Case‐Logging Practices in Otolaryngology Residency Training: National Survey of Residents and Program Directors

Dermody, Sarah M.; Gao, William; McGinn, Johnathan D.; Malekzadeh, Sonya

doi:10.1177/0194599817702622

Cited by 15 publications

(23 citation statements)

References 8 publications

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“…Since ascertaining competence is so difficult, we often will use surrogate markers, such as case logs, procedural checklists, and summative evaluations . Case logs can be inaccurate, and deciding whether an individual was the assistant surgeon, resident surgeon, or supervising surgeon is open to interpretation . For example, to meet the key indicator for ossiculoplasty and stapedectomy, a resident must complete 10 cases as primary surgeon, where they perform greater than 50% of the case in addition to the key portions of the procedure .…”

Section: Discussionmentioning

confidence: 99%

Experience with key indicator cases among otolaryngology residents

O’Brien

Kellermeyer

Chung

et al. 2019

Laryngoscope Investig Oto

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Objective To describe the resident experience with respect to key indicator cases for each year of training. Study Design Multi‐institution, cross‐sectional assessment. Methods Using an electronic survey, current otolaryngology residents were solicited to complete a survey regarding their experiences with the key indicator cases to that point. The survey was sent to this cohort in the winter of 2017–2018. Results Three hundred and three residents responded, with 293 completing the survey. Twenty‐three percent were PGY1, 19% PGY2, 21% PGY3, 18% PGY4, and 19% PGY5 or higher. The majority of residents progress from resident assistant as a PGY2, to resident surgeon as a PGY3 and self‐assessed competent surgeon as a PGY4 for the majority of the key indicator cases. Less than 50% of the surveyed PGY5 residents had reached independent practice in all the key indicator cases, with stapedectomy (16%), rhinoplasty (18%), and paramedian forehead flap (14.5%) being the cases least frequently performed independently. Ninety‐five percent of the respondent residents felt their program provided adequate training, but 20% of the respondents were either unsure or believed that they would be unable to perform all the key indicator cases by the completion of their training. Conclusions The majority of otolaryngology residents feel confident in their training, but experience with certain cases lags behind and may not currently be taught as resident level cases. These findings raise the question of whether the current key indicator cases are the best option for assessing breadth and depth of residency training. Level of Evidence NA

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Section: Discussionmentioning

confidence: 99%

Experience with key indicator cases among otolaryngology residents

O’Brien

Kellermeyer

Chung

et al. 2019

Laryngoscope Investig Oto

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“…Unfortunately, case logs are notoriously inaccurate largely due to underreporting of cases performed despite program directors advising residents to log all procedures. [ 5 ] This is particularly true for procedures performed outside of the operating room and common procedures, both of which dominated our results. [ 5 ] Case logging methods also vary greatly between programs.…”

Section: Discussionmentioning

confidence: 93%

“…[ 5 ] This is particularly true for procedures performed outside of the operating room and common procedures, both of which dominated our results. [ 5 ] Case logging methods also vary greatly between programs. Moving forward with a national CBD curriculum, case logging will be standardized and submitted prior to graduation from residency to the Royal College of Physicians and Surgeons of Canada (RCPSC).…”

Section: Discussionmentioning

confidence: 96%

“…Moving forward with a national CBD curriculum, case logging will be standardized and submitted prior to graduation from residency to the Royal College of Physicians and Surgeons of Canada (RCPSC). [ 5 ] Surgical case numbers vary drastically between programs, and despite new minimum volume of key indicator procedures recommended by the Accreditation Council for Graduate Medical Education (ACGME) in the United States (U.S.), many graduating residents have not met these requirements. [ 6 ] Anecdotally, we know the same to be true for Canadian programs.…”

Section: Discussionmentioning

confidence: 99%

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Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology – head & neck surgery in Ontario, Canada

Eskander

Campisi

Witterick

et al. 2018

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundAn analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency programs implement competency-based training strategies, this data may be used to align residency curricula with the clinical and surgical practice of recent graduates.MethodsOntario billing data were used to identify the most common diagnostic and procedure codes used by general otolaryngologists issued a billing number between 2006 and 2012. The codes were categorized by OHNS subspecialty. Practitioners with a narrow range of procedure codes or a high rate of complex procedure codes, were deemed subspecialists and therefore excluded.ResultsThere were 108 recent graduates in a general practice identified. The most common diagnostic codes assigned to consultation billings were categorized as ‘otology’ (42%), ‘general otolaryngology’ (35%), ‘rhinology’ (17%) and ‘head and neck’ (4%). The most common procedure codes were categorized as ‘general otolaryngology’ (45%), ‘otology’ (23%), ‘head and neck’ (13%) and ‘rhinology’ (9%). The top 5 procedures were nasolaryngoscopy, ear microdebridement, myringotomy with insertion of ventilation tube, tonsillectomy, and turbinate reduction. Although otology encompassed a large proportion of procedures billed, tympanoplasty and mastoidectomy were surprisingly uncommon.ConclusionThis is the first study to analyze the nature of the clinical and surgical cases managed by recent OHNS graduates. The findings demonstrated a prominent representation of ‘otology’, ‘general’ and ‘rhinology’ based consultation diagnoses and procedures. The data derived from the study needs to be considered as residency curricula are modified to satisfy competency-based requirements.

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“…Cadish et al investigated multiple specialty residents in a single training institution and found that nearly two-thirds of resident physicians considered the "case logs" work to be highly arduous, which affected the willingness, frequency, and accuracy of registration [21]. Dermody et al conducted an anonymous questionnaire survey of all otolaryngology-head and neck surgery residents and program directors (PDs) in the US; the survey revealed that most of the residents and PDs believed that accuracy was not high for online surgical case logs prescribed by the ACGME [22]. Therefore, whether these surgical case logs genuinely re ect the operative ability of residents is questionable [23].…”

Section: Discussionmentioning

confidence: 99%

Attainment of Core Competencies Milestones in Otolaryngology Residency Training in Taiwan: A Pilot Study

Liu

Hsieh

Chen

et al. 2019

Preprint

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Background: Competency-based medical education has emerged as a mainstream method for educating and assessing the next generation of physicians. This study aims to initiate and examine the preliminary results of an integrated Traditional Chinese Otolaryngology Milestone Project in Taiwan. Methods: This prospective study enrolled 18 participants in an academic hospital setting from July 2017 to August 2019. Participants included twelve attending and six resident physicians. Using the Integrated Traditional Chinese Otolaryngology Milestones (ITCOM), five biannual evaluations involved independent self-assessments by the resident doctors, which the chief resident and attending physicians independently reevaluated. A Kruskal–Wallis test was used to compare the results of the five assessments. Results: The average scores of attained milestones for the five assessments were as follows for residents PGY1– PGY6: PGY1 (1.48 ± 0.24; 1.69 ± 0.10, P = 0.01), PGY2 ( 1.24 ± 0.12; 1.51 ± 0.23; 1.75 ± 0.06; 1.98 ± 0.21; 2.47 ± 0.18 , P < 0.0001), PGY3 (2.19 ± 0.24; 2.36 ± 0.25; 2.80 ± 0.19; 2.96 ± 0.24; 3.33 ± 0.23, P < 0.0001), PGY4 (2.68 ± 0.17; 2.96 ± 0.09; 3.35 ± 0.13; 3.58 ± 0.10; 4.17 ± 0.08, P < 0.0001), PGY5 (3.07 ± 0.24; 3.38 ± 0.12; 3.58 ± 0.10; 4.05 ± 0.09, P < 0.0001) and PGY6 ( 3.30 ± 0.27; 3.61 ± 0.28; 4.22 ± 0.20, P = 0.0001). The score results for patient care, medical knowledge, and professionalism were more likely to indicate heightened attainment of milestone levels as the program progressed. However, the curves of the score results for system-based practice, problem-based learning and improvement, and interpersonal and communication skills were more horizontal, showing that the milestones might indicate a better performance than expected, even in residents with low training seniority. Conclusions: The results of the five biannual assessments revealed that all resident physicians demonstrated a significant improvement. Further study involving large-scale participants and multiple institutions is warranted.

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Case‐Logging Practices in Otolaryngology Residency Training: National Survey of Residents and Program Directors

Cited by 15 publications

References 8 publications

Experience with key indicator cases among otolaryngology residents

Experience with key indicator cases among otolaryngology residents

Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology – head & neck surgery in Ontario, Canada

Attainment of Core Competencies Milestones in Otolaryngology Residency Training in Taiwan: A Pilot Study

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