ACGME Case Log: Record Your Residency Experiences

What is the ACGME Case Log?

The Case Log System is used by the Accreditation Council for Graduate Medical Education (ACGME) to keep record of and track the medical procedures and patients treated by resident doctors in certain ACGME accredited programs.

The Case Log System is a part of ACGME’s Accreditation Data System (ADS), and allows residents and fellows in certain medical specialties to input data and keep track of individual cases throughout their residency or medical fellowship training. Case logs are an important part of patient care for not only practicing physicians but also for hospitals, clinics, patients, healthcare staff and providers and the greater healthcare system as a whole. Case logs are also used as a way to track a resident’s progress through their postgraduate medical training and determine whether they meet the graduation requirements of their program.

For some residents, you’ll be asked to begin recording each of your patient cases and procedures in the ACGME case log once you start with your residency program. Or you may be asked to keep your own personal record or input data into an individual program’s case log system.

Not every residency or fellowship program will require you to record your cases through the ACGME case log system, and there are some specialties that don’t require it, either. Each individual program may have its own procedures for logging cases and assessing resident performance, depending on the specialty and program policies.

Why is it Important to Log Your Cases During Residency?

Logging your cases during residency is an important part of your training as a physician. Whether your program uses the ACGME case log or not, you’ll need some kind of record of the medical procedures or examinations you’ve performed, the patients you’ve seen and what type of medical cases you’ve seen in the clinical environment. Here’s a few reasons why keeping a record of your case logs is important:

1. Keep official documentation of patient care – Keeping record of patient care is an essential part of being a healthcare provider, so it’s good to get used to the paperwork side of being a doctor during your residency! Keeping a detailed record of each patient’s care and procedures ensures that the patient is provided with the best possible care and helps to avoid mistakes. It’s also a good learning tool for PGY1 residents or transitional year residents who are making the transition from medical school to working full-time in a clinical environment.
2. Record of meeting graduation requirements – Residency programs will have specific requirements you need to meet before completion or graduation, such as a minimum number of surgical procedures for a general surgery residency or reaching an independent level of practice where you don’t need require supervision from a chief resident or physician. Your case logs are used to track your progress towards these goals and provide feedback on individual cases from your supervisors.
3. Proof of competency in a specialty – When looking for a job after residency, many employers will want to see proof that you have sufficient competency in your chosen specialty or even adequate experience with a specific procedure or case type. Once you’ve completed your residency program, you’ll be able to access your case logs and share them with potential employers to demonstrate your knowledge and skills. A bit like resume of your clinical experience, if you will.

Curious which are the least and most competitive residencies? Watch this video!

Which Specialties Use the ACGME Case Log?

Not all residency programs use the ACGME case log, and this can vary from specialty to specialty. For instance, many of the surgical residencies, such as thoracic surgery residency programs, plastic surgery residency programs and orthopedic surgery residency programs use the ACGME case log, since it’s critical for residents in training to log their surgical cases. Other specialties that require the use of the ACGME case log include dermatology residency programs and pathology residency programs.

However, programs in family medicine residency, radiology residency and emergency medicine residency programs don’t usually require it and may use a different case log system. Keep in mind that non-ACGME accredited programs will use their own case logging system, and not all ACGME-accredited programs will use the ADS.

Here’s a list of the medical specialties and subspecialties that do and do not require the use of the ACGME case log system:

List of Specialties that Require ACGME Case Log Use

• Allergy and immunology
• Anesthesiology
• Adult cardiothoracic anesthesiology
• Pediatric anesthesiology
• Obstetric anesthesiology
• Pediatric cardiac anesthesiology
• Colon and rectal surgery
• Dermatology
• Micrographic surgery and dermatologic oncology
• Medical genetics and genomics
• Neurological surgery
• Epilepsy 
• Nuclear medicine
• Obstetrics and gynecology
• Reproductive endocrinology and infertility
• Ophthalmology
• Ophthalmic plastic and reconstructive surgery
• Orthopaedic surgery
• Osteopathic neuromusculoskeletal medicine
• Otolaryngology
• Neurotology
• Pathology-anatomic and clinical
• Cytopathology
• Hematopathology
• Physical medicine and rehabilitation
• Plastic surgery
• Interventional radiology
• Radiology-diagnostic
• Surgery
• Vascular surgery
• Thoracic surgery
• Urology

List of Specialties that Do Not Require ACGME Case Log Use

• Regional anesthesiology and acute pain medicine
• Emergency medicine
• Family medicine
• Cardiovascular disease
• Neurology
• Child neurology
• Neurodevelopmental disabilities
• Selective pathology
• Blood banking/transfusion medicine
• Chemical pathology
• Forensic pathology
• Medical microbiology
• Neuropathology
• Pediatrics
• Pediatric hematology/oncology
• Abdominal radiology
• Neuroradiology
• Pediatric radiology
• Nuclear radiology
• Musculoskeletal radiology
• Vascular and interventional radiology
• Internal medicine/Pediatrics

How Does the ACGME Case Log Work?

To access your ACGME case log, you can login securely through the ACGME ADS system here. When you begin your training with a residency program, you will be given a login for the case log system or instructions on how to log your case information if the program does not use the ACGME ADS system.

When you’re entering any of your case log details into the system, keep in mind that each program may ask for specific data, based on the specialty or case type. In general, though, you’ll need to fill in all the basic patient identifying information, the clinical team information and a description of the case, diagnosis, treatment and outcome. Your supervisor may also include case feedback. Depending on your specialty, your case logs will also use specific codes and shorthand terminology, so you’ll want to get familiar with these codes as you start entering case log data.

What are ACGME Milestones?

The ACGME milestones are based on the 6 core competencies for practicing physicians, similar to the AAMC core competencies for entering medical students. The core competencies are a framework for providing residents and fellows with a competency-based medical education (CMBE) in an ACGME-accredited program. The 6 core competencies residents and fellows strive for as they train to become practicing physicians are:

• Patient Care and Procedural Skills
• Medical Knowledge
• Practice-based Learning and Improvement
• Interpersonal and Communication Skills
• Professionalism
• Systems-based Practice

Many ACGME residency programs use milestones in their programs to categorize the level of proficiency and competency of a resident during the length of their residency training. The ACGME case log milestones are a way to track how skilled or experienced a resident has become in a certain area of patient care or in a specific procedure.

For example, a resident who has reached a milestone of Level 4 may be able to perform a certain procedure without supervision, whereas a resident with a milestone of Level 1 in patient interaction is still in the early stages of their residency training and is under direct supervision.

The specific milestones and levels of competency will vary from specialty to specialty and program to program. It may also take residents months to years to complete all ACGME milestones and reach the highest levels of competency, again based on the complexity of the specialty they’ve chosen and the level of training required to reach a state of independent practice as a physician in that specialty.

Knowing how to study during residency for licensing exams is important, too! Here's a quick guide:

ACGME Case Log Sample Entries

Here are a few ACGME Case Log sample entries to give you an idea of what kind of information is included in a typical ACGME case log entry and what sort of data is recorded. Keep in mind that individual residency programs may have additional data required based on the specialty, procedure or program policy.

ACGME Case Log Sample Entry: Thoracic Surgery

Resident Name: C. Andrews

Specialty: Thoracic Surgery

Case Date: XX-XX-XX

Patient: E.F.B

Gender: M

Age: 63

Procedure: Coronary Artery Bypass Grafting (CABG)

Procedure Date: XX-XX-XX

Case Description: The patient presented with a history of coronary artery disease (CAD) and angina. After a thorough evaluation and discussion of the risks and benefits, the decision was made to proceed with Coronary Artery Bypass Grafting (CABG).

Clinical Team:

- Attending Surgeon: F. Fitzwilliam

- Chief Resident: C. Angelo

- Anesthesia Team:

Procedure Details:

- Total number of grafts: 4

- Type of grafts used: Saphenous vein, internal mammary artery

- Approach: Median sternotomy

- Operative time: 4 hours

- Intraoperative Complications: No complications occurred.

Postoperative Care:

- The patient was transferred to the Cardiothoracic Intensive Care Unit (CTICU) postoperatively.

- Ventilation duration: 6 hours

- Length of stay in CTICU: 2 days

- Total hospital length of stay: 7 days

Outcome: The patient's recovery was uneventful, with no major postoperative complications. Follow-up appointments were scheduled for ongoing cardiac care.

Educational Experience: This case provided the resident with valuable experience in performing CABG and managing postoperative care in a thoracic surgery setting.

ACGME Milestones: Dr. C. Andrews achieved milestones related to surgical technique, patient care, and medical knowledge during this case.

Supervising Faculty Assessment: Faculty feedback on Dr. C. Andrews’ performance during the surgery and in the management of thoracic surgery cases was positive, highlighting her technical skills and clinical judgment.

ACGME Case Log Sample Entry: Dermatology

Resident Name: Dr. Amanda Lee

Program: [Insert Program Name]

Specialty: Dermatology

Case Date: XX-XX-XX

Patient: Patient Initials - S.B.

Gender: Female

Age: 32 years

Diagnosis: Psoriasis

Case Description: The patient presented with a chronic history of psoriasis, a chronic autoimmune skin condition characterized by red, scaly plaques. The condition had been refractory to previous treatments, and the patient's quality of life was significantly affected.

Clinical Team:

- Attending Dermatologist: Dr. Karen Smith

- Resident Physician: Dr. Amanda Lee

- Nursing Staff: [Insert Nursing Team Members]

Procedure and Treatment Plan: A comprehensive dermatological examination was performed to assess the extent and severity of psoriasis lesions. Biopsy or other diagnostic tests (if applicable): No biopsy was needed.

Treatment Plan: The patient was prescribed a combination of topical corticosteroids, phototherapy, and systemic medications, tailored to the severity and extent of the psoriasis lesions. Patient education on disease management and self-care: Patient received education on proper skin care and medication usage.

Follow-up Visits: The patient was scheduled for regular follow-up visits to monitor the response to treatment, adjust medications as needed, and provide ongoing support

Outcome: Over the course of treatment, the patient experienced significant improvement in psoriasis symptoms. Follow-up visits showed a reduction in erythema, scaling, and plaque formation. The patient reported an improved quality of life and a decrease in the impact of psoriasis on daily activities.

Educational Experience: This case provided Dr. Amanda Lee with valuable experience in diagnosing and managing psoriasis, including treatment planning and patient education.

ACGME Milestones: Dr. Amanda Lee achieved milestones related to diagnosis, patient care, and medical knowledge during this case.

Supervising Faculty Assessment: Faculty feedback on Dr. Amanda Lee's performance in diagnosing, managing, and educating patients about psoriasis was positive, highlighting her clinical skills and patient communication.

ACGME Case Log Sample Entry: Cytopathology

Resident Name: Dr. John Anderson

Program: [Insert Program Name]

Specialty: Cytopathology

Case Date: XX-XX-XX

Patient: Patient Initials - L.T.

Gender: Female

Age: 42 years

 Procedure: Fine Needle Aspiration (FNA) of a Thyroid Nodule

 Case Description: The patient was referred for an FNA of a thyroid nodule identified during a routine ultrasound examination. The procedure was performed to assess the nature of the nodule and to determine if it was benign or suspicious for malignancy.

Clinical Team:

Cytopathologist: Dr. Mary Wilson

Resident Pathologist: Dr. John Anderson

Nursing Staff: [Insert Nursing Team Members]

Procedure and Interpretation: Ultrasound-guided FNA was performed using a fine needle to aspirate cells from the thyroid nodule. The collected cellular material was prepared on slides and stained for cytological examination. Cytopathological examination revealed the presence of thyroid follicular cells with nuclear features suggestive of a benign follicular nodule.

Diagnosis and Reporting: The final diagnosis was reported as "Benign Thyroid Follicular Nodule" based on the cytological examination findings. The results were communicated to the referring physician for further management.

Educational Experience: This case provided Dr. John Anderson with hands-on experience in performing FNA procedures, sample preparation, and cytological interpretation of thyroid nodules.

ACGME Milestones: Dr. John Anderson achieved milestones related to diagnostic skills, laboratory techniques, and medical knowledge during this case.

Supervising Faculty Assessment: Faculty feedback on Dr. John Anderson's performance in the FNA procedure and cytological interpretation was positive, highlighting his technical skills and attention to detail.

ACGME Case Log Sample Entry: Pediatric Orthopedic Surgery

Resident Name: Dr. Sarah Johnson

Program: [Insert Program Name]

Specialty: Pediatric Orthopedic Surgery

Case Date: October 15, 2023

Patient: Patient Initials - J.S.

Gender: Female

Age: 12 years

Procedure: Scoliosis Correction Surgery

Case Description: The patient, a 12-year-old child, presented with a diagnosis of adolescent idiopathic scoliosis with a spinal curvature of 45 degrees. The decision was made to proceed with scoliosis correction surgery to prevent further progression of the curvature and to improve the patient's quality of life.

Clinical Team:

- Pediatric Orthopedic Surgeon: Dr. Michael Anderson

- Resident Surgeon: Dr. Sarah Johnson

- Anesthesia Team: [Insert Anesthesia Team Members]

- Nursing Staff: [Insert Nursing Team Members]

Procedure Details:

- Surgical approach: Posterior spinal fusion

- Number of spinal levels fused: 9 levels (T4-L3)

- Instrumentation used: Pedicle screws and rods

- Operative time: 6 hours

- Intraoperative Complications: No intraoperative complications occurred.

Postoperative Care:

- The patient was transferred to the pediatric orthopedic ward postoperatively.

- Duration of hospital stay: 5 days

- Postoperative pain management: Multimodal pain control with opioids and non-opioid analgesics.

- Mobilization and physiotherapy: Commenced on postoperative day 2 with emphasis on spinal precautions.

Outcome: The patient's spinal curvature was successfully corrected, and spinal alignment was significantly improved. Postoperative imaging confirmed the appropriate placement of instrumentation. The patient showed satisfactory progress during the postoperative period, including pain management and mobilization.

Educational Experience: This case provided the resident, Dr. Sarah Johnson, with hands-on experience in pediatric scoliosis correction surgery, including surgical techniques, intraoperative decision-making, and postoperative care in a pediatric orthopedic setting. Opportunities for discussions on the management of pediatric spinal deformities and the nuances of scoliosis surgery were provided during case discussions.

ACGME Milestones: Dr. Sarah Johnson achieved milestones related to surgical technique, patient management, and interprofessional communication during this case.

Supervising Faculty Assessment: Faculty feedback on Dr. Sarah Johnson's performance during the surgery and in the management of pediatric orthopedic cases was positive, highlighting her technical skills and ability to work effectively in a team.

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