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Surgery Policy Information
ACGME CASE LOG SYSTEM Two major requirements will be implemented July 1, 2005: 1. All surgery programs must use the ACGME Web-based case log system 2. All residents, including categorical, designated preliminary, and non-designated preliminary residents (C, DP, and NDP) must enter their cases into the system as of day 1 in the program beginning July 1, 2005. RRC Surgery Newsletter, Summer 2004 OPERATIVE DATA For implementation July 1, 2005: The RRC approved a standard age limit for pediatric surgery cases done by a general surgery resident as twelve (12) years, i.e., less than 13 years. All cases aged 13 or over should be listed as an adult. The RRC also approved the case distribution in the pediatric surgery category as follows: 8 herniorrhaphy cases (both inguinal and umbilical) 6 appendectomy cases (both laparoscopic and open) 6 additional cases, not specified 20 Total cases for the category of pediatrics Residents are reminded to review cases that have already been entered to ensure that the age dropdown box has been annotated for “pediatrics.” Source: Surgery Newsletter, 2004 OPERATIVE DATA The members of the Residency Review Committee analyze the national operative data annually to evaluate case trends and discuss the impact of new techniques and experiences on the needs of new graduates. As the field is aware, and as the RRC members have acknowledged, new graduates are required to document competence in laparoscopy, both basic and advanced, and endoscopy as part of those required skills for entry into practice. Based upon these analyses and discussions, the RRC voted to increase the requirements in these techniques and procedures. At present, the Committee considers the requirements for advanced laparoscopy as the minima, and given changing trends, these requirements may be increased in future. Those surgery graduates completing the program June 30, 2008 must document the increased Laparoscopy requirements and graduates completing the Program June 30, 2009 must document the increased Endoscopy requirements : Laparoscopy Basic: 60 total cases Cholecystectomy Appendectomy Advanced: 25 total cases Lap, Gastrostomy and Feeding Jejunoscopy Lap, Inguinal and Incisional Herniorrhaphy Bariatric Laparoscopy Lap, Anti-reflux Procedure Lap, Enterolysis Lap, Small and Large Bowel Lap, Renal and Adrenal surgery Lap, Donor Nephrectomy Lap, Splenectomy Endoscopy : 85 total Upper endoscopy, including percutaneous endoscopic gastrostomy: 35 procedures Colonoscopy: 50 procedures Source: February 2006 E-mail OPERATIVE DATA The members of the Residency Review Committee analyze the national operative data annually to evaluate case trends and discuss the impact of new techniques and experiences on the needs of new graduates. As the field is aware, and as the RRC members have acknowledged, new graduates are required to document competence in laparoscopy, both basic and advanced, and endoscopy as part of those required skills for entry into practice. Based upon these analyses and discussions, the RRC voted to increase the requirements in these techniques and procedures. At present, the Committee considers the requirements for advanced laparoscopy as the minima, and given changing trends, these requirements may be increased in future. Those surgery graduates completing the program June 30, 2008 must document the increased Laparoscopy requirements and graduates completing the Program June 30, 2009 must document the increased Endoscopy requirements : Laparoscopy Basic: 60 total cases Cholecystectomy Appendectomy Advanced: 25 total cases Lap, Gastrostomy and Feeding Jejunoscopy Lap, Inguinal and Incisional Herniorrhaphy Bariatric Laparoscopy Lap, Anti-reflux Procedure Lap, Enterolysis Lap, Small and Large Bowel Lap, Renal and Adrenal surgery Lap, Donor Nephrectomy Lap, Splenectomy Endoscopy : 85 total Upper endoscopy, including percutaneous endoscopic gastrostomy: 35 procedures Colonoscopy: 50 procedures Source: February 2006 E-mail OPERATIVE DATA The Committee approved the revised mapping and minimum case designations effective July 1, 2002. Vascular surgery programs will be reviewed based upon the new data generated during the 2002-2003 academic year. Note that programs will be cited for deficiencies based upon these data beginning July 1, 2004. Source: Surgery Newsletter, August 2002 OPERATIVE DATA Beginning July 2001 , the documentation of surgical critical care management will include: 1) a description in the Program Information Forms of the educational assignments by which residents gain experience in surgical critical care; and 2) a log identifying a list of sample “index” cases of critical care patient management that will be kept by the residents. The CPT code for surgical critical care in the on-line system is 99292. This code is different from other codes, as it will map to all 7 critical care categories. The Critical Care Index Cases (CCIC) log was developed to provide documentation of resident management of a broad scope of critical care patients as follows: 1) Each resident will develop a log of at least twenty critical care patients who represent the broad scopeof critical care index management. (NB: do not submit 20 of the same conditions) 3) The completed logs should include experience, with at least one patient in all sevenof the categories. 4) The categories are:
Source: Surgery Newsletter, May 2001 & 2003 New Surgical Critical Care Program Information Forms (PIF) All programs surveyed July 1, 2006 and thereafter must use the new SCC Program Information Form (PIF). The document has been posted on the ACGME website (acgme.org). Source: E-mail June 2005 Surgical Critical Care Case Logs Source: E-mail June 2005 Duty Hours Update definition for the “new patient” were approved and have been incorporated into the program requirements. The Program Requirements for Surgery including that revision are available www.acgme.org. The specific additions (underlined) follow: Program Requirements IV. F 3c: No new patients may be accepted after 24 hours of continuous duty. A new patient is Restated positively, this statement may be interpreted to mean: Any patient that has been seen by a member of the surgery (pediatric, hand, vascular) service or department is not considered new, and a resident may perform surgery on these patients during the “up to 6 additional hours” post in-house call if they evaluate that patient prior to surgery. Source: Surgery Newsletter, 2003 Early Specialization Project (ESP) Guidelines 1) A letter of support from both the program director of the surgery residency program and the pediatric/vascular surgery program, and 2) A letter of support from the designated institutional official (DIO). 3) Both the surgery and the subspecialty programs must be in substantial compliance with the Program Requirements as judged by the RRC, i.e., the program accreditation history, the program’s ability to correct areas cited on the last program review, and the breadth of operative experience available for education including the defined category data will be evaluated and addressed. 4) Both programs’ passing rates on the Qualifying and Certifying Examinations must meet or exceed those listed in the Program Requirements. 5) The procedure outlining the resident selection process must be submitted. 6) The first 4 years of surgery education justifying resident preparation for ESP must be completely described. NB: Normally, no more than 4 months of the first 36 months of the surgery residency may be spent exclusively on the applicable subspecialty service, i.e., the pediatric or vascular surgery service. 7) Operative data should be submitted and should reflect that the program can provide sufficient operative experience during the PG1-4 years in the principal (essential) content areas. 8) The program director must document sufficient resources to provide all other residents and subspecialty residents with a sufficient breadth and balance of operative experience in the principal content areas. 9) A block diagram of the proposed clinical assignments for the PG3, 4, and 5 years and the ESP 1 and 2 years in the applicable subspecialty must be submitted. 10) A narrative statement describing the implementation and sequencing of the chief resident experience is required. NB: The program will be required to track the resident’s operative experience and provide the RRC with an annual progress report of these data. When the resident completes the ESP, the resident must meet or exceed these requirements: the defined category data, the chief year data, and the data in aggregate for the 4 years of general surgery experience. 11) Both program directors must stipulate in writing that she or he and the faculty will comply with the Program Requirements regarding resident evaluation, i.e., documenting a written, semiannual evaluation; and a written, summative evaluation at the completion of each PG year, including the PG4 and the ESP years. 12) The program may submit a proposal for only 1 position per subspecialty during the duration of the ESP pilot project. Early identification of residents interested in ESP is encouraged. 13) The program may, at its discretion, apply for a temporary increase in categorical positions per current RRC policy. However, the program is not encouraged to request approval for additional nondesignated preliminary positions. Proposed Evaluation Process for the Early Specialization Program: 1) At each RRC review, the program must justify the volume and breadth of operative experience available for all residents in the program, including the ability to provide the ESP resident with sufficient cases in the essential content areas by completion of the PG4 year. Areas of insufficiency and noncompliance with the Program Requirements may be reason to discontinue the ESP. 2) The passing rate of candidates on both the QE and CE for surgery and the subspecialty 3) The faculty evaluation of the educational quality of the program should play an integral role in the implementation and development of the program and this should be documented. 4) Employer and graduate evaluations of the quality of the graduate and the educational program should also prove helpful. Submission date: Applications may be submitted beginning October 2003 for those residents who wish to begin the early specialization program during their PG 4 year beginning July 1, 2004. Source: Surgery Newsletter, 2003 RESIDENT COMPLEMENT Source: Spring 2002 RESIDENT COMPLEMENT Beginning July 1, 2002 , the current Program Requirements for Surgery have been revised to permit 200% in total of the approved PG-5 (chief) residents. NDPs may be admitted for the PG-1 and 2 levels only. PG-3 NDP positions will no longer be approved in future. If you have filled any such PG-3 positions for academic year 2003-04, these positions remain accredited for this academic year only. All such increases require advance RRC approval. Source: Surgery Newsletter, 2003 RESIDENT COMPLEMENT Due to an increase in the number of program requests for additional categorical positions outside of their regular review cycle, the RRC agreed that such requests must be in conjunction with a full site survey to verify the program’s capability for the increase. A program director may request an early site visit for that purpose if and the DIO must co-sign the request. Source Newsletter, 2002 Rural Tracks Within Surgery Programs The RRC considered a request to accredit separate rural tracks for surgical residency programs and voted not to do so. The Committee agreed that in some programs non-metropolitan assignments may be fruitful educational experiences. However, the Committee agreed that rural rotations were not educationally unique based solely on geographic location, and as such, did not qualify for consideration as a separate track. Source: Surgery Newsletter, 2004 Joint Surgery/Thoracic Surgery Residency Programs The application for the joint program must address the following areas: I. Program Requirements 1. Only those institutions currently possessing bothACGME-accredited General Surgery and Thoracic Surgery residencies are eligible to participate in this project. The DIO of the sponsoring institution must submit a letter of commitment and support for the joint program and must co-sign the application. 2. Written approval by both program directors in general surgery and thoracic surgery with documentation of their commitment and ability to meet the requirements also must be submitted. 3. Both the general surgery and thoracic surgery residencies and the sponsoring institution must be in substantial compliance with the Requirements. (The RRCs will review the accreditation history of both programs and the institution that staff routinely appends to the application.) 4. Documentation must be submitted to show that both programs' pass rate for first-time takers for the ABS and ABTS examinations meets or exceeds standards. 5. The submission must include a specific curriculum for all years that has been approved by both program directors; it must clearly identify the required components as further explained below. This curriculum will be reviewed and approved by both RRCs. 6. General Surgery Content Areas *Those rotations denoted with an asterisk have been identified by the ABTS as areas of expertise specifically applicable to the education of a thoracic surgeon. It is in these areas that appropriate "cross training" can occur within the last 24 months of general surgical residency. These specific areas are already included within the content of a standard general surgery residency, thus, specifying their inclusion would not dilute resident experience. a. Principal content areas b. Secondary content areas Abdomen Plastic surgery Alimentary tract* Thoracic surgery* Head and neck Endoscopy* Skin, soft tissue and breast Endocrine surgery Surgical oncology* Trauma/burns Critical care* Vascular surgery * Pediatric surgery Transplantation* c. Technical experiences d. Other specialty areas Laparoscopy Anesthesia Advanced laparoscopy* Gynecology Neurosurgery Orthopaedic Surgery Urology 7. Requirements by PG Year a. Thirty-six of the first 48 months of the general surgery program must be documented in areas 6 a, b, and c above. b. Twelve additional months will be spent in the Principal Content Areas in the PG4 and 5 years (6 a above). c. During the PG4 and 5 years, a minimum of 12 months must be spent as a Chief Resident in general surgery in the Principal Content Areas (6a above). Thus, the total Content Area time will be 48 of the 60 general surgery months. d. The majority of the chief year must be spent in the PG5 year. (A chief resident rotation is defined as those in which the resident is the most senior resident on the service, is directly responsible for overseeing all patients on that service, and reports directly to the responsible attending physician. The chief resident must be responsible for pre-operative, operative and post operative care of patients on that service. The volume and complexity of cases performed must be appropriate for the chief resident level). e. No more than 4 months of the 24 months in the PG4 and 5 years may be devoted exclusively to any one of the Principal Content Areas in general surgery. f. Those rotations designated as important to the preparation of a thoracic surgeon may comprise a minimum of 8 months but not more than 12 months of the PG4 and 5 years. Some of these rotations will be Primary Content Areas (i.e., vascular surgery, surgical critical care), some will be Secondary Components (i.e., thoracic surgery, endoscopy, laparoscopic surgery) and some will be in areas not currently classified in the general surgery curriculum (i.e., cardiac surgery). It is anticipated that these 8-12 months of thoracic surgery educational preparation will be assigned throughout both the PG4 and PG5 years; however, the majority of these assignments must occur in PG4 year. g. All 24 months of the PG4 and 5 years must be spent in clinical assignments and cannot include research rotations. 8. Attestations regarding resident classification and supervision a. During the PG1 through the PG4 years, the program director in general surgery will be directly responsible for the resident regarding evaluation and supervision. b. During the PG5 year, the two program directors will share these responsibilities. c. The joint program resident will be classified as a categorical general surgery resident on the surgery roster during the PG1-5 years. d. In the PG6 and PG7 years, the thoracic surgery program director will assume these responsibilities, and the resident will be on the thoracic surgery roster as a thoracic surgery resident. e. The General Surgery Program Director will be required to sign attesting to this resident's successful completion of the Surgery Program. Source: ACGME Website 2006 |