Constraints on the performance of minor surgery by family physicians: study of a 'mock' skin biopsy procedure.

Despite the availability of a procedure room equipped for the performance of common surgery procedures, physicians in a family medicine training programme have reported that minor surgery training objectives are not being accomplished. To examine this issue, the frequency of minor surgery procedures was audited among 357 randomly selected medical records. The frequency of documented sigmoidoscopy in this group of active patients over the age of 50 years was 4.8%. A similar low frequency for the performance of skin biopsy was also observed. All 15 senior residents participated in an attitude survey and a timed exercise in which they sought to find the necessary items for performance of a skin biopsy. In a questionnaire the group agreed that sigmoidoscopy and skin biopsies were procedures appropriate for their family practice goals. In their offices, these residents required over nine minutes to partially locate equipment chosen for skin biopsy. The attitude survey revealed few constraints other than insufficient time to perform indicated elective procedures. Further study of procedure room utilization and family physicians' office surgery skills is recommended.