2019 HSC Section 2 - Practice Management

Medical Education Resident Case Log System practi- ces among orthopaedic surgery residents. J Bone Joint Surg Am . 2014;96(3):e22. 2. Rosenberg TL, Franzese CB. Extremes in otlaryngol- ogy resident surgical case numbers. Orolaryncol Head Neck Surg . 2012;147(2):261-270. 3. Fronza JS, Prystowsky JP, Darosa D, Fryer JP. Surgical residents ’ perception of competence and relevance of the clinical curriculum to future practice. J Surg Educ . 2012;69(6):792-797. 4. Suwanabol PA, Mcdonald R, Foley E, Weber SM. Is surgical resident comfort level associated with experi- ence? J Surg Res . 2009;156(2):240-244. 5. Nygaard RM, Daly SR, Van Camp JM. General surgery resident case logs: do they accurately re fl ect resident experience? J Surg Educ . 2015;72(6): e178-e183. 6. King MS, Sharp L, Lipsky MS. Accuracy of CPT evaluation and management coding by family physicians. J Am Board Fam Med . 2001;14(3): 184-192. 7. Lee JS, Sineff SS, Sumner W. Validation of electronic student encounter logs in an emergency medicine clerkship. Proc AMIA Symp . 2002:425-429. 8. Gill DJ, Freeman W, Thoresen P, Corboy JR. Residency training the neurology resident case log: a national survey of neurology residents. Neurology . 2007(68):E32-E33. 9. Patel MB, Guillamondegui OD, Ott MM, Palmiter KA, May AK. O ’ surgery case log data, where art thou? J Am Coll Surg . 2012;215(3):427-431. 10. Tsue TT, Dugan JW, Burkey B. Assessment of surgical competency. Otolaryngol Clin North Am . 2007;40:1237-1259. 11. Safavi A, Lai A, Butterworth S, Hameed M, Schiller D, Skarsgard E. Does operative experience during resi- dency correlate with reported competency of recent general surgery graduates? Can J Surg . 2012;55(4 suppl 2):S171-S177.

competence by surgical residents correlates poorly with resident operative experience. 11 There are several limitations to our study. First, our data are from one institution in consecutive years. Evaluating a larger sample size would illustrate whether inaccurate coding is a problem at residency programs in general. Additionally, 2 of our residents studied completed preliminary intern years at outside institutions. Thus, we were not able to match their PGY1 cases with our gold standard for accuracy. The large difference in major cases identi fi ed between the PGY1 to 2 and PGY3 to 5 years limits our ability to con fi dently say that improvement did or did not occur over time. De fi ning a “ correct ” coding entry was also a potential limitation. Our model works on the assumption that attending submitted procedures were accurately coded by our coding department. Residents who have completed a given category of procedure may not enter an operation that was done under that category. We attempted to control for this by accepting any match between attending procedures and resident codes on a given patient and day as correct. Thus, if tracheostomy and PEG placement were done and the resident only logged tracheostomy, this would be counted correct given that the attending submitted both procedures as completed. Finally, this analysis was done using one surgical specialty ’ s residents. Identifying whether or not this was a problem across all surgical or medical specialties would improve the effect of these fi ndings. CONCLUSIONS The overall accuracy of CPT codes recorded by general surgery residents in the ACGME case log is low. Potential factors affecting this include coding habits, the ACGME case log system interface, lack of formal education, or suboptimal resident-attending communication. Improve- ments in these areas may improve accuracy in CPT coding, and thus make the ACGME case log a more accurate representation of a resident ’ s surgical experience.

REFERENCES 1. Salazar D, Schiff A, Mitchell E, Hopkinson W. Variability in Accreditation Council for Graduate

Journal of Surgical Education Volume 73/Number 6 November/December 2016

5