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Variance Among Accreditation Council for Graduate Medical Education Hand Surgery Fellowship Program Case Minimum Logs
Ryan Lubbe, MD
1; Sean Hogan, PhD
2; Yoon Soo Park, PhD
3; Sameer Puri, MD
1; F. Thomas Kaplan, MD
4; Brandon S. Smetana, MD
11Indiana Hand to Shoulder Center, Indianapolis, IN; 2ACGME, Chicago, IL; 3University of Illinois Chicago, Chicago, IL; 4Indiana Hand Center, Indianapolis, IN
Introduction: Not all hand surgery fellowship programs meet yearly Accreditation Council for Graduate Medical Education (ACGME) case minimum requirements. Additionally, case logging practices might have changed after hand surgery minimum requirements were introduced.
Material & Methods: A retrospective cohort analysis was performed on ACGME hand surgery fellowship case logs for three consecutive academic years pre- (2017-2018 through 2019-2020) and post-implementation (2020-2021 through 2022-2023) of hand surgery fellowship case minimum requirements. All case logs and Current Procedural Terminology (CPT®) codes were included. We assessed number of cases submitted for each case minimum category as our primary outcome. Secondary outcomes included total number of cases submitted, total number of CPT codes submitted, and average number of CPT codes per case. Descriptive statistics were used to examine aggregate trends on documented case logs, with units of analyses at the CPT, case, and trainee levels. Bivariate comparisons were conducted using t-tests between pre- and post-implementation of case minimum requirements.
Results: All hand surgery fellowship case logs available through the ACGME database (152- 161 for 2017-2018 through 2022-2023) were reviewed. All fellows exceeded total minimum number of cases required. After implementation of case minimum requirements, significantly fewer programs failed to meet at least one minimum category (pre-: 80.1% vs. post-: 19.5%, p <0.05). Mean number of amputations, extensor tendon repair, flexor tendon repair, nerve repair, vascular repair, and wrist arthroscopy were significantly lower post-implementation (p <0.05). Mean number of open/closed reduction internal fixation distal radius fractures, scaphoid fractures, soft tissue reconstruction, ulnar nerve decompression, wrist arthrodesis, and wrist instability or dislocation were significantly higher post-implementation (p <0.05). Mean number of total case logs was significantly higher post-implementation (pre-: 637.26 (range 235-1,457) and post-: 782.64 (range 372-2,008), p <0.05). Mean number of unique CPT codes and average CPT codes per case were significantly lower post-implementation (p <0.05).
Conclusions: Implementation of hand surgery fellowship case minimum requirements resulted in fewer programs failing to meet at least one minimum category; however, still almost 20% of programs were not meeting minimum requirements post-implementation. Although the majority of fellows met minimum requirements, differences exist in mean number of cases for several case categories pre- and post-implementation. Additionally, while total case logs increased post-implementation, the average number of CPT codes per case decreased. This may be attributable to limitations of the ACGME's case logging system, where only the first logged CPT code in each case counts towards the minimum.
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