The ACGME case log: General surgery resident experience in pediatric surgery

Abstract

Background General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. Methods The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989–1990 to 2010–2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989–90 to AY1993–94), Period II (AY1994–95 to AY1998–99), Period III (AY1999–00 to AY2002–03), Period IV (AY2003–04 to AY2006–07), and Period V (AY2007–08 to AY2010–11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. Results Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. Conclusions GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended.

Toward Data-Driven Radiology Education—Early Experience Building Multi-Institutional Academic Trainee Interpretation Log Database (MATILDA)

“…Manual recording is tedious and prone to inaccuracy. The literature on ACGME surgical resident case logs suggests underreporting when using manual submission, with only half of the residents surveyed recording major procedures and only 13 % logging minor procedures [15,16]. On the other hand, waiting for the semi-annual report may preclude proper intervention should a trainee fall behind case log minimum numbers.…”

Simulation for Pediatric Surgery and Surgical Specialties

“…Findings show that the average pediatric surgery resident completes less than five and in some cases zero esophageal atresia repairs, choledochal cyst excisions, portoenterostomies, or resections of sacrococcyceal teratoma [7,8]. Of further concern is that general surgery residents, many of whom will care for children at significant geographic distance from major pediatric centers, seem to be doing fewer pediatric cases [9]. It is not known what factor is driving this trend, but the decline in operative exposure does not appear related to classified index cases, considered the domain of fellows or more senior trainees.…”

“…It is not known what factor is driving this trend, but the decline in operative exposure does not appear related to classified index cases, considered the domain of fellows or more senior trainees. Cases appropriate for a community institution such as inguinal and umbilical hernia repair dropped from 26.7 cases per North American general surgery resident to 18.5, a 30.7 % drop from the 1989-1990 academic year through 2007-2008 [9]. Since volume-outcome relationships are a well-described phenomenon across multiple surgical specialties, a drop in cases gives pause for concern.…”

Automated Reporting of Trainee Metrics Using Electronic Clinical Systems

“…8 There are limited reports of methods to facilitate GME programs providing objective performance measures to trainees. ACGME case logs have been developed for surgical residencies, [9][10][11] and to some extent, written experience logs have been described in primary care 12 and internal medicine. 13 Studies have shown that manual entry into case logs may only reflect 60% of true encounters.…”