A strategy to improve quality of outpatient education for residents and medical students on a vascular surgery service

In the current era of same-day admissions and decreased length of hospitali zation for major vascular operations, education of residents and medical st udents in the outpatient setting has become an increasingly challenging pro blem. We developed a strategy to provide improved outpatient experience for advanced vascular surgery residents (VSRs), general surgery residents (GSR s), and medical students (MSs) on a vascular surgery service. A survey of p rogram directors and VSRs at accredited vascular surgery fellowships in the United States and Canada was undertaken to determine the manner in which o utpatient education was accomplished and the amount of time devoted to pre- and postoperative patient evaluation. The survey revealed that VSRs, GSRs, and MSs spent 1 or more days in clinic at approximately half of accredited vascular surgery programs. There were no appreciable differences in time sp ent in clinic for different levels of trainees. VSRs preoperatively evaluat ed at least half of their patients at approximately two-thirds of the progr ams, while at the other third of the programs they preoperatively evaluated one-quarter or less of their patients before surgery. GSRs preoperatively evaluated at least half of their patients at 50% of programs, according to program directors, and at 69% of programs, according to VSRs. Because of re cent changes in health care delivery and the effect of these changes on res ident training, outpatient education of VSRs, GSRs, and MSs will require in creased attention on the part of vascular surgeons involved with their educ ation. Increasing time demands and decreasing reimbursements for vascular s urgeons as a result of managed health care may make this goal increasingly difficult to accomplish. Improved strategies and extra efforts are necessar y to ensure that trainees obtain sufficient experience to evaluate vascular patients pre- and postoperatively and maintain high quality of care for va scular surgery patients.