Assessing the accuracy of neurological surgery resident case logs at a single institution

BACKGROUND Despite the importance of case logs in evaluating residents, no studies assess their accuracy in neurological surgery. Studies from other specialties reveal variations in reporting. This study assesses the accuracy of neurological surgery resident case logs at a single institution. METHODS Data was collected from three databases: billing data and two separate resident-managed case logs [department log and Accreditation Council for Graduate Medical Education (ACGME) case logs], containing records of procedures performed by 14 neurological surgery residents at a single institution over a 1-year period. The billing data was used as a proxy for a census of procedures performed during the study period. The difference between the number of procedures logged by residents and the number of procedures billed was calculated to determine the accuracy of the resident case logs. RESULTS Over the study period, 2150 procedures were billed at the institution, whereas 1749 procedures were logged in the ACGME case log and 1873 in the department log, representing an error rate of -18.65% and -12.88%, respectively. The error rate varied significantly (-1150% to +50.23%) between ACGME procedure categories. In 13 of the 22 ACGME procedure categories, the procedures were under-logged by residents in both resident-managed case logs. No category demonstrated over-logging in both case log systems. CONCLUSION Resident managed case logs are an incomplete representation of clinical work. The cause for inaccuracy is multifactorial. The authors suggested that further research is necessary to validate their results and to identify means by which the accuracy of case logs can be increased.