Can Continuity-of-Care Requirements for Surgery Residents Be Demonstrated in the Current Teaching Environment?

Abstract

In 1994, the Residency Review Committee in Surgery began evaluating the ability of programs to provide adequate continuity-of-care experiences to residents, based on 6 criteria requiring resident participation in each phase of a surgical patient's care. The Residency Review Committee document further described resident and patient experiences as being synonymous. No previous studies were found that examined the 6 criteria or compared them with the patient's experience with continuity. Study objectives were 2-fold: (1) to assess the 6 required continuity-of-care experiences provided to general surgery residents and (2) to compare resident experiences to the patient's experience with continuity. Surgery residents from 2 academic years, representing each postgraduate year, were studied. Patients had (1) undergone an operation involving a resident and (2) remained hospitalized for longer than 24 hours but less than 10 days. Data were collected from a retrospective randomized review of each patient's medical records. Of the 114 cases, 23.7% showed that the same resident participated in all phases of care. In the remaining cases, residents provided preoperative care in 70.2%, directed the postoperative hospitalized care in 86.8%, and provided postdischarge care in 37.7%. Patients saw an average +/- SD of 4.6 +/- 1.5 surgical providers during the entire course of their surgical care. In conclusion, continuity experiences were provided to surgery residents in varying quantities and combinations, with one quarter of the residents experiencing "perfect continuity." Resident continuity experiences and patient continuity were not synonymous. Although improved medical record documentation may have enhanced these results, continuity-of-care remains difficult to demonstrate in view of the current surgery teaching environment.

Use of the Electronic Health Record to Track Continuity of Care in Neurological Surgery Residency

“…Past efforts, including resident participation questionnaires for limited periods 5,19,20 and retrospective medical record reviews, 21 were time consuming, labor intensive, and incomplete, capturing only a glimpse of the overall experiences. With the advent (and requirement) of electronic health records (EHRs), there are new opportunities for acquisition of data on residents' educational experiences.…”

Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

“…Previous studies of individual specialties suggest poor continuity of care in outpatient follow-up is not unique to our study population. 10,11,14 A study of general surgery residents identified outpatient continuity of care in only 1% of cases when a resident had been involved in the operative procedure. 14 Holmboe et al 15 noted that trainees' frequent rotational transitions promote a ''trainee as a tourist'' mentality in current medical education.…”

“…8,10,11,[14][15][16] Pu et al 16 suggested that resident surgery clinics provide trainees with an invaluable patient-physician interaction. Resident clinics, however, are not without shortcomings.…”

“…[5][6][7] A number of studies from the surgical literature have also examined resident continuity of care. [8][9][10][11][12][13] Mittal et al 8 highlighted the importance of surgical residents participating in all phases of patient care to fully appreciate the impact of preoperative and intraoperative decisions on postoperative outcomes. Ledwidge et al 9 advocated measures to increase care continuity for surgical residents after their study noted that only 23% of patients had the same admitting resident from the emergency department for all phases of care.…”

So Much to Do, So Little Time

“…To be fair, though, the problem of patient continuity in surgical training predates the duty hour rules. 3 In my experience, residents faced with spending a day in clinic or spending a day in the operating room will always choose the latter. The residency review committee (RRC) program requirements only call for half day per week in clinic and programs are almost never cited for failure to meet this low bar.…”