Residency Training The neurology resident case log
A national survey of neurology residents
David J. Gill, MD,
W. D. Freeman, MD,
Paul Thoresen, MA and
John R. Corboy, MD
Address correspondence and reprint requests to Dr. David J. Gill, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642
Beginning in July 2004, the Neurology Residency Review Committee(NRRC) of the Accreditation Council for Graduate Medical Education(ACGME) required neurology residents to enter patient encountersinto a Web-based data entry system. This system was meant todocument actual resident experience for informational purposes1(Robert Pascuzzi, MD, personal communication) as the ACGME believedthe current institutional databases were inadequate and a nationalWeb-based system was needed.2 To assess the burden from andcompliance with the case log system, the Graduate EducationSubcommittee (GES) of the American Academy of Neurology (AAN)created an anonymous resident survey. The preliminary resultsof this survey were made available to the NRRC in May 2005.Citing inefficiencies in the current system, the NRRC made entryof the data voluntary on June 1, 2005.3 Here we present thefull results of the survey.
Members of the GES and the Consortium of Neurology Residentsand Fellows created survey questions aimed at assessing compliancewith the case log system, time spent entering the cases, useof a personal digital assistant, and perceived educational andpatient care benefits of the system. Questions were tested bymembers of the GES. An e-mail notification to participate wassent to all US AAN member neurology residents and fellows basedon AAN databases. Two percent (n = 29) of residents had alreadyreceived three AAN surveys in 3 years and were excluded fromthe survey, per AAN policy. This resulted in 1,629 eligiblesurvey participants. Participants were identified by their AANidentification code only. Five e-mail reminders and two postalletters were sent to those who had not responded. Finally, neurologyresidency program directors were asked to encourage responses.One percent (21) of the survey participants indicated they didnot use the case log system, and did not complete the survey.Respondents’ and non-respondents’ demographic datawere obtained from the AAN membership databases. For the demographicdata, age means were compared with a two-tailed t test analysisand proportions with a 2 analysis. p Values < 0.05 were consideredsignificant.
The final response rate was 50% (810/1,629). There were no significantdifferences between responders and non-responders in age, gender,geographic location, or year in residency. Key results are presentedin the table. The remainder of the results are available intable E-A-1, table E-A-2, and appendix E-1. Fourteen percentof residents entered every patient encounter into the case log.A majority of residents could not find the correct InternationalClassification of Diseases (ICD) code (54% found the code lessthan 50% of the time). Sixty-one percent took 2 minutes or moreto enter a single patient encounter, and 59% said it took 10minutes or more to enter their daily encounters. Fifty-threepercent agreed or strongly agreed that the case log interferedwith their education vs 23% who disagreed or strongly disagreed.Similarly, 40% agreed or strongly agreed that the case log interferedwith patient care vs 29% who disagreed or strongly disagreed.
The results of this survey showed an overall dissatisfactionwith and lack of use of the case log system. Over 50% of residentsentered less than half of their cases and a significant percentageof residents felt the case log system interfered with theireducation and patient care.
This survey demonstrates two other points. First, a survey ofneurology residents can be done and produce useful information.This is only the third published report of a survey that includedneurology residents.4,5 This survey, unlike the previous two,was meant to obtain information about a specific topic, thecase log system, for the purpose of giving feedback to the NRRC.The response rate to the survey was 50% and provided consistentfeedback.
Second, data from a resident survey may yield feedback thatthe NRRC can use to shape its policies. This survey was createdand implemented over a short time, and the results were instrumentalin guiding the decision of the NRRC to suspend the mandatoryuse of the case log (Robert Pascuzzi, MD, personal communication).
Based on the process and results of this survey, we suggestresidents and residency programs should be integral to any futuredevelopments in a case log system, so that any future case logsystem will be more efficient and provide synchronous institutional,educational, and patient care data. In addition, we suggestthat an effective method to evaluate the use of the case logsystem is a national resident survey.
Disclosure: The authors report no conflicts of interest.
Rosen N, Daube JR, Sulton LD. Update for the neurology residents and fellows from the Neurology Residency Review Committee (NRRC). Neurology 2004;63:E2–E3.[Free Full Text]
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2 analysis. p Values < 0.05 were considered significant. 
