Case Log Information for Anesthesiology Programs

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Background

The ACGME-I Case Log System is a data depository to support programs in complying with

Advanced Specialty Requirements and to enable program directors to monitor each resident’s

clinical experience by capturing and categorizing resident cases.

The Surgical/Hospital-based Review Committee-International examines cases completed by

graduating residents to determine a program’s compliance with clinical experience

requirements, judge if educational resources are sufficient for the program’s accredited

complement of residents, and evaluate the breadth and depth of resident experiences. The

Committee understands that achievement of the minimum number for each listed procedure

does not signify achievement of competence in any procedure, nor do the cases that must be

logged represent the totality of clinical competency needed in any given specialty. Most

importantly, meeting the minimum requirements for procedures does not replace or negate the

requirement that, upon a resident’s completion of the program, the program director must verify

that he or she has demonstrated sufficient competence to enter practice without direct

supervision.

Residents have a responsibility to enter cases accurately and in a timely manner. It is

recommended that residents log cases daily or at least weekly. Residents must continue to log

cases throughout the duration of their program, even if the minimum requirements have been

met.

Program directors have the responsibility to regularly review and analyze each resident’s

completed cases. It is recommended that program directors review the Case Minimums Report

at least quarterly to ensure each resident is making appropriate progress toward meeting the

required minimum numbers.

The Accreditation Data System (ADS) Case Log tab includes general references on entering

and retrieving information. Each specialty’s page on the ACGME-I website contains additional

Case Log references, including a Resident Quick Guide with definitions and case entry

requirements particular to the specialty and a Faculty and Staff Quick Guide to assist program

directors and faculty members choose and evaluate Case Log reports. Residents are

encouraged to review these resources prior to their first case entries and to continue to refer to

them as needed. Program directors can use information from the reports in ADS to review

resident progress toward meeting clinical experience requirements, to set and evaluate

curriculum, and to inform clinical faculty members about residents’ clinical experience needs.

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FREQUENTLY ASKED QUESTIONS

Why are minimum numbers used?

The Surgical/Hospital-based Review Committee-International determined that minimum

numbers for key procedures would provide information on clinical resources without

detracting from the latitude that the program director must have to manage the clinical

curriculum.

How were case and procedure categories and minimum numbers identified?

The ACGME-I uses the same case and procedure categories and minimum numbers

that are used for residency training in the United States. In the U.S., some specialties

determined minimum case numbers after the specialty Review Committee analyzed

national data for graduating residents. Some specialties worked with their respective

boards to determine case and procedural categories and minimum numbers.

The Review Committee-International felt that adhering to the same numbers as in the

U.S. provided a baseline to begin monitoring ACGME-I-accredited programs. Minimum

numbers have been in place in the U.S. for a number of years. In addition to the

information obtained from block diagrams and ACGME-I Resident and Faculty Survey

results, Case Logs for graduating residents are recognized as one important data point

for judging resident clinical experience. The Review Committee-International will

continue to monitor Case Log reports for graduating residents to determine if the use of

U.S. minimum numbers will need modification for the international community.

Are residents required to enter cases according to Current Procedural

Terminology (CPT) codes?

No. Codes are not required when residents are logging cases. The ACGME-I Case Log

System uses descriptors to identify and log cases. The Review Committee-International

will evaluate graduate resident cases based on descriptions of the procedures, not the

codes.

If the institution uses an electronic system to track cases, duty hours, resident

evaluations, etc., can the Case Log data from this system be uploaded into ADS?

No. At present there is no mechanism to electronically transfer cases from another

system into ADS. The program director has ultimate responsibility to ensure that all data

reported in ADS is accurate and complete, and should encourage residents to enter their

case data daily in the Case Log System in ADS.

Note that if your institution’s electronic system has the capability, it may be

possible to download ADS case log data into your system. Please contact

technical

support at [email protected] to obtain technical assistance for this

function.

Will residents have access to their Case Logs after graduation?

Yes. Residents can access their Case Log reports after completion of the program to

use for hospital credentialing, apply for fellowship training, etc. Residents are not able to

add cases after completing the program.

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How can a resident use information from their Case Logs?

During the residency, Case Logs are useful to help residents determine the breadth and

depth of their procedural experience. Case Logs can be used to inform revision of

rotations to allow for more experience in a procedure or prevent too much experience

with one type of patient or procedure at the expense of broader educational goals. After

residency, Case Logs provide a record of experiences when applying for fellowship

training or for hospital credentialing.

How can a program director use information from resident Case Logs?

Program directors can apply filters for several of the reports available on the Case Log

tab in ADS to determine how individual rotations, participating sites, or supervising

faculty members are contributing to the residents’ experiences. Program directors can

also review when and how residents are recording their cases. For example, if a

program requires residents to enter cases each week, the Resident Activity Report can

be run weekly, and it can be quickly identified if a resident has not logged any cases.

How does the Review Committee use Case Log data?

The Review Committee-International will review minimum case reports for those

residents that have graduated from the program to determine how many residents met

required minimums and which procedures were deficient. The Committee will also review

the data to determine if residents are completing large numbers of certain procedures

while not meeting minimums in all procedures. These analyses will allow the

Committee to determine the breadth and depth of experiences provided by a program

and to judge the residents’ service obligations. Citations will result if minimums are not

consistently met, if the Committee judges that residents are performing certain

procedures as excessive service over education, and if resident reporting is inconsistent

or lacking.

What are the minimum case numbers for anesthesiology procedures?

The following table summarizes minimum number requirements for graduating residents

in anesthesiology

Procedure

Minimum Number

Vaginal delivery

Cesarean section

Total pediatric patients younger than 12 years of age

undergoing surgery or other procedures, including:

100

Pediatric patients younger than 3 years of age

Pediatric patients younger than 3 months of age

Cardiac surgery

Bypass cardiac procedures (effective 2017/2018)

Open or endovascular procedures on major vessels

Intrathoracic Non-Cardiac

Intracerebral procedures

Total Intracerebral Open

Epidural anesthetics or epidural catheters

Spinal anesthetics

Complex, life-threatening injuries

Surgical procedures utilizing peripheral nerve blocks

Management of acute, chronic, or cancer-related pain