A Review of Orthopaedic Resident Case Logs to Identify Fluctuations in Exposure to Adult Orthopaedic Procedures

Abstract

Introduction:Orthopaedic surgery resident case exposure is an important component of surgical training and is monitored by the Accreditation Council for Graduate Medical Education (ACGME) to ensure resident readiness for graduation. The purpose of this study was to investigate trends in exposure to adult orthopaedic surgical procedures and analyze the impact of the 2013 update in ACGME case logging expectations.Methods:A retrospective review of ACGME case log data was conducted for adult orthopaedic procedures performed by graduating orthopaedic surgery residents from 2012 to 2020. Trends in the number of cases logged and the case share by anatomical location were investigated. Linear regression analysis was performed to analyze changes in case number over the 9-year period.Results:For all surgical categories, there was stability in the average case number per resident from 2012 to 2013, followed by a precipitous decrease from 2013 to 2014. From 2014 to 2020, there has been a gradual increase in case number for all categories except “other musculoskeletal (MSK),” resulting in a total 46% recovery since the 2014 decline. Concomitant with the decline, there was a relative increase in pelvis/hip and femur/knee procedures and decrease in shoulder, other MSK, and spine procedures. From 2014 to 2020, shoulder, humerus/elbow, pelvis/hip, leg/ankle, foot/toes, and spine cases have gradually accounted for a larger proportion of total cases while femur/knee and “other MSK” cases have accounted for less.Conclusions:The 2013 update in ACGME case logging expectations was associated with a significant decrease in case number. This is likely a reflection of residents correctly entering 1 primary Current Procedural Terminology code for each surgical case. Programs should be aware of a general increase in case number since 2014 and acknowledge the fact that some procedure types may be given priority from a logging standpoint when multiple Current Procedural Terminology codes apply.

The effect of COVID-19 on orthopaedics in Aotearoa New Zealand—a survey of orthopaedic surgeons and training registrars

“…12 Orthopaedic residency directors have expressed concerns about the negative impact of COVID-19 on training. 13,20 Education has also suffered through the cancellation of conferences and courses; online teaching has become commonplace during the pandemic, but both our study and others have found satisfaction with this is lower than traditional in-person teaching. 21 The issue of surgeon burnout has received significant attention in recent years.…”

Orthopedic surgery residents reported increased shoulder procedure volumes during the COVID-19 pandemic

“…Multiple studies have analyzed resident exposure and shoulder procedure log reporting before and after the implementation of case minimums, and several of which have identified a decrease in resident-reported arthroscopic case volumes. 2 , 10 , 14 , 21 , 25 While the indication for these procedures is not provided by the ACGME data sets, this may be due to the shifting of the limited opportunities during the pandemic from residents to fellows, as they generally have less time allotted to develop mastery of a difficult visuospatial skill. 6 , 9 Prior to 2019-2020 academic year, orthopedic sports medicine fellows performed approximately 275% more shoulder ( P <.0001) surgeries than residents.…”

“…Studies have previously evaluated the trends of resident and early surgeon-reported shoulder case volumes, 2 , 3 , 7 , 8 , 14 , 16 , 17 , 20 , 21 but there is a paucity of literature analyzing the breadth of shoulder case logs since case log reporting inception or the effect of the coronavirus disease 2019 (COVID-19) pandemic. Our objective is to analyze the 16 years of ACGME-reported shoulder case log data and to assess the impact of the COVID-19 pandemic on resident shoulder case log volumes.…”

Surgical Benchmarks for ACGME-accredited Adult Reconstructive Orthopaedic Fellowship Training

“…Finally, case volume data are self-reported and susceptible to coding inaccuracies and misrepresentation. [23][24][25][26][27] However, given its effect on the accreditation process, case logs are routinely monitored by faculty and accreditation bodies in orthopaedic surgery resident education on a regular basis.…”