Continuity of care experience of residents in an academic vascular department: Are trainees learning complete surgical care?

Background: It is widely accepted that exemplary surgical care involves a surgeon's involvement ill the preoperative, perioperative, and postoperative periods. In an era of ever-expanding therapeutic modalities available to the vascular surgeon, it is important that trainees gain experience in preoperative decision-making and how this affects a patient's operative and postoperative course. The purpose of this study was to define the current experience of residents on a vascular surgery set vice regarding the continuity of care they are able to provide for patients and the factors affecting this experience. Methods. This prospective cohort study was approved by the Institutional Review Board and conducted at the University of British Columbia during January 2005. All patients who underwent a vascular procedure at either of the two teaching hospitals were included. In addition to type of case (emergent, outpatient, inpatient), resident demographic data and involvement in each patient's care (preoperative assessment, postoperative daily assessment, and follow-up clinic assessment) were recorded. Categoric data were analyzed with the x(2) test. Results. The study included 159 cases, of which 65% were elective same-day admission patients, 20% were elective previously admitted patients; and 15% were emergent. The overall rate of preoperative assessment was 67%, involvement in the decision to operate, 17%; postoperative assessment on the ward, 79%; and patient follow-up in clinic, 3%. The rate of complete in-hospital continuity of care (assessing patient pre-op and post-op) was 57%. Emergent cases were associated with a significantly higher rate of preoperative assessment (92% vs 63%, P < .05). For elective cases admitted before the day of surgery compared with same-day admission patients, the rates of preoperative assessment (78% vs 58%, P < .05) and involvement in the decision to operate (16% vs 4%, P < .05) were significantly higher. Conclusions: The continuity-of-care experiences of vascular trainees are suboptimal. This is especially true for postoperative clinic assessment. Same-day admission surgery accounted for most of the cases and was associated with the poorest continuity of care. To provide complete surgical training in an era of changing therapeutic modalities and same-day admission surgery, vascular programs must be creative in structuring training to include adequate ambulatory experience.