J. A. Perone1, H. B. Mehta1, J. McClintic1, R. Norcini1, P. Rothenberg1, J. Rhodes1, D. S. Tyler1, K. M. Brown1 1University Of Texas Medical Branch,Galveston, TX, USA
Introduction:
Graduates of general surgery residency programs are not consistently ready for the autonomy expected by fellowships and practice partners. In an attempt to better meet training needs, the Accreditation Council for Graduate Medical Education (ACGME) recently increased the number of cases required for resident graduation to 850, keeping the requirements for involvement in peri-operative care as part of “surgeon” role. However there is no clear evidence that increasing case numbers will improve competency or if the ACGME case log reflects the residents’ true operative experience or skill. To evaluate how accurately resident case logs reflect faculty and resident assessments of operative participation, we compared the residents’ ACGME case logs with faculty and resident surveys completed immediately following those cases.
Methods:
A 16-question survey was administered to residents and faculty following each case over a 4-week period. Residents and faculty were asked to assess the resident’s role in the case, whether the resident performed the critical portions of the case, and the resident’s role in pre- and post-operative care. The survey reported data were then compared to the residents’ ACGME case logs.
Results:
ACGME case logs were accessible and complete for 105 cases. Eighty-three of those cases had corresponding completed faculty surveys and 95 had resident surveys. Faculty assessment of role differed from case log in 30/83 (36%) cases, with residents logging themselves as surgeon when faculty considered them first assistant in 26 of those cases. Faculty and residents were more likely to disagree on the residents’ role in advanced cases compared to core cases, using Surgical Council on Resident Education (SCORE) definitions. (p=0.01). Agreement was not associated with PGY year, the presence of more than one resident in the case, or any specific resident or faculty. Case logs agreed with resident self-assessment of role in 82/95 (86%) cases. In 11% of cases, residents logged their experience as surgeon despite stating in the survey that they acted as first assistant. Of the 88 cases logged as either surgeon chief or surgeon junior, residents reported meeting criteria for “surgeon” as defined by ACGME in only 55%.
Conclusion:
Resident operative experience as assessed by faculty participating in their cases is not accurately captured by the current case log system. This problem appears to be multi-factorial – residents overestimate their participation, especially in complex procedures, and residents log themselves as surgeon despite reporting that they did not fulfill criteria for that role. This suggests that the accuracy of the resident case log may be improved by logging cases in real time and involving faculty input.