Can continuity-of-care requirements for surgery residents be demonstrated in the current teaching environment?

C. I. Anderson, R. R. Albrecht, K. D. Anderson and R. E. Dean
Department of Surgery, Michigan State University, East Lansing.

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.