Variability in Accreditation Council for Graduate Medical Education Resident Case Log System practices among orthopaedic surgery residents.
BACKGROUND
The Accreditation Council for Graduate Medical Education (ACGME) Resident Case Log System is designed to be a reflection of residents' operative volume and an objective measure of their surgical experience. All operative procedures and manipulations in the operating room, Emergency Department, and outpatient clinic are to be logged into the Resident Case Log System. Discrepancies in the log volumes between residents and residency programs often prompt scrutiny. However, it remains unclear if such disparities truly represent differences in operative experiences or if they are reflections of inconsistent logging practices. The purpose of this study was to investigate individual recording practices among orthopaedic surgery residents prior to August 1, 2011.


METHODS
Orthopaedic surgery residents received a questionnaire on case log practices that was distributed through the Council of Orthopaedic Residency Directors list server. Respondents were asked to respond anonymously about recording practices in different clinical settings as well as types of cases routinely logged. Hypothetical scenarios of common orthopaedic procedures were presented to investigate the differences in the Current Procedural Terminology codes utilized.


RESULTS
Two hundred and ninety-eight orthopaedic surgery residents completed the questionnaire; 37% were fifth-year residents, 22% were fourth-year residents, 18% were third-year residents, 15% were second-year residents, and 8% were first-year residents. Fifty-six percent of respondents reported routinely logging procedures performed in the Emergency Department or urgent care setting. Twenty-two percent of participants routinely logged procedures in the clinic or outpatient setting, 20% logged joint injections, and only 13% logged casts or splints applied in the office setting. There was substantial variability in the Current Procedural Terminology codes selected for the seven clinical scenarios.


CONCLUSIONS
There has been a lack of standardization in case-logging practices among orthopaedic surgery residents prior to August 1, 2011. ACGME case log data prior to this date may not be a reliable measure of residents' procedural experience.
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153. E-mail address for D. Salazar: dsalazar@post.com.
Dane
D
Salazar
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153. E-mail address for D. Salazar: dsalazar@post.com.
Adam
A
Schiff
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153. E-mail address for D. Salazar: dsalazar@post.com.
Erika
E
Mitchell
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153. E-mail address for D. Salazar: dsalazar@post.com.
William
W
Hopkinson
D000068:Accreditation / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D009873:Operating Rooms / Q000706:statistics & numerical data; D009985:Orthopedics / Q000193:education* / Q000592:standards; D011364:Professional Practice / Q000592:standards; D012015:Reference Standards; D014481:United States