Collins Courtney, Dudas Lauren, Johnson Mason, Davenport Daniel, Bernard Andrew, Beck Sandra, Muchow Ryan, Pittman Thomas, Talley Cynthia
University of Kentucky, Department of Surgery, Lexington, Kentucky.
West Virginia University, Department of Surgery, Morgantown, West Virginia.
J Surg Educ. 2020 Nov-Dec;77(6):e78-e85. doi: 10.1016/j.jsurg.2020.08.045. Epub 2020 Sep 16.
This study evaluates the accuracy of reported the Accreditation Council for Graduate Medical Education (ACGME) operative case logs from graduated residents compared to institutional operating room electronic records (ORER). We hope this will help guide review committees and institutions develop complete, accurate resident case logs.
This is a retrospective, cross-sectional study of general surgery (GS), neurosurgery (NS), and orthopedic surgery (OS) resident physicians. ACGME and ORER cases from 2009 to 2010 were analyzed and each case and current procedural terminology (CPT) code directly compared (ORER vs. ACGME).
Single academic tertiary-care medical center (University of Kentucky, Lexington, KY).
Eleven thousand nine hundred and twenty-three cases for 46 residents among the 3 residency programs were analyzed.
There was an overall logging accuracy of 72% for ORER cases reflected in the ACGME case logs. OS residents had a higher rate of logging accuracy (OS 91%, GS 69%, NS 58%, chi-square p = 0.014) and mean annual number of cases compared to the other 2 programs (OS 452, GS 183, NS 237, ANOVA p = 0.001). NS residents had higher accuracy of CPT codes than post-graduate years 2 to 5 in other programs (p < 0.017). There was a strong positive correlation between the number of cases completed per resident and case logging accuracy, (rho = 0.769, p < 0.001) consistent for NS and GS, but not OS.
This study shows only 72% of a residents' operative experience is captured in the ACGME case log across 3 surgical programs. There is significant variability among surgical programs and among post-graduate year cohorts regarding case log and CPT code accuracy. There is a strong correlation with the total number of cases performed and increasing case log accuracy. Low case log accuracy may reflect individual resident behavior instead of program operative exposure. Further studies are needed to determine if ORER may serve as a more complete assessment of the operative experience of a resident and program.
本研究评估了毕业住院医师报告的毕业后医学教育认证委员会（ACGME）手术病例记录与机构手术室电子记录（ORER）相比的准确性。我们希望这将有助于指导评审委员会和机构制定完整、准确的住院医师病例记录。
这是一项对普通外科（GS）、神经外科（NS）和整形外科（OS）住院医师的回顾性横断面研究。分析了2009年至2010年的ACGME和ORER病例，并对每个病例和当前程序术语（CPT）代码进行了直接比较（ORER与ACGME）。
单一学术三级医疗中心（肯塔基大学，列克星敦，肯塔基州）。
对3个住院医师培训项目中的46名住院医师的11923例病例进行了分析。
ACGME病例记录中反映的ORER病例的总体记录准确率为72%。与其他2个项目相比，OS住院医师的记录准确率更高（OS为91%，GS为69%，NS为58%，卡方检验p = 0.014），且年均病例数更多（OS为452例，GS为183例，NS为237例，方差分析p = 0.001）。NS住院医师的CPT代码准确率高于其他项目中研究生2至5年级的住院医师（p < 0.017）。每位住院医师完成的病例数与病例记录准确率之间存在强正相关（rho = 0.769，p < 0.001），NS和GS一致，但OS不一致。
本研究表明，在3个外科项目中，ACGME病例记录仅涵盖了住院医师72%的手术经验。在病例记录和CPT代码准确性方面，外科项目之间以及研究生年级队列之间存在显著差异。病例执行总数与病例记录准确率的提高密切相关。病例记录准确率低可能反映了住院医师个人的行为，而非项目的手术暴露情况。需要进一步研究以确定ORER是否可作为对住院医师和项目手术经验更全面的评估。
