The ACGME Case Log System May Not Accurately Represent Operative Experience Among General Surgery Interns

Naik, Nimesh D.; Abbott, Eduardo; Aho, Johnathon M.; Pandian, T.K.; Thiels, Cornelius A.; Heller, Stephanie F.; Farley, David R.

doi:10.1016/j.jsurg.2017.09.032

Cited by 40 publications

(41 citation statements)

References 18 publications

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“…For example, automated operative case reporting systems have been shown to increase the capture of operative cases for general surgery interns compared with manual case entry by residents. 8 Similar results have been shown for cardiology fellows, where procedure logs automatically generated from the clinical record increased the number of documented procedures and reduced administrative time required for logging of cases. 9 Patient attribution, or attributing patient-level metrics to providers, can be modeled using electronic health record data to improve the capture of trainee provider-patient interactions, which is vital in providing appropriate feedback and evaluations to trainees.…”

Section: Discussionsupporting

confidence: 62%

Improving ACGME Compliance for Obstetric Anesthesiology Fellows Using an Automated Email Notification System

et al. 2021

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Background The Accreditation Council for Graduate Medical Education establishes minimum case requirements for trainees. In the subspecialty of obstetric anesthesiology, requirements for fellow participation in nonobstetric antenatal procedures pose a particular challenge due to the physical location remote from labor and delivery and frequent last-minute scheduling. Objectives In response to this challenge, we implemented an informatics-based notification system, with the aim of increasing fellow participation in nonobstetric antenatal surgeries. Methods In December 2014 an automated email notification system to inform obstetric anesthesiology fellows of scheduled nonobstetric surgeries in pregnant patients was initiated. Cases were identified via daily automated query of the preoperative evaluation database looking for structured documentation of current pregnancy. Information on flagged cases including patient medical record number, operating room location, and date and time of procedure were communicated to fellows via automated email daily. Median fellow participation in nonobstetric antenatal procedures per quarter before and after implementation were compared using an exact Wilcoxon-Mann-Whitney test due to low baseline absolute counts. The fraction of antenatal cases representing nonobstetric procedures completed by fellows before and after implementation was compared using a Fisher's exact test. Results The number of nonobstetric antenatal cases logged by fellows per quarter increased significantly following implementation, from median 0[0,1] to 3[1,6] cases/quarter (p = 0.007). Additionally, nonobstetric antenatal cases completed by fellows as a percentage of total antenatal cases completed increased from 14% in preimplementation years to 52% in postimplementation years (p < 0.001). Conclusion Through an automated email system to identify nonobstetric antenatal procedures in pregnant patients, we were able to increase the number of these cases completed by fellows during 3 years following implementation.

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Section: Discussionsupporting

confidence: 62%

Improving ACGME Compliance for Obstetric Anesthesiology Fellows Using an Automated Email Notification System

et al. 2021

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“…The limitations of this study include that it was a small, observational, single-institution study and its reliance on the case logs for operative experience, which can be inaccurate especially in the junior years. 4 Although case volume increases throughout the PGY-1 year, we were unable to show a parallel increase in clinical efficiency as a likely causative factor. Although intern year has historically not been a highvolume operative experience, increasing operative exposure for interns has many benefits.…”

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confidence: 61%

Growth in Monthly Case Volume in the First Year of Postgraduate Surgical Training

Woelfel

Strosberg

Abdel‐Misih

et al. 2019

The American Surgeon™

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Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.In general, authors of case reports should use the Brief Report format. Growth in Monthly Case Volume in the First Year of Postgraduate Surgical TrainingIn 2014, the American Board of Surgery required 250 major cases, minor cases, and endoscopies to be completed before the second year of residency as a way to encourage early exposure to the operating room. Despite the antilock braking system requirements, it is not known what factors correlate to increased junior operative experience and how to improve individual performance. One of the most elusive and consequential intern traits for intern year is efficiency while maintaining high-quality patient care. Surgical services are often the largest in the hospital, and the combination of juggling the necessary administrative duties with perioperative preparation can limit time available for operating during intern year. Our goal was to analyze efficiency by one of its anticipated outcomes: time in the operating room. The aim of this study was to determine whether a hypothesized increase in clinical efficiency throughout the first year of postgraduate training translates into increased time in the operating room.This research was conducted with the approval of the Institutional Review Board in the Office of Responsible Research Practices. The de-identified Accreditation Council of Graduate Medical Education case logs for 25 interns spanning the years from July 1, 2011, to June 30, 2017, were collected from the case log database. This yielded a total of 3751 cases for review. Central line placements in addition to endoscopy cases were included. Ultrasound cases were excluded because of their common use in conjunction with central line placement, which

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“…Although there is controversy regarding the correlation between ACGME case logs and operative competency or technical proficiency, the global reduction in operative experience during COVID-19 is concerning as studies have shown an association between higher operative volume and improved outcomes, which has been used as a surrogate for competence [ 16 , 17 , 18 , 19 , 20 ]. In examining how to remedy the volume deficit observed in this study, it is evident that surgical education across the U.S. will need to adapt and modernize to continue high-quality education of residents.…”

Section: Discussionmentioning

confidence: 99%

Examining the impact of COVID-19 restrictions on the operative volumes of US general surgery residents

Ammann

Cortez

Vaysburg

et al. 2022

Surgery

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Background In March 2020, the COVID-19 virus global pandemic forced healthcare systems to institute regulations including the cancellation of elective surgical cases, which likely decreased resident operative experience. The objective of this study was to determine if the COVID-19 pandemic affected operative experiences of U.S. general surgery residents. Methods The operative experience of general surgery residents was examined nationally and locally. Aggregate Accreditation Council for Graduate Medical Education (ACGME) case logs for 2018-2019 (pre-COVID) and 2019-2020 (COVID) graduates were compared using national mean cumulative operative volume for total major and surgeon chief cases. Locally, ACGME case logs were used to analyze the operative experience among residents at a single, academic center. Average operative volumes per month per resident during peak COVID-19 quarantine months were compared with those the previous year. Results Compared with 2019 graduates, 2020 graduates completed 1.5% fewer total major cases (1055 ± 155 vs 1071 ± 150, p=0.011). This was most evident during chief year, with 8.4% fewer surgeon chief cases logged in 2020 compared to 2019 (264 ± 67 vs 289 ± 69, p < 0.001). Institutional data revealed that during the peak of the pandemic, residents across all levels completed 42.5% fewer total major operations (12 ± 11 vs 20 ± 14, p < 0.001). This effect was more pronounced among junior residents compared with senior and chief residents. Conclusions The COVID-19 pandemic was associated with decreased resident case volume. The ramifications of the COVID-19 pandemic for operative competency and autonomy should be carefully examined.

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The ACGME Case Log System May Not Accurately Represent Operative Experience Among General Surgery Interns

Cited by 40 publications

References 18 publications

Improving ACGME Compliance for Obstetric Anesthesiology Fellows Using an Automated Email Notification System

Improving ACGME Compliance for Obstetric Anesthesiology Fellows Using an Automated Email Notification System

Growth in Monthly Case Volume in the First Year of Postgraduate Surgical Training

Examining the impact of COVID-19 restrictions on the operative volumes of US general surgery residents

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