Continuity of care in general surgery resident education.

BACKGROUND: Lack of continuity of care for patients managed by general surgery residents is a commonly recognized problem but objective data evaluating its incidence are limited. The goal of this pilot study was to determine the extent to which senior residents at a large American urban academic center participate in the full course of care for patients on whom they operate.

METHODS: Two hundred twenty-eight total cases performed between January 1, 2012 and December 31, 2012 were reviewed and the operative senior resident was noted: laparoscopic cholecystectomy (n = 50), breast lumpectomy (n = 33), thyroidectomy (n = 50), laparoscopic appendectomy (n = 50), and open partial colectomy (n = 45). Frequency of operative resident involvement in the initial preoperative clinic visit, initial postoperative visit, or both (the entire course of care) was recorded.

RESULTS: Overall rate of operative resident involvement was 9.2% for the initial preoperative consultation, 9.0% for the initial follow-up visit, and 0% for the entire course of a patient's care. Residents were on service for greater than 40 days, whereas the average total duration of care for an individual patient was 26 days.

CONCLUSIONS: The results of this pilot study suggest that continuity of care among general surgery residents is lacking and cannot be entirely accounted for by rotation-specific time constraints. Further research is needed to identify and validate effective curricular strategies for improving opportunities to participate in this essential experience.