Resident continuity of care experience in a Canadian general surgery training program.
OBJECTIVE
To provide baseline data on resident continuity of care experience, to describe the effect of ambulatory centre surgery on continuity of care, to analyse continuity of care by level of resident training and to assess a resident-run preadmission clinic's effect on continuity of care.


METHODS
Data were prospectively collected for 4 weeks. All patients who underwent a general surgical procedure were included if a resident was present at operation.


METHODS
The Division of General Surgery, Queen's University, Kingston, Ont.


METHODS
Preoperative, operative and inhospital postoperative involvement of each resident with each case was recorded.


RESULTS
Residents assessed preoperatively (before entering the operating room) 52% of patients overall, 20% of patients at the ambulatory centre and 83% of patients who required emergency surgery. Of patients assessed by the chief resident, 94% were assessed preoperatively compared with 32% of patients assessed by other residents (p < 0.001). Of the admitted patients, 40% had complete resident continuity of care (preoperative, operative and postoperative). There was no statistical difference between this rate and that for emergency, chief-resident and non-chief-resident subgroups. Of the eligible patients, 58% were seen preoperatively by the resident on the preadmission clinic service compared with 54% on other services (p < 0.1).


CONCLUSIONS
This study serves as a reference for the continuity of care experience in Canadian surgical programs. Residents assessed only 52% of patients preoperatively, and only 40% of patients had complete continuity of care. Factors such as ambulatory surgery and junior level of training negatively affected continuity experience. Such factors must be taken into account in planning surgical education.
Sidhu
R S
RS
Department of Surgery, Queen's University, Kingston, Ont.
Walker
G R
GR
D000556:Ambulatory Surgical Procedures; D003266:Continuity of Patient Care; D017558:Elective Surgical Procedures; D004630:Emergencies; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D009864:Ontario; D010343:Patient Admission; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D013514:Surgical Procedures, Operative