Graduate Medical Education Case Logs Research Articles

Trends and Distribution of Ileal Pouch Anal Anastomosis (IPAA) in the United States; Becoming Harder to Find in Colon and Rectal Surgery Residency Training?

BACKGROUND: There has been concern among colon and rectal surgery residency training programs in the United States that ileal pouch anal anastomosis procedures have been decreasing, however evidence is limited. OBJECTIVE: To evaluate the number of ileal pouch anal anastomosis performed by colon and rectal surgery residents in the United States and examine the distribution of these cases on a national level. DESIGN: Retrospective. SETTINGS: The Accreditation Council for Graduate Medical Education Case Log National Data Reports were used to examine the number of ileal pouch anal anastomosis performed by residents from 2005 to 2021. The Nationwide Inpatient Sample database was used to identify all patients undergoing these procedures from 2005 to 2019. PATIENTS: All ileal pouch anal anastomosis procedures regardless of indication. MAIN OUTCOME MEASURE: Primary outcome is the number of ileal pouch anal anastomosis performed by residents yearly. Secondary outcome is the national distribution of these procedures. RESULTS: Among colon and rectal surgery residents, case log data revealed an increase in mean and total number of ileal pouch anal anastomosis from 2005 to 2013, followed by a decline in both metrics after 2013. Despite the decrease, the mean number of cases per resident remained >6 between 2011 and 2021. A weighted national estimate of 48,532 ileal pouch anal anastomosis patients were identified in the Nationwide Inpatient Sample database. A significant decrease was noted in the number of ileal pouch anal anastomosis after 2015 that persisted through 2019. There was a significant decrease in rural and urban non-teaching hospitals (from 2.1% to 1.6% and 25.6% to 4.3% respectively, p < 0.001) and an increase in urban teaching hospitals (from 72.4% to 94.1%, p < 0.001). LIMITATIONS: Nonrandomized retrospective study. CONCLUSION: Despite the recent increase in the percentage of ileal pouch anal anastomosis performed at urban academic centers, there has been a decrease in cases performed by colon and rectal surgery residents. This can have significant implications for residents who graduate without adequate experience in performing this complex procedure independently, as well as training programs that may face challenges with maintaining accreditation. See Video Abstract.

Impact of Integrated Vascular Surgery Residency on General Surgery Resident and Vascular Fellow Operative Volume: A National Analysis.

The impact of integrated vascular surgery (VS) residency (0 + 5) programs on general surgery (GS) resident and VS fellow (5 + 2) operative volume has not been investigated on a national scale. Accreditation Council for Graduate Medical Education (ACGME) case logs were reviewed for GS resident, VS resident, and VS fellow operative volume from 2001-2021. Integrated VS resident data was available from 2012-2021, corresponding with the introduction of the 0 + 5 paradigm. Trends in operative volume were evaluated via linear regression analysis. The national cohort of chief GS resident graduates increased from 1005 to 1357 per year. Total operative volume also increased from 932 to 1039 cases (+7.4 cases/yr, R2 = .80, P < .0001) among GS residents. Major vascular cases decreased among GS residents from 138 to 101 cases (-2.4 cases/yr, R2 = .58, P < .0001) with a decrease in proportion of chief-level vascular cases from 30.4% to 11.9% (-1.0%/yr, R2 = .92, P < .0001). Palliative procedures (amputations and hemodialysis access) comprised a significant proportion of GS cases (median 44.7%). Concurrently, integrated VS graduates increased from 11 to 37 per year, with an increase in major vascular case volume from 506 to 658 cases (+18.4 cases/yr, R2 = .63, P = .01). Total VS fellow major case volume also increased from 369 to 444 cases (+3.5 cases/yr, R2 = .73, P < .0001). The introduction of the 0 + 5 intgrated VS residency paradigm has correlated with a significant decrease in GS operative experience in major vascular procedures on a national level. Traditional VS fellow case volume does not appear to be impacted by 0 + 5 integrated residents. Further analysis with program-level data may help to explain the causative relationship of these findings.

Orthopedic surgery residents reported increased shoulder procedure volumes during the COVID-19 pandemic

The purpose of this study is to evaluate the impact of the COVID-19 pandemic on shoulder procedure volumes reported to the Accreditation Council for Graduate Medical Education by orthopedic surgery residents. We performed a retrospective review of Accreditation Council for Graduate Medical Education case logs reporting data from graduating orthopedic surgery residents during the academic years of 2006-2022. Data were queried for all patients for the following shoulder Current Procedural Terminology codes: incision, excision, intro or removal, repair/revision/reconstruction, fracture and/or dislocation, manipulation, arthroscopy, trauma, and total procedures performed. Individual t-tests were used to compare case log trends of graduating academic years before (classes of 2018 and 2019) and during (classes of 2020, 2021, and 2022) the COVID-19 pandemic. Statistical significance was established to be P <.05 for total procedure types, but at P <.005 during category comparisons to protect against alpha errors. Reported mean total shoulder procedures per resident steadily increased each year from 2017 to 2022, but the only significant increase was seen when comparing the graduating classes of 2020 to 2021 (157.9 vs. 165.7, P=.02). Stratification of these procedures by subgroup revealed a significant increase in manipulation procedures from 2021 to 2022 (7.3 vs. 8.8, P=.001). COVID-19 did not have a negative impact on logged shoulder procedure volume. Orthopedic surgery residents graduating during the COVID-19 pandemic reported more shoulder procedures than those graduating prepandemic. However, shoulder procedure log trends should be longitudinally investigated, as preceding years of procedural opportunities may underestimate the pandemic's impact.

Expansion of Urology Residency Training Programs Has Not Had a Negative Impact on Trainee Case Log Experience

Background: The expansion of urology residency programs is necessary to offset the projected workforce shortage. However, this expansion must occur without compromising the current trainee environment. To date, there is limited information on how the growth of urology residency programs has affected resident operative experience. Objective: We examined the Accreditation Council for Graduate Medical Education (ACGME) Case Log Graduate Statistics National Report for Urology from 2016 to 2021 to determine changes in the number and types of cases that graduating residents performed. Methods: The Urology ACGME Case Log Graduate Statistics National Report for the academic years 2015 to 2016 to 2020 to 2021 were analyzed. Data were grouped into 6 major categories: general, endourology, reconstructive, oncology, pediatrics, and laparoscopic/robotic. Results: There was an increase in the average total cases logged by graduating urology residents from 1449.3 to 1569.4 cases per resident (P &lt; .0001). The average number of general urology procedures increased (P = .0071). There was also an increase in the average number of reconstructive (P = .0470), oncology (P = .0215), and laparoscopic/robotic (P ≤ .0001) cases performed by graduating urology residents. There was no difference in the average number of endourology cases completed by graduating residents (P = .0918). There was a significant decrease in the average number of pediatric cases performed by graduating residents (P = .0002). Conclusion: The expansion of urology programs and trainee positions has not negatively affected the average operative case log experience of residents between the 2015 to 2016 and 2020 to 2021 academic years.

Operative Case Volume for Vascular Integrated Residents and Fellows Following the Elective Surgery Shutdown due to COVID-19.

In response to the COVID-19 pandemic, nonemergent surgery was postponed in efforts to limit disease spread. To determine whether these changes affected vascular integrated resident (VR) and fellow (VF) operative volume, Accreditation Council for Graduate Medical Education (ACGME) case log data was reviewed. Case volume and standard deviation for each major category was for graduates of 2020 and 2021 were compared to the year prior to the pandemic, 2019. There were only 3 significant changes when comparing 2020/2021 to the prepandemic baseline of 2019, with increase in abdominal obstructive cases for VRs (8.1 in 2021 vs 5.9 in 2019, P = .021), an increase in upper extremity cases for VFs (18.9 in 2021 from 15.8 in 2019, P = .029), and a decrease in venous cases for VFs (39.6 in 2021 from 48.4 in 2019, P = .011). Postponing nonemergent surgery did not translate to significant changes in operative cases for graduating VRs and VFs.

Decreased Case Volumes for Pediatric Orthopaedic Surgery Fellows during the Early Stages of the Coronavirus-19 Pandemic

Background: In the early months of the coronavirus disease 2019 (COVID-19) pandemic, elective procedures were suspended to reallocate resources, notably impacting 1-year surgical fellowship programs. The purpose of this study is to compare the case volume of pediatric orthopaedic surgery fellows during the pandemic's peak year to the years before and after.Materials and Methods: Accreditation Council for Graduate Medical Education (ACGME) case log reports of key procedures in pediatric orthopaedic surgery were compared between the fellowship classes of 2018-2019 (pre-pandemic), 2019-2020 (peak pandemic), and 2020-2021 (post-peak pandemic). Both overall case volume and individual key procedures were analyzed for significant differences between each of the three class years.Results: There was a significant decrease (−43.7 cases, −15.5%) in the overall number of key procedures completed by the fellowship class of 2020 compared to 2019 (p=0.014), with similar significant decreases in various individual key procedures (foot and ankle deformity, limb deformity, and soft tissue: transfer, lengthening, and release). In the subsequent year, there was a significant increase (+98.8 cases, +41.5%) in the average case volume for the class of 2021 (p<0.001), with significant increases in procedures for foot and ankle deformity, clubfoot, limb deformity, hip, and soft tissue: transfer, lengthening, and release. Additionally, the rebound in overall case volume for the class of 2021 surpassed the pre-pandemic caseload completed by the class of 2019 (p=0.008).Conclusion: During the peak of the pandemic when elective cases were suspended, pediatric orthopaedic surgery fellows logged fewer surgical cases compared to the pre-pandemic class of 2019. While the case volume rebounded in the subsequent year, further research is needed to quantify the overall impact of the decreased caseload for the pediatric orthopaedic fellowship class of 2020.Level of Evidence: Level IVKey Concepts•With the onset of the unprecedented COVID-19 pandemic, the ensuing shutdowns' effects on the training and case volumes of pediatric orthopaedic fellows remain unclear.•This study quantified the change in case volume of pediatric orthopaedic fellows during the first year of the COVID-19 pandemic and identified a significant decrease of nearly 44 total cases (15.5%) performed by fellows of the graduating class of 2020 when compared to those who graduated in 2019.•This study quantified the rebound in case volume for the fellows of the 2021 graduating class when compared to the graduates of the 2020 fellowship class.

MP07-18 EFFECT OF COVID-19 PANDEMIC ON FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY FELLOWSHIP CASE LOGS: ANALYSIS OF THE ACCREDITATION COUNCIL OF GRADUATE MEDICAL EDUCATION NATIONAL DATA REPORTS

You have accessJournal of UrologyCME1 Apr 2023MP07-18 EFFECT OF COVID-19 PANDEMIC ON FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY FELLOWSHIP CASE LOGS: ANALYSIS OF THE ACCREDITATION COUNCIL OF GRADUATE MEDICAL EDUCATION NATIONAL DATA REPORTS Adam Daily, Shreeya Patel, Hannah Koenig, Thomas Fuller, and Una Lee Adam DailyAdam Daily More articles by this author , Shreeya PatelShreeya Patel More articles by this author , Hannah KoenigHannah Koenig More articles by this author , Thomas FullerThomas Fuller More articles by this author , and Una LeeUna Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Given widespread disruptions to healthcare during the COVID-19 pandemic, the objective was to assess the national case logs of graduating Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows for effects on surgical volume. METHODS: The nationally aggregated Accreditation Council for Graduate Medical Education case logs were obtained for graduating FPMRS fellows, both urology and obstetrics and gynecology (OBGYN), for available academic years (AYs) 2018-2019, 2019-2020, and 2020-2021. Standard deviation was derived from percentile data. Case volume differences for tracked index category averages were compared between AYs with one-way analysis of variance. RESULTS: Graduating fellows logged an average of 517.4 (SD 28.6) and 818.0 (SD 37.9) cases, for urology and OBGYN respectively, over their fellowship training during the examined period. Total surgical procedures were not statistically different between pre-COVID AY 2018-2019 and COVID-affected AYs 2019-2020 and 2020-2021 for either specialty. For urology fellows, the only index case category with a statistically significant difference was a decrease in AY 2020-2021 compared to 2019-2020 in GI procedures (8.9 vs 4.2, p=0.04). Reclassification of mesh removal cases to genital procedures in 2020-2021 resulted in a statistical decrease for both specialties of graft/mesh augmentation prolapse cases for that same AY. There were no other statistically significant differences between AYs for OBGYN fellows. CONCLUSIONS: Compared to pre-pandemic case volumes, FPMRS urology and FPMRS OBGYN graduating fellow surgical volume remained stable. Both total surgical procedures and index case categories showed no statistically significant difference between pre-COVID and COVID-affected years. Despite nationwide disruptions in health care, FPMRS trainee case volumes remained consistent. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e92 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Daily More articles by this author Shreeya Patel More articles by this author Hannah Koenig More articles by this author Thomas Fuller More articles by this author Una Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Pediatric Shoulder Arthroscopy Case Volume Is Uniformly Low for Graduating Orthopaedic Residents

To evaluate shoulder arthroscopy case volume for graduating United States orthopaedic surgery residents. We used the Accreditation Council for Graduate Medical Education case log records to evaluate reports from academic years 2016 to 2020. Logs were queried for pediatric, adult, and total (pediatric and adult) cases. The 10th, 30th, 50th, and 90th percentiles of case volumes from 2016 to 2020 were presented to demonstrate case volume variability. There was a significant increase in the average number of total (70.7 ± 35 vs 81.8 ± 45; P < .001), adult (69 ± 34 vs 79.7 ± 44; P < .001), and pediatric (1.8 ± 2 vs 2.2 ± 3; P= .003) shoulder arthroscopy cases performed byorthopaedicsurgery residents between the academic year 2016 and 2020. Residents were involved in more than 36times the number of adult cases compared with pediatric cases in 2020 (79.7 ± 44 vs 2.2 ± 3; P < .001). The 90th percentile ofresidents performed 6 pediatric cases in 2020, compared with zero cases in the 30th percentile and lower. Approximately one-third of orthopedic surgery residents graduate without having performed a pediatric shoulder arthroscopy. The findings from this study could help guide the revision of current Accreditation Council for Graduate Medical Education guidelines for orthopaedic surgery residents.

A Consensus-Driven Revision of the Accreditation Council for Graduate Medical Education Case Log System: Pediatric Anesthesiology Fellowship Education.

Clinical experiences, quantified by case logs, are an integral part of pediatric anesthesiology fellowship programs. Accreditation of pediatric anesthesiology fellowships by the Accreditation Council of Graduate Medical Education (ACGME) and establishment of case log reporting occurred in 1997 and 2009, respectively. The specialty has evolved since then, but the case log system remains largely unchanged. The Pediatric Anesthesiology Program Directors Association (PAPDA) embarked on the development of an evidence-based case log proposal through the efforts of a case log task force (CLTF). This proposal was part of a larger consensus-building process of the Society for Pediatric Anesthesia (SPA) Task Force for Pediatric Anesthesiology Graduate Medical Education. The primary aim of case log revision was to propose an evidence-based, consensus-driven update to the pediatric anesthesiology case log system. This study was executed in 2 phases. The CLTF, composed of 10 program directors representing diverse pediatric anesthesiology fellowship programs across the country, utilized evidence-based literature to develop proposed new categories. After an approval vote by PAPDA membership, this proposal was included in the nationally representative, stakeholder-based Delphi process executed by the SPA Task Force on Graduate Medical Education. Thirty-seven participants engaged in this Delphi process, during which iterative rounds of surveys were used to select elements of the old and newly proposed case logs to create a final revision of categories and minimums for updated case logs. The Delphi methodology was used, with a two-thirds agreement as the threshold for inclusion. Participation in the Delphi process was robust, and consensus was almost completely achieved by round 2 of 3 survey rounds. Participants suggested that total case minimums should increase from 240 to 300 (300-370). Participants agreed (75.86%) that the current case logs targeted the right types of cases, but requirements were too low (82.75%). They also agreed (85.19%) that the case log system and minimums deserved an update, and that this should be used as part of a competency-based assessment in pediatric anesthesia fellowships (96%). Participants supported new categories and provided recommended minimum numbers. The pediatric anesthesiology case log system continues to have a place in the assessment of fellowship programs, but it requires an update. This Delphi process established broad support for new categories and benchmarked minimums to ensure the robustness of fellowship programs and to better prepare the pediatric anesthesiology workforce of the future for independent clinical practice.

The Impact of Endovascular Repair of Abdominal Aortic Aneurysms on Vascular Surgery Training in Open Aneurysm Repair

Since the introduction of endovascular abdominal aortic aneurysm (AAA) repair (EVAR) in 1992, the number of open AAA repair (OAR) cases continue to decline. The consequence of reduced OAR cases raises valid concerns related to patient safety and future training of vascular surgeons that need to be appropriately addressed. Our objective is to analyze trends in open and endovascular AAA repair cases and to assess their implications on the quality of vascular surgery training. We analyzed the Accreditation Council for Graduate Medical Education (ACGME) case log database for total clinical experience in open and endovascular AAA repair for graduating vascular surgery fellows (VSF) finishing 5+2 programs between 2002-2019 and vascular surgery integrated residents (VSR) between 2013-2019. VSF case totals were calculated by combining average total cases of open and endovascular supra- and infra-renal AAA repair during fellowship years combined with total cases performed during their general surgery residency. VSR case totals included only the cases performed during the 5-year residency period. Isolated Iliac and thoracic aortic aneurysms were excluded from our analysis. The average number of OAR cases per trainee has decreased by 60% (from 36.9 to 14.7) with a rate of 1.4 cases per year (P<0.001) for VSF. Meanwhile, EVAR average cases have increased by 102% (from 22 to 44.4). However, there were two different trends exhibited with EVAR over the study period. Between 2002 and 2007, EVAR cases tended to increase by 5.9 cases per year (P<0.001). Whereas, between 2007 and 2019, there was a slightly decreased trend in EVAR cases by 0.3 cases per year (P=0.01) (Figure 1). For VSR, while no significant trend was observed in the mean number of OAR cases (Coef. -0.3, P=0.2) due to limited time frame, the proportion of open cases was significantly lower compared to endovascular cases. Additionally, there were two different trends exhibited with EVAR over the study period. Between 2013 and 2015, EVAR cases tended to increase by 1.7 cases per year (P=0.1). Whereas, between 2015 and 2019, there was a slightly decreased trend in EVAR cases by 0.2 cases per year (P=0.007). A significant reduction of average OAR cases and increase in EVAR cases were observed over the study period. Vascular surgery training programs may need to introduce further training programs in open surgical repair to ensure vascular surgery trainees have the required technical skills and expertise to perform such a high-risk procedure safely and independently.

10 Year Analysis of Pediatric Surgery Fellowship Match and Operative Experience: Concerning Trends?

This paper aims to evaluate the pediatric surgery training pipeline vis-à-vis the pediatric surgery match and operative experience of pediatric surgery fellows. Pediatric surgery remains a competitive surgical subspecialty. However, there is concern that operative experience for pediatric surgery fellows is changing. This paper examines the selectivity of the pediatric surgery match, along with the operative experience of pediatric surgery fellows to characterize the state of pediatric surgery training. The pediatric surgery fellowship match was analyzed from the National Resident Matching Program data from 2010 to 2019. Selectivity among fellowships was compared using analysis of variance with Dunnett test. Operative log data for pediatric fellows was analyzed using the Accreditation Council for Graduate Medical Education case logs from 2009 to 2019. Linear regression analysis was used to evaluate trends in operative volume over time. Pediatric surgery had the highest proportion of unmatched applicants (47.2% ± 5.3%) and lowest proportion of unfilled positions (1.4% ± 1.6%) when compared to other National Resident Matching Program surgical fellowships. Accreditation Council for Graduate Medical Education case log analysis revealed a statistically significant decrease in cases for graduating fellows (-5.3 cases/year, P < 0.05). Total index cases decreased (-4.7 cases/year, P < 0.01, R 2 = 0.83) such that graduates in 2019 completed 59 fewer index operations than graduates in 2009. Although pediatric surgery fellowship remains highly selective there has been a decline in the operative experience for graduating fellows. This highlights the need for evaluation of training paradigms and operative exposure in pediatric surgery to ensure the training of competent pediatric surgeons.

A Dedicated Simulator Training Curriculum Improves Resident Performance in Surgical Management of Pediatric Supracondylar Humerus Fractures.

The primary goal of including simulation in residency training is to improve technical skills while working outside of the operating room. Such simulation-related skill improvements have seldom been measured in the operating room. This is largely because uncontrolled variables, such as injury severity, patient comorbidity, and anatomical variation, can bias evaluation of an operating surgeon's skill. In this study, performance during the wire navigation phase of pediatric supracondylar humerus fracture fixation was quantitatively compared between 2 groups of orthopaedic residents: a standard training group consisting of residents who participated in a single simulator session of wire navigation training and an expanded training group consisting of residents who participated in a dedicated multifaceted wire navigation simulation training curriculum. To evaluate performance in the operating room, the full sequence of fluoroscopic images collected during wire navigation was quantitatively analyzed. Objective performance metrics included number of fluoroscopic images acquired, duration from placement of the first wire to that of the final wire, and wire spread at the level of the fracture. These metrics were measured from 97 pediatric supracondylar humerus fracture pinning surgeries performed by 28 different orthopaedic residents. No differences were observed between the groups for wire spread in the final fluoroscopic images (t(94) = 0.75, p = 0.45), an important clinical objective of the surgery. Residents who received the expanded simulator training used significantly fewer fluoroscopic images (mean of 46 vs. 61 images, t(85) = 2.25, p < 0.03) and required less time from first to final wire placement (mean of 11.2 vs. 14.9 minutes, t(83) = 2.53, p = 0.013) than the standard training group. A post hoc review of Accreditation Council for Graduate Medical Education case logs for 24 cases from the standard training group and for 21 cases from the expanded training group indicated that, at the time of surgeries, residents who received expanded training had completed fewer comparable cases than residents in the standard training group (mean of 13 vs. 21, t(42) = 2.40 p = 0.02). Further regression analysis indicated that the expanded simulator training produced an effect comparable with that associated with completing 10.5 similar surgical case experiences. This study demonstrates that training on a wire navigation simulator can lead to improved performance in the operating room on a critical skill for all orthopaedic residents. By taking fewer images and less time while maintaining sufficient pin spread, simulator-trained residents were objectively measured to have improved performance in comparison with residents who had not participated in the pediatric elbow simulator curriculum. As programs aim to provide safe and effective training for critical orthopaedic skills such as pinning a pediatric elbow, this study demonstrates a simulator curriculum that has demonstrated the transfer of skill from a learning environment to the operating room.

Dedicated Chalazion Clinic as a Tool for Early Surgical Education in Ophthalmology Residency.

Objective Ophthalmology residency programs aim to improve resident surgical teaching through increased surgical exposure over a 4-year period. Resident-centric surgical clinics across various surgical specialties have been established to help develop surgical autonomy and experience. We present the first demonstration of a resident-centric chalazion incision and drainage clinic (chalazion clinic) in an ophthalmology residency with the goal of increasing early surgical exposure to residents. Design The chalazion clinic was founded in July 2019. It is a once weekly procedure clinic conducted by an ophthalmology resident and supervised by an ophthalmology attending. Patients with chalazia were referred directly to this clinic for evaluation and management, rather than the oculoplastics clinic as they were in the past. Retrospective review of Accreditation Council for Graduate Medical Education (ACGME) case logs of all residents per academic year before and after establishment of the chalazion clinic was performed in order to assess the impact on residents' chalazion procedures numbers per academic year. Setting The study involved a single academic ophthalmology department. Participants Ophthalmology residents of all years were present. Results A resident of any year performed an average of 3.0 chalazion procedures per year in the 2018 to 2019 academic year, 3.8 in 2019 to 2020, and 8.4 in the 2020 to 2021, which represents a 180% increase in procedure numbers per resident. Among post-graduate-year 2s (PGY)2s, the average number of chalazion procedures increased from 2.1 procedure per year to 22.3 per year (961.9% increase). Conclusion To the best of our knowledge, this is the first description of a dedicated resident-centric chalazion clinic in an ophthalmology residency program. PGY2s demonstrated the largest increase in procedural numbers. While chalazion incision and drainage is a minor procedure, increased exposure to surgical procedures early in training could help improve residents' skills and confidence. This clinic provides a proof of concept of a dedicated minor procedure clinic for ophthalmology residents to increase early procedural volume.

Ophthalmology Resident Oculofacial Surgery Case Exposure: An ACGME Case Log Analysis.

The authors quantified trends in resident oculofacial surgery exposure between 2009 and 2018, reviewed specific procedure volume, and correlated procedure volume with program characteristics. The authors requested de-identified case logs of residents graduating US ophthalmology residency programs in 2018 from all 118 programs. Current Procedural Terminology codes of all oculofacial procedures were analyzed. Current Procedural Terminology codes were grouped into 25 unique categories that the authors created in addition to the 11 Accreditation Council for Graduate Medical Education categories. One hundred and sixty-six of 488 (34%) US ophthalmology residents graduating in 2018 provided case logs (32.2% of programs). According to Accreditation Council for Graduate Medical Education case logs, residents graduating in 2018 completed significantly fewer eye removal/implant procedures, lacrimal surgeries, "other orbital" procedures, entropion/ectropion repairs, and temporal artery biopsies as primary surgeon than residents graduating in 2009, yet significantly more eyelid laceration repairs, chalazion excisions, tarsorrhaphies, ptosis repairs, and blepharoplasty/reconstruction procedures ( p < 0.05). No difference was found between the total number of oculofacial cases between 2009 and 2018 ( p = 0.051). The most frequently logged procedure per resident in the sample was blepharoplasty/reconstruction (17.2 ± 15) followed by "other oculoplastic" (12.7 ± 10.6). The least commonly performed procedures included temporal artery biopsy (1.5 ± 2.2) and "other orbital" (1.9 ± 3.1). Program size, location, and presence of oculofacial fellowship program all impacted case volume. Oculofacial surgery has the second highest case number requirement for residents per Accreditation Council for Graduate Medical Education guidelines. However, resident exposure to oculofacial surgery cases greatly varies in each ophthalmology residency program.

Automating Anesthesiology Resident Case Logs Reduces Reporting Variability.

The Accreditation Council for Graduate Medical Education (ACGME) case log system for anesthesiology resident training relies on subjective categorization of surgical procedures and lacks clear guidelines for assigning credit roles. Therefore, resident reporting practices likely vary within and between institutions. Our primary aim was to develop a systematic process for generating automated case logs using data elements extracted from the electronic health care record. We hypothesized that automated case log reporting would improve accuracy and reduce reporting variability. We developed a systematic approach for automating anesthesiology resident case logs from the electronic health care record using a discrete classification system for assigning credit roles and Anesthesia Current Procedure Terminology codes to categorize cases. The median number of cases performed was compared between the automated case log and resident-reported ACGME case log. Case log elements were identified in the electronic health care record and automatically extracted. A total of 42 individual case logs were generated from the extracted data and visualized in an external dashboard. Automated reporting captured a median of 1226.5 (interquartile range: 1097-1366) total anesthetic cases in contrast to 1134.5 (interquartile range: 899-1208) reported to ACGME by residents (P = .0014). Automation also decreased the case count interquartile range and the distribution approached normality, suggesting that automation reduces reporting variability. Automated case log reporting uniformly captures the resident training experience and reduces reporting variability. We hope this work provides a foundation for aggregating graduate medical education data from the electronic health care record and advances adoption of case log automation.

Effects of 24-hour versus night-float call schedules on the clinical and operative experiences of postgraduate year 2 and 3 neurosurgical residents.

To comply with the removal of the 88-hour week exemption and to support additional operative experience during junior residency, Oregon Health & Science University (OHSU) switched from a night-float call schedule to a modified 24-hour call schedule on July 1, 2019. This study compared the volumes of clinical, procedural, and operative cases experienced by postgraduate year 2 (PGY-2) and PGY-3 residents under these systems. The authors retrospectively studied billing and related clinical records, call schedules, and Accreditation Council for Graduate Medical Education case logs for PGY-2 and PGY-3 residents at OHSU, a tertiary academic health center, for the first 4 months of the academic years from 2017 to 2020. The authors analyzed the volumes of new patient consultations, bedside procedures, and operative procedures performed by each PGY-2 and PGY-3 resident during these years, comparing the volumes experienced under each call system. Changing from a PGY-2 resident-focused night-float call system to a 24-hour call system that was more evenly distributed between PGY-2 and PGY-3 residents resulted in decreased volume of new patient consultations, increased volume of operative procedures, and no change in volume of bedside procedures for PGY-2 residents. PGY-3 residents experienced a decrease in operative procedure volume under the 24-hour call system. Transition from a night-float system to a 24-hour call system altered the distribution of clinical and procedural experiences between PGY-2 and PGY-3 residents. Further research is necessary to understand the impact of these changes on educational outcomes, quality and safety of patient care, and resident satisfaction.

Implementation and Evaluation of Integrating an Electronic Health Record With the ACGME Case Log System.

It is essential to log resident-performed procedures to assess training programs and fulfill specialty requirements, but resident case numbers are often underreported. Current systems require inefficient data entry steps, and residents and fellows report that user interfaces and administrative burden contribute to logging inaccuracy. To determine the accuracy, feasibility, and acceptability of a single logging approach for resident case logging. In 2018, we implemented a case logging system integrated with the institutional electronic health record (EHR) and the Accreditation Council for Graduate Medical Education (ACGME) case log system to record procedures performed by ophthalmology residents. We compared the proportion of resident-performed cataract extractions in the EHR that were reported to ACGME for 3 periods: before the deployment of the new system (6 months), during the transition (6 months), and after the change (2 years). Resident satisfaction with the new system was evaluated using surveys. An analysis of resident cataract surgeries showed that the percentage of resident cases logged increased from 85% prior to implementation to 91% after implementation. The integrated system became the preferred case logging method, with 100% of all logged cases being entered using the new platform. Surveys showed that the percentage of trainees who were moderately or very satisfied with the case log process increased from 55% before implementation to 100% after implementation. A resident case log system integrated with an EHR more accurately reflects resident operative volume and increases trainee satisfaction with the logging process.

Variability in Operative Experience Among US Gynecologic Oncology Fellows (030)

<b>Objectives:</b> The Accreditation Council for Graduate Medical Education (ACGME) case log system provides a mechanism to assess the breadth and depth of the clinical experience provided by gynecologic oncology fellowships. Logging has been required since 2017; however, the required minimum number of procedures has not yet been determined. We aimed to evaluate the range of operative experience across gynecologic oncology fellowship programs in relation to proposed procedure-specific minimum numbers. <b>Methods:</b> ACGME surgical case logs of graduating gynecologic oncology fellows from 2019 to 2020 were analyzed for case volume trends. <b>Results:</b> Data were collected from 64 graduating gynecologic oncology fellows enrolled in 50 US programs. The median number of intestinal surgeries performed by graduating fellows was 42 (19 performed by those in the 10^th percentile to 89 performed by those in the 90^th percentile); a minimum of 20 has been proposed by the ACGME. By contrast, ACGME requires general surgery residents to complete a minimum of 25 small and 40 large intestinal surgeries during training. Gynecologic oncology fellows who performed more than ten intestinal procedures in training were more likely to feel prepared to perform these surgeries independently, however, only 58% reported feeling prepared to do so within three years of graduation. The median number of urologic procedures performed by graduating fellows was one (0 to 4); a minimum of 2 has been proposed by the ACGME. However, ACGME requires urology residents to complete a minimum of eight urinary diversion procedures during training, with the stipulation that this minimum "does not signify the achievement of competence." The median number of radical hysterectomies performed by graduating fellows was 17 (8 to 32). A minimum of ten has been proposed by the ACGME. A single-institution study of gynecologic oncology fellow productivity reported 17 radical hysterectomies completed per fellow per year since 2005. The median number of exenterations performed by graduating fellows was three (1 to 8); a minimum of two has been proposed by the ACGME. A single-institution study of exenterations over 20 years showed an average of six procedures per surgeon and no association of operative experience with complications or survival. The median number of inguinal dissections performed by graduating fellows was 11 (4 to 18). As this is considered a rare procedure, no minimum has been proposed by the ACGME. A minimum of ten was proposed to overcome the surgeon learning curve for inclusion in GROINSS-V-I. <b>Conclusions:</b> In the US, gynecologic oncology fellows experience significant variability in their surgical training. Based on our extrapolation of ACGME data, approximately half of the fellows fall below the proposed case minimums for urologic procedures. All but those in the bottom 10^th percentile met proposed minimums for radical hysterectomies, exenterations, and intestinal procedures. However, ACGME-proposed case minimums may be inadequate to achieve competence. Understanding the scope and variability of gynecologic oncology surgical training is needed to continue to improve and address gaps in fellow education.

Decreased Case Volume for Orthopaedic Sports Medicine Fellows During the Early Stages of the Coronavirus Disease 2019 Pandemic

PurposeTo compare the surgical case volume for orthopaedic sports medicine fellows in the most recent classes with one another and in years preceding the pandemic.MethodsThe Accreditation Council for Graduate Medical Education case log reports of key procedures for orthopaedic sports medicine fellows during academic years 2018-2019, 2019-2020, and 2020-2021 were extracted. Comparisons between these years in adult, pediatric, and total case volumes were performed using a 2-sample t-test to detect significant changes in the average number of key procedures completed between consecutive years.ResultsThere was a significant decrease in the total number of cases completed by fellows during the 2020 academic year (P = .043) compared with 2019, immediately followed by a significant increase in case volume in 2021 (P < .001) (2019, 339 ± 123; 2020, 316.2 ± 108; 2021, 356.5 ± 117). There was a significant increase in adult case volume from 2020 to 2021 (2020, 295.7 ± 106; 2021, 332.9 ± 117; P < .001), whereas no trends were noted in pediatric case volume. Between the prepandemic year of 2019 and the first year of the pandemic, significant decreases were noted in case volume for several procedures, including multiligamentous knee injuries, knee instability and pediatric hip arthroscopy. From the first to the second years of the pandemic (2019-2020 to 2020-2021), significant increases were observed in case volume for rotator cuff, acromioclavicular instability, elbow instability, knee cartilage, and meniscal surgeries.ConclusionsOrthopaedic sports medicine fellows experienced significant decreases in volume for several key case categories between the year preceding the coronavirus disease 2019 pandemic and the first academic year during the pandemic. There were subsequent increases in cases between the first year of the pandemic and the second year, which may be associated with resuming elective surgical cases.Level of EvidenceIV, retrospective database analysis.

Elective Surgery Shutdown Due to COVID-19 Did Not Decrease Vascular Integrated Resident or Vascular Fellow Operative Experience

To determine whether nationwide and/or institutional policy changes affected vascular integrated resident (VR) and vascular fellow (VF) operative experience during the coronavirus disease-2019 (COVID-19) pandemic using national Accreditation Council for Graduate Medical Education case log data.