26(6):227-31.

5. Karthikesalingam A, Buxton P, Marron C et al. Deficiencies persist in the experience of UK vascular trainees: a survey of Rouleaux Club members. Vasc Endovascular Surg. 2012 Jul;46(5):358-63.

6. Spanos K, De Maeseneer M, Nicolaides A et al. A survey of the European Venous Forum on education and training in venous surgery and phlebology in Europe. Int Angiol. 2015 Apr;34(2):182-7.

7. Onida S, Shalhoub J, Davies AH. Position of the European college of phlebology. Phlebology. 2015;30(1 suppl):111-115.

8. Zimmet SE, Min RJ, Comerota AJ, et al. Core content for training in venous and lymphatic medicine. Phlebology. 2014;29:587-593.