Resident continuity of care experience: a casualty of ambulatory surgery and current patient admission practices.
BACKGROUND
The purpose of this study was to define and assess the impact of changes in health care delivery on the current continuity of care experience of surgical residents.


METHODS
This 4-week, prospective cohort study included all patients who underwent a general surgical procedure at the University of British Columbia if a resident was present at the operation. The residents' perioperative involvement in each patient's care was recorded.


RESULTS
Of the 592 eligible cases, 74.8% were elective same-day admissions, 5.4% elective previously admitted patients, and 19.8% emergencies. The overall rate of assessment was 27% preoperatively, 84% postoperatively on the ward, and <1% in oupatient clinic postdischarge. Elective cases were associated with significantly lower rates of preoperative assessment compared with emergency cases (15% versus 74%, P < .001).


CONCLUSIONS
Changes in health care delivery have outpaced changes in the structure of surgical education, resulting in suboptimal continuity of care experiences for trainees. Residency programs must adapt their curricula to include adequate ambulatory experience.
Melck
Adrienne L
AL
Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, C318-1-91 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
Weber
Eric M
EM
Sidhu
Ravi S
RS
D000556:Ambulatory Surgical Procedures / Q000193:education*; D001955:British Columbia; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000458:organization & administration; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D010343:Patient Admission; D011446:Prospective Studies