Case Log Monitoring: Ensuring Your Program and Residents ...€¦ · Case Log Monitoring: Ensuring Your Program and Residents Meet Their Case Log Requirements Carl Backer, MD RC,

Case Log Monitoring:

Ensuring Your Program and

Residents Meet Their Case Log

Requirements

Carl Backer, MD RC, Vice Chair

HelenMari Merritt, MD RC Resident Member

Donna L. Lamb, MBA, BSN ACGME Executive Director

Thoracic Surgery Director’s Association Meeting

Phoenix, AZ

23 January 2016

© 2016 Accreditation Council for Graduate Medical Education (ACGME)

Introductions

HelenMari Merritt, DO

• U Nebraska, Cardiac Faculty and APD (Ind)

• I6 at UTHSC San Antonio (the first!)

• Past Resident Member of RC-TS

Donna L. Lamb, MBA, BSN

• Ex Dir -Thoracic, General, and Plastic Surgery

• Prior DIO and GME/Hospital Administrator

• Old CT/Trauma/NICU Nurse

• Completing Doctorate - Sept 2016!© 2016 Accreditation Council for Graduate Medical Education (ACGME)

Disclosures

No financial conflicts to disclose


Objectives

How are cases counted?

Is this data flowing to the RRC?

How are programs held responsible if

residents do not meet requirements for

graduation?

How are these numbers confirmed?

How can RRC encourage more frequent

monitoring to ensure resident eligibility for

Boards?


Case Logs


HelenMari Merritt, DO



• For any MRN/case code, multiple

CPTs may be entered - only ONE is

counted as primary procedure.

• Residents decide which code is

counted as primary for a procedure.



• All CPTs should be entered - only

one may be chosen as primary

designation.

• The “Minimums Report” helps to gage

which category will be most useful.

• The primary code may be changed

any time prior to final submission.© 2016 Accreditation Council for Graduate Medical Education (ACGME)

What can be counted twice?




The ABTS has designated instances

where multiple CPTs may be tracked

for a single case. These can be found

on the ABTS website.

https://www.abts.org/root/home/certification/

operative-requirements.aspx


https://www.abts.org/root/home/certification/operative-requirements.aspx


• Cardiac Examples

• Re-operations

• Conduit preparation

• Tricuspid if performed w/CABG

• Aortic Procedures

• TEVAR

• Arrhythmia Surgery

• IABP, ECMO, VAD, & OHT

• Pacemakers© 2016 Accreditation Council for Graduate Medical Education (ACGME)


• Thoracic Examples

• EPP (lung/pleura)

• Chest wall resection

• Sleeve lobectomy and carinal

pneumonectomy

• Mediastinal Assessment

• VATS procedures

• Endoscopic procedures

• Lung transplantation © 2016 Accreditation Council for Graduate Medical Education (ACGME)


CLARIFICATION

Only 1 pneumonectomy can be double-

counted for bilateral lung transplant.

Residents must choose how to log this

case (ie: as a transplant or as a

pneumonectomy)



CLARIFICATION

There is presently no ABTS

requirement for transplantation.

Transplant implant can be counted for

Major Lung or Airway

First assistant cases only are tracked in

the congenital category.© 2016 Accreditation Council for Graduate Medical Education (ACGME)

How do residents double

count cases?

Each CPT must be logged as a

separate case to claim credit.

• No rule that a single MRN can not be used

>1 time (like in GS);

• However, residents may also add -01, -02

to the end of an MRN to designate a

separate case as well.



count cases?

EX: Re-do Sternotomy with CABG and

MAZE procedure.

Three separate cases must be entered for

MRN 56789.

• Case ID #1: 56789 CABG CPT 33533

• Case ID #2: 56789-01 MAZE CPT 33254

• Case ID #3: 56789-02 Re-do Sternotomy CPT

33530



count cases?

EX: VATS Lobectomy and

mediastinoscopy

• #1 VATS

• #2 Lobectomy

• #3 Mediastinoscopy

• #4 Bronchoscopy (if performed)


Resident Monitoring

Residents must ensure all cases are

appropriately captured.


Resident Monitoring

There are still some catches in the

system.

EX: VATS Decortication is one option for a

CPT

• This does not automatically count as a pleural

case (decortication) and VATS case, though

the CPT implies it will.

Residents will need to enter two separate cases.


Resident Starting Before 2012

All I6 Residents in their PGY5 and

PGY6 years presently.

The current ACGME “Minimums Report”

does not apply completely to these

residents.

Case minimums listed on ACGME Thoracic

Surgery webpage


Resident Starting Before 2012

These residents and PDs should cross-

check the ABTS to verify they have met

the 2007-2012 requirements https://www.abts.org/root/home/certification/operative-requirements.aspx

• No FLS requirement.

• No Critical Care requirement

• No Simulation requirement

• In general, requirements are less specific.


https://www.abts.org/root/home/certification/operative-requirements.aspx

I6 Residents years 1-3

Operative Requirements:

• 375 operations averaged over 3 years

• 125 must be CT cases

• 50 of these may be component cases

• 150 ABS index cases

(www.abts.org)


http://www.abts.org

I6 Residents year 1-3

In addition to semiannual evaluation, you

may wish to incorporate a “check point”

between PGY-3 and PGY-4.

This is otherwise difficult to track, but can be

done by changing the date-range on the

reports screen


ACGME Minimums

Guide to track resident’s progress.


ACGME Minimums

Recommendations for Residents

from an ex-Resident

• Keep a record of cases for possible

discrepancies.

• Save a comprehensive ACGME report at

least once a month.


Case Logs

Is this data flowing to the RC?

Donna L. Lamb, Executive DirectorThoracic Surgery, General Surgery, Plastic Surgery


Is this data flowing to the RC?

Yes, but…

The RC will begin to review case log

data beginning January 2017 for the

2016 graduate residents.

The RC will not see your current resident

case logs.


Case Logs: RC Assessment


Example of Surgery as there

are no minimums reports

available for thoracic surgery.

Case Logs: RC Assessment

Pink box means missed minimum


Case Logs

Program Accountability?


Program Accountability

Operative Experience is outlined in the

program requirements beginning with

IV.A.5.g) and is defined by the ABTS

Curriculum Organization and Resident Experiences

Residents must have a minimum operative

experience that includes…..



Programs are expected to routinely

monitor resident/fellow case logs.

Case logs are monitored on ALL

graduating residents with each annual

review


Program Accountability: Monitoring














Case Logs


What happens if my

residents/fellows are deficient in

meeting the minimum case log

requirements?


Case Logs:


Programs may have:

Clarifying Information request

Formal request for specific information

Has a due date (hard stop)

May defer accreditation decision

Will be considered by the RC to determine

further needs/action

Resolve/Investigate further/RC Review


Case Logs:


Programs may have:

Areas for Improvement

“Heads up” that the RC is concerned about

something

Does not require a response

Not connected to a program requirement


Case Logs:


Programs not in compliance may receive:

Citation

Articulates an area of non-compliance

Must have a justifying program requirement

Requires a response by the program

Response should include how program

investigated issue, will ensure compliance,

routinely oversee the issue, and sustain

improvement

Considered by the RC at the next annual

meeting© 2016 Accreditation Council for Graduate Medical Education (ACGME)

Case Logs:


Programs w/ citations may also have:

Progress Report

Result from citations and are a formal request

for a response

Requires a response by the program

Response should include how program

investigated issue, will ensure compliance,

routinely oversee the issue, and sustain

improvement

Considered by the RC at the next annual

meeting© 2016 Accreditation Council for Graduate Medical Education (ACGME)

Can RC Encourage Frequent

Monitoring?

Yes

Requirement V.A.2.b).(4) states the

program must provide each resident with

documented semiannual evaluation of

performance with feedback. • Case logs should be reviewed as part of the

comprehensive semiannual evaluation by the

CCC.


Confirmation of Case Logs

Honor System for residents and PDs

Program Requirement: IV.A.5.g.6(a & b)

The resident must be involved in the preoperative

planning and postoperative care of the patient, as

well as perform the key steps of the surgery to count

as a primary case.


Case Logs: 4+3 programs

Problems for these programs:

Incoming residents cases being logged

into General Surgery (GS) case log

GS case log mapping different/more narrow

Some cases that do not count for GS need to

count for TS

GS reports do not align with the needs of the

TS report



Problems for these programs:

Availability of case log

Resident case log records split between

programs

GS case log not available in ADS once resident

moves into the TS program

Residents printing out paper logs to provide to

program

No comprehensive record of operative

training for resident



Solution:

Migrate the GS case log into the TS case

log beginning 01 January 2016

Once resident is “claimed” by TS program:

Program must contact [email protected]

to transfer the data

**Of note – some CPT codes map to more than

one operative category for TS

Working to identify and adjust at time of transfer


mailto:[email protected]

Case Logs - The Transition

• Initial Roll out

• Correct mapping to

correct minimum

• Report to ABTS


ACGME Resources

Donna L. Lamb, BSN, MBA--Executive Director

[email protected] / 312.755.5499

Cathy Ruiz, MS--Senior Accreditation Administrator

[email protected] /312.755.5495

Olivia Orndorff--Accreditation Administrator

[email protected] / 312.755.7491

June Thiele-Accreditation Assistant

[email protected] /312.755.5038

[email protected]© 2016 Accreditation Council for Graduate Medical Education (ACGME)






Questions?

Thank you


Case Log Monitoring: Ensuring Your Program and Residents ...€¦ · Case Log Monitoring: Ensuring Your Program and Residents Meet Their Case Log Requirements Carl Backer, MD RC,

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