ACGME Resident Operative Log Guidelines

ACGME, the accreditation council for Graduate Medical Education, is the body that oversees the graduate medical education programs in the United States. It is a non-profit private council working with a mission of improving the health care system’s quality and working methodologies.

Its six focus areas are Patient Safety, Health Care Quality, Care Transitions, Supervision, Well-Being, and Professionalism. The ACGME manages programs like fellowships, internships, residencies, etc., and hence its work has a direct impact on residents and fellows.

Through these initiatives and accreditations, the ACGME works to ensure that the residents and fellows are appropriately trained in all six focus areas. A part of the success of the initiatives taken by ACGME is defined by residents’ feedback.

ACGME Resident Operative Log Guidelines
ACGME Resident Operative Log Guidelines

Common Program Requirements

Common program requirements are a basic standard set by ACGME in training and preparing residents and fellow physicians. These requirements define clinical learning environments for residents and physicians so that they can develop the skills and knowledge required for patient care.

Residents and fellows also get to interact with patients and work under the guidance of medical experts. As part of reviewing the performance of these initiatives, the ACGME collects data which includes the Case Log System, and the Resident/Fellow and Faculty Surveys.

ADS, Accreditation Data System, is a web-based software system or tool to collect and organize information for accreditation purposes. It is internally used by the staff of the Review Committees to conduct accreditation activities. Functions like Case Logs, Milestones, Annual Updates, etc. are logged in ADS.

Also Read: ACGME (CLER) Clinical Learning Environment Review

Case logs

The sponsoring institutions are required to follow certain rules and regulations in maintaining case logs. Higher accuracy in this process will help in monitoring the clinical volume of residency. This, in turn, will provide insights into the residency’s educational experience. The requirements are listed below:

  • The case logs should be up to date
  • Case logs of every resident are reviewed by the Clinical Competency Committee every 6 months.
  • The cases should be logged immediately along with brief op notes and orders.

CPT(Current Procedural Terminology) codes are used to document the case logs. Details about these codes are:

  1. These are 5 digit codes that describe specific operations.
  2. These codes are used to determine professional fee billing metrics.
  3. Some medical operations don’t have a CPT code defined. For such cases, use the closest approximation.
  4. Documentation should be provided for every CPT code for ease of billing.
  5. ACGME case log doesn’t have a requirement of showing clinical documentation.

ACGME has defined Case Log Guidelines for medical fields like Orthopedic Surgery, Neurological Surgery, General Surgery, etc. The guidelines of preparing Surgery OPERATIVE LOG Data for submission to ACGME post-training completion are explained with an example.

Credit Roles for Surgery Residents

Only one resident may take credit as a surgeon for each operation. Different credits available for each surgical operation are:

  • Surgeon Chief (SC): credit during 12 months of the chief year.
  • Surgeon Junior (SJ): credit during all other years of training.
  • Teaching Assistant (TA): senior resident working with a junior resident who is taking credit as Surgeon Junior.
  • First Assistant (FA): when the resident is not the primary surgeon but an assistant in the surgery.

Total Cases by Year

Residents have to log the number of TTL MAJ cases by the end of each post-graduate year. This category consists of all Surgeon Chief, Surgeon Junior, and the first 50 Teaching Assistant cases including operative trauma. The total case requirement by each PG year is:

  • PGY-1 – 150 cases
  • PGY-2 – 300 cases
  • PGY-3 – 500 cases
  • PGY-4 – 800 cases
  • PGY-5 – 1050+ cases

The trauma and non-operative trauma cases come under the CPT code 99199. The most senior resident on the trauma service can claim credit for these cases. ACGME requires the resident to complete at least 40 Critical Care index cases. CPT Code 99292 maps to all seven of the surgical critical care conditions. Reports should provide a summary of instances in which the resident executed 2 of the seven index critical care conditions.


Hopefully, this article has shed some light on the operative log guidelines for ACGME residents and fellows. If you wish to learn more about the ACGME case log definitions, then visit this link.

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