Do Resident Case Logs Meet ACGME Requirements? A Comparison Between Acute Care and Elective Cases

Operative experience is at the core of general surgery residency, and recently operative volume requirements for graduating residents were increased. The ACGME has outlined 4 areas of required resident participation and documentation in order for a surgical case to be logged: determination or confirmation of the diagnosis, provision of preoperative care, selection and accomplishment of the operative procedure, and direction of the postoperative care. The purpose of this study was to examine whether general surgery residents are currently meeting the required care participation documentation standard and to examine the effect of acute care vs. elective cases on documentation.

The operative case logs of 7 PGY-3 and 7 PGY-5 general surgery residents from March 2016 were retrospectively reviewed and compared to the electronic medical record (EMR) to verify documentation of resident participation in each of the 4 required areas. Chart review was also utilized to classify cases as either acute care or elective.

A total of 339 cases were reviewed (159 PGY-3 and 180 PGY-5). Of these, 251 cases were classified as elective and 88 were classified as acute care. Overall, documentation of comprehensive care (participation in all four required areas) was found for 44% of cases, with residents reporting participation in a higher percentage of comprehensive care (all 4 domains completed) than was actually documented in the EMR (71.9% vs. 44.4%, t[13] = 2.57, p = 0.023, d = 1.13). Comprehensive care was documented more frequently in elective cases than acute care cases (49.7% vs. 38.3%), and there was less discrepancy between perceived and documented comprehensive care within elective cases (67% vs. 49.7%, t[13] = 1.17, p = 0.27) than acute care cases (80.9% vs. 38.3%, t[13] = 4.40, p = 0.001).

Despite ACGME requirements, the majority of cases logged by general surgery residents do not have documentation by the operating resident in the EMR verifying provision of comprehensive care. Elective cases were more likely to meet documentation requirements than acute care cases, and we purport that this is possibly secondary to restricted work hours. We expect that other programs would find similar compliance in the documentation of comprehensive care. These results question whether the requirement for documenting comprehensive care to log a surgical case is practical in surgical residency training, particularly with an increasing demand for operative volume in the setting of limited work hours.