ACGME case log system

[hajiyev]

I have some questions about the case log system currently in use for surgery resident programs in US. I'm a Dutch business student studying such applications across the world and US seem to be quite advanced with this.
Is the ACGME case log system mandatory to use by surgical residents? If yes at which stage of the medical career it becomes so? I mean would all graduate schools as well as PG require logging cases in that system?
Is anybody using an alternative logbook?

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[LucidSplash]

I have some questions about the case log system currently in use for surgery resident programs in US. I'm a Dutch business student studying such applications across the world and US seem to be quite advanced with this.
Is the ACGME case log system mandatory to use by surgical residents? If yes at which stage of the medical career it becomes so? I mean would all graduate schools as well as PG require logging cases in that system?
Is anybody using an alternative logbook?

Everyone uses the system starting with 1st year of residency. There is no alternative, it is required to enter cases into the ACGME system for them to be counted.

 

[hajiyev]

Thanks! That was my understanding too..
But I also see some other sistems in place such as Surgeon Specific Registry from the American College of Surgeons. This is post-residency application, true? On their website it says it's "an online quality improvement tool and software application database that allows surgeons to track their cases and outcomes in a convenient, easy-to-use manner from their computer or mobile devices".

Regarding the ACGME system of case logs, I see in the discussions that there is some confusion on for what to claim credit when multiple people are in the OR. What would you say are the main pain points of using the system?

 

[Smurfette]

Thanks! That was my understanding too..
But I also see some other sistems in place such as Surgeon Specific Registry from the American College of Surgeons. This is post-residency application, true? On their website it says it's "an online quality improvement tool and software application database that allows surgeons to track their cases and outcomes in a convenient, easy-to-use manner from their computer or mobile devices".

Regarding the ACGME system of case logs, I see in the discussions that there is some confusion on for what to claim credit when multiple people are in the OR. What would you say are the main pain points of using the system?

The SSR is for practicing surgeons to track their cases and be able to submit for board recertification, credentialing purposes, etc. They added on some quality measures and stuff that is optional for surgeons to complete as well, depending on what the surgeon wants to track. It has also been modified to help submit some regulatory info to the govt for physicians who do not have employers do this on their behalf, among other things.

The ACGME system is for residents and the info is used by the various boards when training is completed to ensure adequate exposure/training prior to being let into independent practice. It collects info and analyzes it differently based on training requirements.
When there are multiple residents scrubbed in, the system will recognize if more than one claims the same credit for the procedure. So clarifying if one is "assistant" and one is "surgeon junior/surgeon chief" (or whatever the verbiage is these days) can help prevent this issue. Chiefs can also claim being a TA if taking a junior resident through a case, so the junior can claim surgeon credit. Just retracting and not doing a major portion of the procedure is assisting. Some people have been known to overstate their involvement in a case and claim bigger credit, which has been discussed on SDN in the past as well.

 

[hajiyev]

How does the system recognize if more than one surgeon claims credit for a particular role? Is there a unique database of all procedures/operations to which the ACGME Case Log system is integrated?
My understanding was that list of possible operations is available for selection when a resident creates a new case. But they are not unique (i.e. an operation may happen twice for the same patient).

 

[LucidSplash]

How does the system recognize if more than one surgeon claims credit for a particular role? Is there a unique database of all procedures/operations to which the ACGME Case Log system is integrated?
My understanding was that list of possible operations is available for selection when a resident creates a new case. But they are not unique (i.e. an operation may happen twice for the same patient).

You have to put in a number to identify the case, usually use the patient’s medical record number or encounter number. If two people put in the same number on the same day for the same CPT, the system recognizes it and doesn’t allow it.

 

[hajiyev]

I have a follow-up question on this... I see that for example in Canada residency programs are recommended to use a new tool from RCSPC called Mainport.
Basically, using this tool one can register both cases and the so-called competency development steps or assessments. To my understanding the latter is obligatory in Canada and not operative cases (in contrast to US). Medical schools use either Mainport or their LMS such as One45, Power etc.

What would you say is used for this in US? Since all residents are required to log the 850+ cases on the ACGME website, what is then used for competency development assessment?

 

[deleted50541]

I have a follow-up question on this... I see that for example in Canada residency programs are recommended to use a new tool from RCSPC called Mainport.
Basically, using this tool one can register both cases and the so-called competency development steps or assessments. To my understanding the latter is obligatory in Canada and not operative cases (in contrast to US). Medical schools use either Mainport or their LMS such as One45, Power etc.

What would you say is used for this in US? Since all residents are required to log the 850+ cases on the ACGME website, what is then used for competency development assessment?

There is a Surgery Milestones assessment provided by the ACGME that is used for review of a resident's performance. While the ACGME says it isn't necessarily used to assess the six core competencies of a practicing surgeon, it provides a more in-depth framework for evaluation than just case logs alone.

In my residency, the milestones for each resident were reviewed twice a year based on attending input and resident self-assessment. Areas of concern were discussed one-on-one between the resident and PD.

 

[LucidSplash]

There is a Surgery Milestones assessment provided by the ACGME that is used for review of a resident's performance. While the ACGME says it isn't necessarily used to assess the six core competencies of a practicing surgeon, it provides a more in-depth framework for evaluation than just case logs alone.

In my residency, the milestones for each resident were reviewed twice a year based on attending input and resident self-assessment. Areas of concern were discussed one-on-one between the resident and PD.

Same in my training and now where I am faculty. We meet about 2x/year to review all the residents and assign their current competency scoring on all the different aspects. Areas where a resident is found to be struggling are addressed with the resident by the PD and the resident’s official and unofficial mentors and a plan is developed to address it with concrete goals (all our residents are assigned a mentor when they start intern year, though they are free to request a change to a different “official” mentor if they so choose at any point, and of course there are also a lot of “unofficial” mentors for everyone along the way in training).

Overview

Review the Milestones by specialty or subspecialty, as well as Milestones resources and national reports, and find opportunities to engage with the ACGME on ...

www.acgme.org

 

[hajiyev]

Same in my training and now where I am faculty. We meet about 2x/year to review all the residents and assign their current competency scoring on all the different aspects. Areas where a resident is found to be struggling are addressed with the resident by the PD and the resident’s official and unofficial mentors and a plan is developed to address it with concrete goals (all our residents are assigned a mentor when they start intern year, though they are free to request a change to a different “official” mentor if they so choose at any point, and of course there are also a lot of “unofficial” mentors for everyone along the way in training).

Overview

Review the Milestones by specialty or subspecialty, as well as Milestones resources and national reports, and find opportunities to engage with the ACGME on ...

www.acgme.org

I could see those milestones by ACGME but I wonder why it is different in US vs Canada or UK.

How does ACGME make sure that residency programs implement these milestones?
If there is no centralized system as for case logs, is it then left each residency program to decide where to register and how?

 

[hajiyev]

There is a Surgery Milestones assessment provided by the ACGME that is used for review of a resident's performance. While the ACGME says it isn't necessarily used to assess the six core competencies of a practicing surgeon, it provides a more in-depth framework for evaluation than just case logs alone.

In my residency, the milestones for each resident were reviewed twice a year based on attending input and resident self-assessment. Areas of concern were discussed one-on-one between the resident and PD.

What kind of digital tool / software were you using to register the Surgical Milestones by ACGME?
Do you also mean that ACGME does not necessitate logging the progress according to these milestones but your residency was practicing it as a useful development method?

 

[deleted50541]

Accredited surgical programs are regularly audited for compliance by the ACGME and I assume that includes assessing their appropriate use of the milestones for resident evaluation. Residency programs are required to have "competency committees" and the milestones are incorporated into that assessment per the ACGME.

ACGME General Surgery Program Requirements

The milestones were just paper evaluations when I was a resident in the mid-2010s that went into our files. I haven't heard or seen anything recently that there's a digital component akin to the case log system. Perhaps that's changed.