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.