ACGME case log questions

[drranjit]

I'm a new intern and I'm trying to log my first cases in the ACGME case log. I have a few questions:

1) Can you only log a case if you were specifically listed (on the brief op note/op note) as the assistant? There were a few cases in which I assisted but the attending did not list me at all (just shows the attending's name) so just wondering if I should not count them/log them

2) What's the "Case ID"? Is it the pt's MRN?

3) For resident role, I assume I will be "First assistant" most of my intern year. When is it appropriate to log a case as "Surgeon junior" vs. "First assistant" (seems like there may be some overlap?)

4) Finally, do I need to fill out the "Code" section (I assume they are referring to CPT codes)? Or do I just fill out the top part and ignore the "Code" section. If so, how would ACGME know what type of cases I logged?

Sorry about the questions, I'm new to this and want to make sure I fill everything out correctly.

Thanks!

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[bannie22]

Its a sham. Log whtever the heck you or your program wants

 

[tideleonheart]

On a similar note, why are sleeve gastrectomies not a tracked case? Seems like a perfectly legitimate laparoscopic case.

 

[swoopyswoop]

I was in a Whipple as an intern with an attending and a chief resident. Didn't even staple skin (let the med student do it), and with a bookwalter retractor I was basically just an observer - I logged it as first assist even though I "technically" could have logged it as surgeon junior.

The other annoying thing about the case log system is that if a 3 walks a 1 or a 2 through a case, the 1/2 can only log it as surgeon junior if the 3 doesn't log it.

 

[LucidSplash]

I was in a Whipple as an intern with an attending and a chief resident. Didn't even staple skin (let the med student do it), and with a bookwalter retractor I was basically just an observer - I logged it as first assist even though I "technically" could have logged it as surgeon junior.

The other annoying thing about the case log system is that if a 3 walks a 1 or a 2 through a case, the 1/2 can only log it as surgeon junior if the 3 doesn't log it.

To log surgeon junior you have to do at least half the case. So I think logging FA was the appropriate thing to do.

 

[bannie22]

I was in a Whipple as an intern with an attending and a chief resident. Didn't even staple skin (let the med student do it), and with a bookwalter retractor I was basically just an observer - I logged it as first assist even though I "technically" could have logged it as surgeon junior.

The other annoying thing about the case log system is that if a 3 walks a 1 or a 2 through a case, the 1/2 can only log it as surgeon junior if the 3 doesn't log it.

you never heard of MRNa MRNb? you never heard of logging it as 71884 v 71883? come on.

 

[surgonc2017]

Teaching assistant cases are only supposed to be logged as a PGY-4 or 5s.


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[Winged Scapula]

you never heard of MRNa MRNb? you never heard of logging it as 71884 v 71883? come on.

Please stop with the annoying comments as well as the bad advice. Failure to be a contributing member of the community is grounds for removal from the website.

 

[TraumaLlamaMD]

I've seen cases logged with MRN by one resident and the account/billing number by a second when both participated actively or in cases of a 3 teaching a junior resident.

 

[ThoracicGuy]

Its a sham. Log whtever the heck you or your program wants

you never heard of MRNa MRNb? you never heard of logging it as 71884 v 71883? come on.

 

[DoctwoB]

I don't worry about the program, our numbers aren't fine. I worry about myself because I want to use my logs to (accurately) sell myself to future jobs and hospital credential if committees.

 

[DoctwoB]

I don't worry about the program, our numbers aren't fine. I worry about myself because I want to use my logs to (accurately) sell myself to future jobs and hospital credential if committees.

Are fine. Damn autocorrect

 

[Winged Scapula]

Are fine. Damn autocorrect

You can edit your own posts.

 

[evilbooyaa]

Please stop with the annoying comments as well as the bad advice. Failure to be a contributing member of the community is grounds for removal from the website.

Bannie is wrong quite often on this board (seems like specifically this subforum), but I've seen folks do what he/she suggested. Attending and chief doing a case, and intern scrubs in. Chief and intern both log it as surgeon Jr.

 

[doc05]

I don't worry about the program, our numbers aren't fine. I worry about myself because I want to use my logs to (accurately) sell myself to future jobs and hospital credential if committees.

If you've graduated from an accredited residency, you will get privileges.

 

[DoctwoB]

If you've graduated from an accredited residency, you will get privileges.

Privileges yes, but will you get credentialed for all surgical procedures within the specialty? What about surgeries typically performed by fellowship trained individuals but that you had an excellent exposure to as primary surgeon in residency?

 

[doc05]

Privileges yes, but will you get credentialed for all surgical procedures within the specialty?

Yes

What about surgeries typically performed by fellowship trained individuals but that you had an excellent exposure to as primary surgeon in residency?

Depends on Hospital bylaws.

 

[Smurfette]

Generally, there are core privileges that they give you (unless you cross off something on the list), as well as some special privileges that may have some requirements to get. It will vary from hospital to hospital. It may require showing a minimum number of cases, proof of fellowship, letter from your PD, etc. In my experience, sometimes what is or is not on the "special privileges" list is surprising but hasn't been a problem as far as being too difficult to qualify for if your request is legit.

 

[ACSurgeon]

If it's a complex case with multiple billable procedures, the ACGME allows separate residents to claim credit for separate CPT codes.

If not, I would really not advise fudging your numbers like described above; and would worry about a program that encourages/requires such to meet the case requirements

I finished with way more cases than I needed.

That said, it's demoralizing to finish the week with a low number of cases as a junior resident. So, if I did a SBR or open chole during another major case as a junior or midlevel resident, I coded it just for morale.

I agree with it being problematic if someone NEEDS to fudge numbers to graduate.

 

[LadyRad]

Do prelims going into advance programs need to log cases?

 

[Winged Scapula]

Do prelims going into advance programs need to log cases?

Why wouldn't you (do it, not whether its required)?

That's a good question for your current PD and the PD of the advanced program.

 

[kemper6036]

with the new case requirements especially in advanced laparoscopic (75!?!), I told my junior residents they better be scrubbing and counting those cases as surgeon jr, even if they didn't do the case

the rules for case logs are twisted daily

 

[surgonc2017]

Basically anything that isn't a lap appy or lap chole counts as an advanced laparoscopic case. Nissens, hellers, RNYGB, sleeves, ventral hernias, inguinal hernias, colon cases, thoracoscopic cases. Honestly it was one of the easier categories for me to fill and was done in 4th year. I have more Lap C cases than Lap B cases. It really shouldn't be a problem to fill.

 

[vhawk]

Is that really a problem to meet?

I graduated with at least double that requirement.

Like I said I worry about any program that needs fudging to meet the numbers

I had met all of the new/updated requirements by the end of PGY4 (except the chief cases obviously)

I think there are probably many very good, solid programs that are either community or smaller academic that have a hard time honestly and genuinely meeting numbers for liver and panc cases.

But I agree, if you are actually worried about meeting your requirements for "Advanced" lap cases, your residency is probably in 1987 and you should probably buy a sports almanac and just start gambling

 

[Winged Scapula]

Yeah, even back in my day, I would have had enough advanced lap cases to fulfill the new requirements. It shouldn't be that hard.

 

[kemper6036]

depends on the program. we had some younger faculty who started using the robot for all that and their focus was learning on how to do it themselves instead of letting the resident operate. definitely was a concern. glad no one else has experienced this apparently

 

[dpmd]

depends on the program. we had some younger faculty who started using the robot for all that and their focus was learning on how to do it themselves instead of letting the resident operate. definitely was a concern. glad no one else has experienced this apparently

Of course before that there was the issue of no one really qualified for a lot of those cases for a sizable portion of time and the pathology not always lending itself to lap approaches.

Nissens, hellers, RNYGB, sleeves, ventral hernias, inguinal hernias, colon cases, thoracoscopic cases.

Let's see, I graduated with 0, 0, 0, 0, not sure, 0, 2 attempts that had to be converted to open, not sure. Would the VHRs and VATS be more than 75? Really don't know but they didn't exactly leave me qualified to do the others really. But given me an intraabdominal disaster and I am quite comfortable managing it.

 

[kemper6036]

Of course before that there was the issue of no one really qualified for a lot of those cases for a sizable portion of time and the pathology not always lending itself to lap approaches.


Let's see, I graduated with 0, 0, 0, 0, not sure, 0, 2 attempts that had to be converted to open, not sure. Would the VHRs and VATS be more than 75? Really don't know but they didn't exactly leave me qualified to do the others really. But given me an intraabdominal disaster and I am quite comfortable managing it.

sounds like we came from the same place or something

 

[surgonc2017]

In the current environment, any general surgery residency that graduates residents with 0 nissens, 0 lap inguinals and 0 lap colons should not continue to be an accredited program.


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