Exposure in emergency general surgery in a time-based residency program: A call for review

Objective: This paper aimed to characterize the resident exposure to acute general surgical conditions during a three-months rotation in a general surgical unit. Setting: The Department of Surgery, University of Nairobi and Kenyatta National Referral and Teaching Hospital in Nairobi. MethodS: Four residents (in their first to third post-basic science year) were evaluated during a 12-week General Surgery rotation. Details assessed included number and variety of admission diagnoses logged by each resident, number and nature of surgical operations performed independently by each resident and with consultant support, and the resident involvement in the continuity of care. The experiences were compared across the residents. Results: One hundred and forty five patients were admitted. The number of admissions per resident varied between 30 and 41. Fifty-eight patients had surgery. Operative experience where the resident was the principal surgeon ranged from 11 cases to 23 cases per resident. A second resident assisted in 8 out of the fiftyeight cases operated on and consultant support was infrequent. Conclusion: The operative experience was variable for the general surgical residents. Exposure could be improved by a policy of resident assistance at emergency surgery. The infrequent consultant support may invalidate formative assessment of resident competence.