Rachel M Nygaard1, Samuel R Daly1, Joan M Van Camp2. 1. Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota. 2. Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota. Electronic address: Joan.vancamp@hcmed.org.
Abstract
INTRODUCTION: Operative experience during residency lays the foundation for independent practice and additional specialty training following general surgery residency. The aim of this study was to examine operative experience of general surgery residents and detail the results of an intervention aimed at improving resident record keeping in the Accreditation Council for Graduate Medical Education (ACGME) case log system to better reflect their experience. METHODS: Residents were asked to characterize variances in recorded operative experience identified through an audit of operative logs. Based on the results of the audit, an intervention was designed to prompt timely record keeping by residents. The intervention included education and discussion of survey audit results, weekly presentation of graphs detailing operative experience, and possible missed cases in the ACGME logs and addition of a first assistant column in morbidity and mortality (M&M) logs. RESULTS: The audit of case logs identified discrepancies in 24.2% of the 636 cases examined. Chief residents were significantly more accurate (95.9%) in recording operative experience in ACGME case logs, whereas 50.3% of junior resident case logs contained variances. Residents characterized discrepancies as "forgot to log" (9.6%), "staff did the case" (5.2%), "another resident did more of the case" (3.6%), "other" (3.6%), a "more advanced resident was present for the case" (1.6%), "not present for case" (0.6%), and "left for consult" (0.3%). Over the 4-week intervention period, residents logged between 72.7% and 94.0% of cases. A month following the intervention period, we observed a 13.3% increase in recorded cases compared with the intervention period. Review of first assistant case logging following inclusion of a "first assistant" column in M&M logs demonstrated a 70.5% increase in first assistant cases logged into the ACGME system compared with the same time period a year ago. CONCLUSIONS: Based on our results, we found that weekly displays of cases improved resident record keeping in the ACGME case log system, especially by junior residents. We believe that the addition of first assistant column on M&M lists, periodic audits reviewed at conferences, and semiannual evaluations will help junior residents more accurately report their experience during training.
INTRODUCTION: Operative experience during residency lays the foundation for independent practice and additional specialty training following general surgery residency. The aim of this study was to examine operative experience of general surgery residents and detail the results of an intervention aimed at improving resident record keeping in the Accreditation Council for Graduate Medical Education (ACGME) case log system to better reflect their experience. METHODS: Residents were asked to characterize variances in recorded operative experience identified through an audit of operative logs. Based on the results of the audit, an intervention was designed to prompt timely record keeping by residents. The intervention included education and discussion of survey audit results, weekly presentation of graphs detailing operative experience, and possible missed cases in the ACGME logs and addition of a first assistant column in morbidity and mortality (M&M) logs. RESULTS: The audit of case logs identified discrepancies in 24.2% of the 636 cases examined. Chief residents were significantly more accurate (95.9%) in recording operative experience in ACGME case logs, whereas 50.3% of junior resident case logs contained variances. Residents characterized discrepancies as "forgot to log" (9.6%), "staff did the case" (5.2%), "another resident did more of the case" (3.6%), "other" (3.6%), a "more advanced resident was present for the case" (1.6%), "not present for case" (0.6%), and "left for consult" (0.3%). Over the 4-week intervention period, residents logged between 72.7% and 94.0% of cases. A month following the intervention period, we observed a 13.3% increase in recorded cases compared with the intervention period. Review of first assistant case logging following inclusion of a "first assistant" column in M&M logs demonstrated a 70.5% increase in first assistant cases logged into the ACGME system compared with the same time period a year ago. CONCLUSIONS: Based on our results, we found that weekly displays of cases improved resident record keeping in the ACGME case log system, especially by junior residents. We believe that the addition of first assistant column on M&M lists, periodic audits reviewed at conferences, and semiannual evaluations will help junior residents more accurately report their experience during training.
Keywords:
ACGME; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; case volume; general surgery residency; graduate medical education; operative experience
Authors: Yihan Lin; James S Dahm; Adam L Kushner; John P Lawrence; Miguel Trelles; Lynette B Dominguez; David P Kuwayama Journal: World J Surg Date: 2018-01 Impact factor: 3.352
Authors: Kurun Partap S Oberoi; Michael T Scott; Jacob Schwartzman; Jasmine Mahajan; Nell Maloney Patel; Melissa M Alvarez-Downing; Aziz M Merchant; Anastasia Kunac Journal: Surg J (N Y) Date: 2022-03-03