ACGME Case Log

1
ACGME Case Log

• ACGME requires RRC assessment of adequacy of
  patient availability for resident education.
• Institutional data bases have been inadequate to
  meet this requirement.
• Individual resident case logs to replace the data
  bases were first implemented for surgery
• They are now being implemented for medical
  specialties Neurology as of July 2004
• At www.ACGME.org instructions, examples, help

2
2004 Neurology Case Log Usage

• 135 residents from 72 programs
• Average 57 patients per month (0 135)
• Average 3.5 minutes per patient (2 7)
• After tenth patient
• Help desk 47 calls total
• During first few entries
• Problems coding, continuity clinic, cross cover

3
Resident Case Log

• All data are entered on ACGME web site
• Resident logs in the patient data with their own
  password.
• The program director can review single or total
  resident data, but cannot change it.
• Resident should keep record of his/her patients
  until the information is entered.
• ACGME software program is available to save
  patient data for later uploading to the ACGME web
  site (booth)

4
Case Log Implementation

• Begin data collection 7/2004
• RRC review of case log data 1/2006
• Programs reviewed in 2006
• 7/2004 6/2005 data for PGY2-4
• Incomplete for continuity clinic
• Case log fully implemented 1/2008
• All data, all years
• Fully replaces institutional data

5
Case Log Resident enters

• Demographics
• Date of the evaluation
• Institution
• Attending physician
• Clinical setting
• Year of birth
• Primary and secondary neurological diagnoses
• a. e.g., complex partial seizures and migraine
  headaches
• b. no more than three per patient.
• May be entered using
• a. categories of disease or
• b. typed in directly.
• For any patient for whom he/she
• a. assumed a significant management
  responsibility
• b.important enough to warrant a written note in
  the chart.

6
Case Log - Inpatient Clinical Setting

• Consult service
• Primary service
• Intensive care listed separately
• Both junior and senior residents can count same
  patient
• Cross covering residents enter patient if patient
  management was required
• No other interaction can be counted
• Any single patient - only once per resident

7
Case Log - Outpatient Clinical Setting

• Clinic
• New Patient entered only once
• Follow up if new to resident - entered only once
• Continuity clinic visit each patient visit
• Consult
• Emergency
• Non-neurology outpatient clinics

8
Case Log - Admitted Patients

• Admitted from an outpatient setting
• a. Counted as an outpatient by resident seeing
  patient in clinic
• b. Counted as inpatient by admitting resident
  (if different)
• c. Counted only as inpatient, if same resident
  does both