Do Orthopaedic Resident and Fellow Case Logs Accurately Reflect Surgical Case Volume?

Abstract

Objective: The purpose of this study is to determine whether orthopedic resident and fellow case logs accurately reflect trainee case volume.

Design: For each orthopedic case performed at our institution between 7/1/14 and 10/31/14, the names of trainees who participated were obtained from the chart. The trainee Accreditation Council for Graduate Medical Education case logs were queried to determine if the procedure in question was logged and, if so, which current procedural terminology (CPT) codes were reported. The CPT codes reported by the trainees were compared to those reported by the attendings in the billing database. To ascertain the opinions of trainees regarding coding, a survey was conducted.

Setting: University of Maryland Medical Center (Baltimore, MD), a tertiary and quaternary care center which features a state-wide trauma referral center as well as orthopedic residency and fellowship training programs.

Participants: All orthopedic surgery residents and fellows present at the institution during the study period.

Results: Trainees failed to log their cases 24% of the time (465/1925), including 25% (283/1117) for residents and 23% (182/808) for fellows (p = 0.16). Among cases that were logged, CPT codes were missed 46% of the time (673/1460) and extra codes were added 28% of the time (412/1460) compared to the attendings. In the survey, most trainees stated that it was "extremely" or "very" important for them to be able to code correctly (83%; 29/35).

Conclusions: In this study of orthopedic trainee case logging practices, cases were not logged 24% of the time. Caution should be taken with activities which rely on trainee case logs given the potential for inaccuracy.

Keywords: Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; fellows; orthopedic surgery; residents; surgical education.