title: Surgical Case Logging Habits and Attitudes: A Multispecialty Survey of Residents.
abstract: OBJECTIVE
  The Accreditation Council for Graduate Medical Education measures surgical residents' experience in the United States by mandating that residents log each procedure in which they have participated. This system is the primary mechanism by which breadth and depth of surgical training are documented, and data are used for program accreditation and by individual program directors to assess resident preparedness. The study objective was to learn from residents across surgical specialties how this system is being used, and whether they believe these data are reliable.
  
  
  METHODS
  Investigators developed and administered a voluntary, 45-item survey. Resident demographic data, program details, logging behaviors, and attitudes were examined using descriptive statistics. Authors used multivariate logistic regression to assess respondent and program characteristics associated with logging habits.
  
  
  METHODS
  The survey was administered at a large academic medical center.
  
  
  METHODS
  All general surgery, obstetrics and gynecology, orthopedics, urology, neurosurgery, otolaryngology, and plastic surgery residents were eligible. Of 126 surgical residents, 82 participated, yielding a response rate of 65%.
  
  
  RESULTS
  Overall, 7.5% considered the case log system highly inaccurate, 28.8% somewhat inaccurate, 52.5% somewhat accurate, and 11.3% highly accurate. Nearly half (48.1%) use an incorrect metric to log their role as surgeon or assistant. Half logged monthly or less frequently. The longest time residents reported falling behind ranged from less than a week to more than a year, with about half (51.4%) reporting backlogs of 3 months or longer. Approximately two-thirds considered the system difficult to navigate (64.2%) and burdensome (68.8%). Departmental training and reminders to log were associated with high fidelity logging habits.
  
  
  CONCLUSIONS
  Inconsistency of logging habits and perceived lack of accuracy raise concerns about use of the system for assessing surgical preparedness or accrediting training programs. Academic departments playing an active role may benefit from more reliable data to guide improvements in surgical training.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, California. Electronic address: lcadish@uci.edu.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Cadish
authors.affiliation: Mongan Institute for Health Policy at Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange, California.
authors.forename: Felicia L
authors.initials: FL
authors.lastname: Lane
authors.affiliation: Mongan Institute for Health Policy at Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Eric G
authors.initials: EG
authors.lastname: Campbell
mesh_terms: D000328:Adult; D004282:Documentation / Q000592:standards*; D004503:Education, Medical, Graduate; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011364:Professional Practice / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D016526:Workload
keywords: ACGME; Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; case log; resident preparedness