R. Thanawala1, J. Engelbart2, J. Jesneck5, R. Rhee4, N. E. Seymour3, J. Shelton2 1University Of Iowa,Division Of Cardiothoracic Surgery/Department Of Surgery,Iowa City, IA, USA 2University Of Iowa,Department Of Surgery,Iowa City, IA, USA 3University of Massachusetts-Baystate Medical Center,Department Of Surgery,Springfield, MA, USA 4Maimonides Medical Center,Department Of Surgery,Brooklyn, NY, USA 5Firefly Lab,Iowa City, IA, USA
Introduction:
For optimal training of surgical residents, it is critical to construct an accurate, comprehensive understanding of trainee operative experience, which is approximated by surgical case logs. The ACGME implemented a competency based approach for surgical training through the Milestones project and requires residents to log surgical cases with credit only given to the primary CPT code. We sought to compare the operative experience of trainees under the current model of primary CPT codes vs. a more inclusive model with secondary CPT codes.
Methods:
The case logs of 218 residents and 164,692 cases (11/2008 – 7/2020) were evaluated across 39 hospitals, 9 training programs, and 7 surgical specialities. We utilized a HIPAA-compliant resident education platform (Firefly) for tracking case assignments and operative case logs. We calculated the average number of procedures logged per case, both in aggregate and grouped by program year. Procedures were counted by primary and secondary CPT codes, to measure the difference in logged procedures that were not considered for residency credit.
Results:
Capturing procedures and sub-procedures directly from the OR schedule was associated with 16% increased CPT codes per procedure (paired t-test, p < 0.00001), with the largest increase for senior residents. Residents performed significantly more procedures than the current model of primary codes recognizes for major credit.
When grouped by ACGME-defined CPT area, the largest differences were observed for coronary sclerosis (51% additional CPT codes per case), peripheral obstructive cases (40%), 29%), and venous cases (26%).
Conclusion:
In this multi-institution, multi-specialty attempt to clarify logging practices, surgical residents logged on average 16% more procedures than credited to them in the existing ACGME case credit allocation model of one primary CPT code per patient each day. This demonstrates significant under-reporting of resident surgical experience during training. Based on several resident interviews and preliminary comparison of assigned cases vs. logged cases (data not shown), the under-reporting is significantly larger than shown by case log data. Residents often forget to log cases, or fail to log secondary procedures, any procedures that are not classified for major credit by the ACGME, and procedures beyond their ACGME minimum requirements. Surgical education is transitioning to more procedural competency-based feedback and assessment. Consideration of crediting residents for all aspects of surgical procedure completed as a part of their training may help improve characterization of the quality of the trainee operative experience.
